Insurers: Claim Management


Malcomson v. Liberty Northwest, 2014 MT 242 Insurers have a legitimate interest in engaging in ex parte contact with healthcare providers for the sole purpose of facilitating the administrative aspects of the claim handling procedure.  A release crafted to authorize this type of limited ex parte contact would not violate a claimant’s right of privacy.

Malcomson v. Liberty Northwest, 2014 MT 242 During 90 of the nearly 100 years which the WCA has been in effect, the WCA contained no provision allowing agents of the insurer to communicate directly with healthcare providers without prior notice to the claimant, and yet relevant information was obtained by insurers.  Appellant conceded that this system was “workable,” and the insurer’s agents testified at trial that they were able to obtain the information they needed without having private talks with the claimant’s physician.  The method for obtaining relevant medical information in effect prior to § 39-71-604(3), MCA (2003), was narrowly tailored to effectuate the State’s interests.  Therefore, the statute as currently written is overbroad and cannot stand.


Koch v. Employers Ins. Group [05/19/14] 2014 MTWCC 14 A ruling by this Court that a claim is compensable should not be viewed as a blank check written out to Petitioner’s treating physician.  However, after liability is established, an insurer cannot decide to terminate a treating physician’s diagnostic work-up in the middle of the process for no discernible reason.

Malcomson v. Liberty Northwest [08/16/13] 2013 MTWCC 21 There are myriad methods of communicating in the current era which allow everyone to be part of the conversation in a time-efficient manner.  While Respondent paints a picture in which the entire system grinds to a halt because of the theoretical need to coordinate everyone’s calendars to schedule real-time conference calls if ex parte communication is prohibited, the use of e-mail allows all parties to be privy to communications and has the additional advantage of creating a written record.

Brown v. Hartford Ins. Co. [12/16/09] 2009 MTWCC 38 The Court found denial of a claimant’s occupational disease claim unreasonable, noting among the factors in reaching that decision that the insurer allowed the claimant’s claims file to sit for four months with no adjuster assigned to it, and the adjuster later assigned to the claim found a physician’s treating notes unclear and continued to deny the claim without seeking clarification from the physician for seven months.