Asking this question in a different category now...
I injured my back while doing yardwork, not a major injury (no surgery needed), but my doctor gave me prescription for physical therapy. The insurance company is now denying my coverage after my 15th visit of the 24 I was suppose to have. Their reasoning was that I had a minor injury in my back before due to work about 1 year ago. The case didn't close, but I had therapy and had fully recovered. I haven't worked at the company where I got injured nor am I doing the same type of tasks as the ones that got me injured for about 6 months now.
Is the insurance company acting in bad faith?
Find a member of the CAOC who handles workers comp. www.caoc.org--they give free consultations.
Bad faith is usually reserved where there is no legitimate avenue to justify the insurance company's actions. Your post indicates a relatively recent, open, workers compensation case, for the same injured body part. Get a denial form workers compensation and then your insurance company should provide coverage. Confirm with local counsel.
Put simply, insurance companies are heavily regulated and are supposed to operate by certain "rules of the road" such as: giving their insured's interests equal consideration as their own, not arbitrarily ignoring evidence that supports a claim, fully investigating a claim, doing so promptly, and not unreasonably delaying the payment of benefits. These are but a few examples. Violating any of these "rules," which can be very difficult to prove, constitutes bad faith.
Put another way- insurance companies are unique in that what they are selling is a promise to come to your aid in the future. Because it is so easy and tempting for insurers to later violate this promise, and because it always happens when insureds are the most vulnerable and in great need, the law in this field has developed in a way that (rightfully) requires insurers to act ethically when their clients need their help....something that can be very, very difficult for profit driven businesses to do.
So, if your insurer's decision here is supported by medical reasoning, then it is probably not bad faith. If, on the other hand, they simply used the prior injury as a reason to terminate without any supporting evidence or even an investigation, then it very well may constitute bad faith.
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