Third-Party_Claims_Administrators

Insurers: Third-Party Claims Administrators

Cissell v. Employers Compensation Ins. Co. [04/18/12] 2012 MTWCC 12 There is an agency relationship between the insurer and the TPA, and any rights and liabilities within the authority of the TPA accrue to the insurer as the principal, including those John Does named by Petitioner who worked on her claim. Since the insurer is already properly named as a respondent, there is no reason to name such entities or persons as parties in addition to the insurer. Petitioner shall file an amended petition to reflect the insurer as the only respondent.

Cissell v. Employers Compensation Ins. Co. [04/18/12] 2012 MTWCC 12 The Petitioner named Brentwood Services as a Respondent. Brentwood adjusted Petitioner’s claim on behalf of the insurer as a third-party administrator (TPA). As this Court has previously held, a TPA will not be named in the caption of a workers’ compensation case as a matter of course, absent a compelling reason for doing so. In the present case, no compelling reason for Brentwood Services’ inclusion in the caption is before the Court.

Ivie v. MUS Self Funded Workers' Compensation Program [06/09/10] 2010 MTWCC 15 If the adjustment of a claim is found by the Court to be unreasonable, any penalty or attorney fees would be assessed against the insurer pursuant to §§ 39-71-611, -2907, MCA.

Ivie v. MUS Self Funded Workers' Compensation Program [06/09/10] 2010 MTWCC 15 Although ARM 24.5.301 does not prohibit naming a third-party claims administrator as a party in a workers’ compensation benefit dispute, it does not necessarily follow that the Court should allow parties other than the insurer to be named in the caption absent a compelling reason for doing so. A third-party claims administrator is obligated to cooperate with the insurer for whom it is administering a claim. If the Court were presented with evidence that an administrator was not cooperating with the insurer and was obstructing discovery, it would consider making the administrator a party. However, the Court will not exercise jurisdiction over a party that is not necessary to the resolution of a dispute simply because it can.