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Thread: Bad Faith

  1. #1
    Join Date
    Apr 2007
    Posts
    52

    Default Bad Faith

    I been on w.c more than 3 years and insurance company giving me the run around .its clear that whats going on is abad faith .i like to get more info about what to expect from filling with thw w.c judge .thank you

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Bad Faith

    bad faith filings are made in civil court and not with the work comp court.
    a work comp judge will make a decision on whatever work comp issue is brought before them.
    if you want more information about bringing an issue to the work comp court and are not represented contact your local Information & Assistance officer
    http://www.dir.ca.gov/dwc/IandA.html

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Bad Faith

    Other states have provided statutes where by IW"s may bring bad faith claims handling in WC cases.
    Not Calif.
    It is very, very difficult to prevail in a bad faith claim, one, IW is not the insured party. The ER is.
    Two, the rules provide for lengthly delays in accepting a claim, and providing benefits.
    I been on w.c more than 3 years and insurance company giving me the run around
    Not unusual, not illegal. Even the dispute resolution under 4062 of the labor code, with the madatory timeframes often takes longer than the Title 8 CCR's provide.

    Getting the 'run around', doesn't necessarily constitute bad faith.

  4. #4
    Join Date
    Apr 2007
    Posts
    52

    Default Re: Bad Faith

    thanks for all of you .its not the run around only .example they accept body parts they send me to Dr.OK when Dr request treatment the adjustor's deny the treatment why its not accepted and they will pay the bill.or medication this what i do mean by bad faith,

  5. #5
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Bad Faith

    Quote Quoting mark14 View Post
    thanks for all of you .its not the run around only .example they accept body parts they send me to Dr.OK when Dr request treatment the adjustor's deny the treatment why its not accepted and they will pay the bill.or medication this what i do mean by bad faith,
    utilization review issues are not bad faith issues.
    you should discuss it with a civil atty if you wish to pursue a bad faith claim.
    as with most civil lawsuits they take a long time to bring to trial and cost lots of investigation $$.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Bad Faith

    OK when Dr request treatment the adjustor's deny the treatment
    One, the CA cannot deny any medical care request. Only UR Dr can modify, delay or deny a PTP request for treatment, and there are specific rules that govern the UR process.

    Two, PTP is the one who must request any treatment, UR determines medical necessity.
    The ER/IC is entitled to know what treatment is necessary, and why the PTP is requesting.

    No bad faith here. It's simply part of the WC process.
    IF there is unreasonable delay in providing any benefits, you may be eligible for up to 25% penalty awarded by a WCAB judge.

    IF there is any bad faith claims practice involved in administration of your claim, it would be handled by the WCAB court...not a civil/tort action. There are numberous case law/decisions that cover this issue. A little research at the DWC/WCAB web site would provide that info. Doubt you'd find a civil action attention atty to take a WC 'bad faith claims action' complaint.

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