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Thread: Bad Faith

  1. #1
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    Question Bad Faith

    What constitutes "bad Faith" in WorkersComp?

    Court orders not answered or bills not being paid?

    ALSO, if bills like hospitals and doctors (all the stuff that goes thru a w/c claim? IF the hospital hasn't been paid for a surgery or even the surgeon not paid could I fill the BadFaith claim since it was me/patient that had the surgery? (I understand the doctor is the one owed the money and not me (or the patient) but it is off of my claim and it makes me look very very bad)

    can anyone give an answer to these quetions and an example of?

    Thank you

  2. #2
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    Default Re: Bad Faith

    Here's a generic answer, it might help though.

    What constitutes "bad Faith" in WorkersComp?
    It is not unusual for an insurance company to limit or even deny coverage of a claim without proper justification or warning. Not every act of an insurance company with which you disagree is bad faith, but if you have been treated unfairly and have been denied coverage or a reasonable settlement wrongfully, you may have a case for bad faith against your carrier.
    http://law.freeadvice.com/insurance_...nce-lawyer.htm


    How do I prove bad faith?
    A: If you think your insurance company acted in bad faith over a claim, you have to make a case by establishing:
    Nothing in the policy said the claim could be denied for the reason they gave, and
    The company acted recklessly and with disregard or your rights.
    Bad faith can also occur when the company fails to process a claim at all.
    http://insurance.lawyers.com/Insuran...aims-FAQs.html

    You'll need to find a lawyer who specializes in bad faith claims.
    Most lawyers who specialize in comp won’t deal with it.

    Tony
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    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
    http://www.workerscompensationinsura...inks/index.htm

  3. #3
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    Default Re: Bad Faith

    ''Oklahoma Allows for a Bad Faith Cause of Action in Workers Compensation Cases'' http://www.settlementboard.com/oklah...nsation-cases/
    The Oklahoma Supreme Court approved a direct action for bad faith against the insurer for workers’ compensation benefits by the injured worker in Sizemore v. Continental Casualty Company, 2006 OK 36, 142 P.3d 47. The bad faith action is one that can only be brought in certain instances. The claimant must have received some type of an award from the workers’ compensation court or other order entered in favor of the claimant that has remained unpaid without valid cause or justification. There must have been a certification of the award under the enforcement provision of the Workers’ Compensation Act. One of the complaints often made by claimants against the workers’ compensation court as well as the insurers that provide indemnification for the benefits is the slow time in receiving payment. The Oklahoma Supreme Court noted that once an order is in place and all procedural safeguards have been previously met, there really is no justification for refusing to pay the order entered by the court. Although the opinion does not address the respect we should all have for lawful court orders, it appears to me there is a slight undertone in which the court is attempting to say the decisions of Oklahoma workers’ compensation judges should be honored, respected, and obeyed. Whether you favor or disfavor allowing a claimant to bring an independent action for bad faith based upon a workers’ compensation award that has not been paid, it is the present law in Oklahoma.
    You can only bring these types of claims for 'bad faith' where you have received the favorable action by the WC court. ie. and order to provide treatment, or pay on an award of TTD/PD indemnity etc.
    You can't bring legal action in the name of a provider, only yourself.
    Those Dr's will have to pursue payment on their own.

    ''Workers' comp suit in Oklahoma causes court confusion''
    The above should be followed by this though...http://findarticles.com/p/articles/m.../ai_n31934870/

  4. #4
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    Default Re: Bad Faith

    So, at least you're beginning to open up to the idea of a bad faith action by an injured worker.

    We've had some contentious debates about this in the past.
    You and others where claiming that bad faith can only be filed by the policy holder (the ER).
    You guys where also citing the “exclusive remedy” rule.
    I’ve insisted for years, an injured worker could file a bad faith claim, depending on the circumstances.
    Tony
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    http://www.workerscompensationinsura...inks/index.htm

  5. #5
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    Default Re: Bad Faith

    Not necessarily, This court set this down just last May/09... and even the court was confused when faced with the WC provisions of 'exclusive remedy'.

