Insurers: Adjusters
Brown v. Hartford Ins. Co. [12/16/09] 2009 MTWCC 38 The Court found the actions of two claims adjusters to be unreasonable in adjusting Petitioner’s claim where: the first adjuster noted after reviewing medical records that Petitioner’s condition was not work-related when the medical notes explicitly stated that it was; the file sat for four months with no adjuster assigned to it; the second adjuster sat on the file for seven months without seeking clarification regarding her “confusion” about the diagnoses; and the second adjuster continued to deny liability and again failed to seek clarification after the physician again examined Petitioner and found her to be suffering from an occupational disease. |
Kramer v. Montana Contractor Compensation Fund [10/27/08] 2008 MTWCC 48 The Court was troubled by some actions of the claims adjuster, including communications with the treating physician which, while ostensibly for the purpose of clarifying Petitioner’s physical restrictions, were also apparently intended to call Petitioner’s credibility into question with his treating physician. This behavior is inappropriate and is not consistent with reasonable claims handling. |
Hernandez
v. ACE USA [4/24/03] 2003 MTWCC 32 By giving its insured veto
power over settlements, the insurer violated section 39-71-107(3), MCA
(2001), which requires appointment of a resident adjuster with settlement
authority. |
Hernandez
v. ACE USA [4/24/03] 2003 MTWCC 32 Under section 39-71-107(3),
MCA (2001), insurers providing workers' compensation coverage in Montana
must appoint a resident Montana claims adjuster and give that adjuster
final settlement authority with respect to Montana workers' compensation
claims. |
Patrick
v. State Compensation Insurance Fund [4/4/00] 2000 MTWCC 20 Penalty
under 39-71-2907, MCA (1997) awarded where adjuster unreasonably limited
rehabilitation evaluation to the gathering of information to support her
prior conclusion claimant suffered no wage loss. Facts suggesting unreasonable
delay and denial of rehab benefits included adjuster's hiring of private
investigator based only a computer generated "fraud flag," which
in turn was based only on claimant's failure to return to work within
a predicted period of time, and did not consider claimant's serious preexisting
condition upon which work injury was imposed; adjuster's apparent communication
to investigator, without any support, that there was no objective evidence
of injury and treating physician was "making matters worse";
referral for neuropsychological evaluation without basis; provision of
report unfavorable to claimant, but not report favorable to claimant,
to expert; and general tendency to ignore evidence favorable to claimant
while seeking opinions to support adjuster's conclusion. Note:
After decision, the parties settled and presented a Stipulated Judgment
to the Court, which then issued its Order Nunc Pro Tunc For Entry
of Judgement and Dismissal with Prejudice, Patrick
v. State Comp. Ins. Fund,
2000 MTWCC 20A. |