Insurers: Claim Management

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.