    Bad faith claims by IW's are very, very difficult to press. And here again, atty fees would likely be up front...and IW's would be charged with proving the action was in fact bad faith by the carrier doing someithing outside what the statutes provide. In ''bad faith''.

    In the end, it will depend on the state. I don't think any state actually bans IW's taking this to court... but it's a tremendous job to provie the point.

  6. #6
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    Default Re: Bad Faith

    WorkComp is strange. It seems to me that the injured worker can't do one single little or nig thing wrong but the I/C can do what they want basicly. They can delay payment for bills (in my case even over 3 years) or deny things such as pt although it clearly states after a surgery you are entitled to. The list goes on and on just the things off the top of my head, the injured/claiment has no room for error in his case.

    IT just doesn't seem right puts it to easy, it's just mind boggling. And they aren't held accountable or by check from anyone. Not even the judge.

  7. #7
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    Default Re: Bad Faith

    Workers' Compensation as the "Exclusive Remedy"
    By Aaron Larson
    March, 2005


    Contents
    What Is Meant by "Exclusive Remedy"
    When Can A Personal Injury Claim Be Filed?
    Common Personal Injury Claims
    What Is Meant by "Exclusive Remedy"
    Workers' compensation statutes in most states limit a worker's remedies for work-related injuries to a workers' comp claim against the employer. Except in narrow circumstances, such as where the employer actually intends to cause harm to the worker, no matter how egregious the employer's conduct the worker's sole remedy against the employer will be through the workers' compensation system. Typical workers' compensation laws similarly bar actions against co-employees who cause the worker's injury. Thus, workers' compensation coverage is referred to as the "exclusive remedy" available to an injured worker. In many cases, this works to the advantage of the employee, as the employee will receive benefits for lost wages, medical care and rehabilitation, even if the worker causes his own injury.

    Nonetheless, there are circumstances where a personal injury action remains possible. For example, sometimes an employee will be injured while on the premises of another business, or by the actions of a person who is not a co-employee. Under those circumstances, the injured worker may be able to bring a personal injury action against that third party defendant..
    Continue this article here.
    http://www.attorneys-usa.com/workers...ve_remedy.html
    Aaron Larson, the above author is the owner of this board


    Below is by a NY atty.
    Exclusive remedy in a nutshellAs a general rule, workers' compensation remedies are exclusive of all other remedies for injuries within the coverage of the act suffered by employees against an employer or insurer. This bar also applies to an employee's dependents to the extent that they are covered by a compensation act. But in some instances, common-law remedies are preserved, and in such cases claimants are usually given the right to elect which remedy they will pursue. http://findarticles.com/p/articles/m...4/ai_97482405/
    The insured party, the employer, has a right or expectation of 'good faith' action by the carrier.
    Where the IW is entitled to the same is after there has been an award of benefits by a judge. Either by cash payments of benefits due, or provision of medical treatment. You have to show where the carrier or legally self insured ER has acted with intent, and committing a fraud... denying benefits outside the statutes. Difficult at best.

  8. #8
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    Default Re: Bad Faith

    We've had this debate before, I hate to beat a dead horse but I strongly disagree.
    (I lke that pic)

    Because of the fact you can pursue punitive damages, it makes bad faith litigation very lucrative.
    There are attorneys who specialize in Bad Faith Litigation.

    January 23, 2004
    Exclusive remedy, "bad faith" claims, and the $12 million lawsuit
    Exclusive remedy generally protects an employer from a lawsuit. If an employee suffers a work related injury, the employer provides a state-regulated schedule of benefits to cover medical care and lost wages during recovery. In exchange for these benefits, the employee forfeits the right to sue. Workers compensation becomes the sole or exclusive legal remedy. Often, this protection is extended to insurers who are acting as agents for the employer.
    However, there are exceptions. One exception is bad faith on the part of the insurer. A successful bad faith suit might be triggered by an insurer's nonpayment of claims, mass denial of claims, or the like.
    http://www.workerscompinsider.com/archives/000052.html

