Insurance Bad Faith Claims & Rights of the Injured

A recent court case addressed the issue of whether a worker could recover additional tort damages after his employer’s insurer wrongfully, and in bad-faith, refused to pay worker’s compensation due to him.

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Insurance companies and employers may pull out all the stops to avoid paying an employee in the wake of an injury claim. OurSpartanburg worker’s compensation lawyers can help review your situation and determine the proper course of action.

The district court which reviewed this case initially erroneously determined that the insurer had only committed a breach of contract when it refused to pay the plaintiff’s worker compensation claim.

However, after the state supreme court reviewed the case, justices reversed the decision of the lower court and sent the case back to for proceedings consistent with their ruling.

The state supreme court held that since the insurer had acted with intentional bad faith when it refused to pay the plaintiff’s valid workers compensation claim, it could be an independent tort claim for the plaintiff.

In this case the employee was injured in the scope and course of his employment. The insurance company delayed paying the claim for a full eight months. The insurance company eventually conceded that it had erroneously withheld the payment of the worker’s compensation claim.

The court explained that the common law instructions to determine whether an action can be considered a “tort” including:

• The place where the injury occurred.
• The location where conduct causing the injury occurred.
• The place of incorporation, place of business, nationality, residence and domicile of the parties involved; and • The place where any relationship between the parties was centered.

In this case, the common law in the relevant jurisdiction instructs that the factors should be evaluated according to the relative importance.

When the court evaluated these particular factors it decided that the worker should be able to sue under tort law for the denial to pay him worker’s compensation.

In jurisdictions that allow bad faith claims it is usually required that the acts of the employer or carrier go beyond mere negligence or knowing unreasonableness. Instead, these states require a showing of conscious, wanton, or willful disregard of the consequences of their actions.

The state supreme court ruled that evidence of this sort of intentional conduct existed in this case and based its opinion, in part on this conclusion.

Worker’s should be aware that an employer or carrier is often required to investigate any claim that is filed and prove it is not a valid claim. This is important because it gives employers and carriers the duty to investigate claims.

Contact our Carolina worker’s compensation attorneys today by calling 800-887-1965.

Additional Resources:

Workers’ Comp & Bad Faith: Unacceptable Oversights
, By Everette Lee Herndon, Jr., July 15, 2013

More Blog Posts:

Welder Injuries in North Carolina Often Substantial, Dec. 24, 2013, Charlotte Workers’ Compensation Lawyer Blog

Your Workers’ Compensation Claim: FAQ, North Carolina Workers’ Compensation Lawyers Blog, January 14, 2014

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