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Workers' Compensation Bad Faith

In a workers' compensation case, an Insurance Company violates its Duty of Good Faith and Fair Dealing by denying or delaying payment of claims if Insurer knew or should have known that it was reasonably clear that the claim was covered.

If you , or a patient, have been so denied, feel free to contact us. We consider a viable case where:

1. If the Insurance Company denial is for medical treatment, there should be:

1. Denial by the Insurance Company
2. Resubmission sent to the Insurance Company by the treating doctor.
3. Second Denial by the Insurance Company
4. Appeal filed with the Medical Dispute division of the Texas Workers' Compensation Commission, if a pre-authorization is sought within 45 days from the Carrier's Reconsideration denial.
5. A ruling by the Medical Disputes Division in favor of the Claimant.

 2. If the denial was for Income Benefits, there must be a final ruling by the Texas Workers' Compensation Commission in favor of the Claimant.

3. There does not have to be a final ruling by the Texas Workers' Compensation Commission if the damages sought are for 1) delay in providing benefits, 2) failure to reasonably investigate, or 3) failure to return telephone calls and timely communicate with Claimant.