    SPECIAL REPORT ON TEXAS WORKERS’ COMPENSATION BAD-FAITH
    LITIGATION
    Trends in Texas Workers’ Compensation Bad-Faith Litigation
    While bad faith lawsuits in Texas arising out of workers' compensation claims have been around since the creation of the bad faith tort in Texas 20 years ago, the number of such suits has been dwarfed by bad faith suits arising out of property, liability, life and health claims. Recently, however, the number of bad faith allegations against workers' compensation carriers has risen at an alarming level in the state. The number of such suits in Texas has reached unprecedented numbers in recent months. Such suits are being filed across the state by numerous different firms. A few successful jury verdicts and multiple large settlements in recent months seem to have fueled the surge in extra-contractual workers' comp allegations.
    http://www.mdjwlaw.com/TIN/070907.pdf

    Attorneys representing injured workers will be filing more bad faith lawsuits. Carriers must review their policies and procedures, provide additional training to its employees, and insure proper supervisory control on all denials. Failure to deny a case based upon legitimate facts could subject a carrier to an E&O action by the insured. However, disputing a case based upon unsubstantiated rumors can lead to a bad faith claim by the injured worker.
    http://law.lexisnexis.com/practicear...-Co-v-Ruttiger

    I could do this all night, there are thousands of successful bad faith claims filed every year.
    Tony
    Last edited by tony; 12-26-2009 at 03:54 PM.
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    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
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  9. #9
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    Default Re: Bad Faith

    Quote Quoting BvIA View Post
    Continue this article here.
    http://www.attorneys-usa.com/workers...ve_remedy.html
    Aaron Larson, the above author is the owner of this board


    Below is by a NY atty.
    The insured party, the employer, has a right or expectation of 'good faith' action by the carrier.
    Where the IW is entitled to the same is after there has been an award of benefits by a judge. Either by cash payments of benefits due, or provision of medical treatment. You have to show where the carrier or legally self insured ER has acted with intent, and committing a fraud... denying benefits outside the statutes. Difficult at best.
    Wouldn't "Fruad" be the same if they don't pay bills and abide by court orders? Of dening staute's in Oklahoma Work Comp system? Seems to me it would but im not a Judge or Lawyer

    Example: (I'd have to look up where it is in Sec85) but it says that after any surgery you are intitled to Phy Ther. If they keep turning down the request from the Surgeon and PT clinic and you are entitled to it then isn't that "fraud"?

    You are by law entitled to it, they won't let you, they keep the money and in several Dr's opinion it possibly effected the outcome of that surgery.

  10. #10
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    Default Re: Bad Faith

    There are lots of provisions for the ER/IC to dispute medical treatments...delaying benefits/treatment isn't necessarily bad faith.

    Like the information/opinions in the links, the IW is entitled (in OK) to civil actions after there has been an award by the court. That doesn't necessarily mean after settlement. If you go to court to get a treatment provided by a judge, that is a 'court order'. The carrier has the right to appeal, but when the final judges order after the appeals have been exhausted, they don't provide the benefits...you have the right to sue.

    Same with TD/PD. After a court order, and non compliance, there could be action taken in civil court.

    These are still going to vary by state. And, even though there may be big awards, litigation is expensive with filing fees, deposition, expert witness, those have to be paid during the ligigation process. The attys are not likely to pay those bills. The claimant will. And there is no guarantee you will prevail at court.

    WC is no fault, you are pretty much guaranteed a settlement/award... bad faith you will have to prove with out guarantee of a dime, but certainly know it's going to cost you.
    Wouldn't "Fruad" be the same if they don't pay bills and abide by court orders?
    Maybe, but that is of no concern to the IW. (in most states the provider is precluded from billing the IW for treatment). And, the again, the carrier has the abilit to deny a provider benefits until there is a court order.
    You are by law entitled to it, they won't let you, they keep the money and in several Dr's opinion it possibly effected the outcome of that surgery.
    Do you have a judge ordering the carrier to authorize the PT ?

    Some states have explicitly permitted bad faith claims by IW...others haven't. Doesn't mean you can't bring the action, and I'm certainly not defending the ER/IC's... what I am saying is you are facing a BIG wall in charging bad faith because they have delayed benefits. And a potentially huge litigation bill. There are a lot more cases where the courts have not permitted these cases to move forward than there are those that have. Maybe that will turn around.

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