What is the name of your state? CA
The following chronology details the underlying issue of the insured's claim against his own Insurance Compan.
- Date of accident was in July 2003. The insurance carrier confirms their insured has a valid uninsured motorist bodily injury claim. The carrier ask the insured to sign a medical and wage authorization form for the carrier to obtain copies of the insured's medical and employment records for purpose of evaluating the insured's UMBI claim.
-In August 2003, the insured returns the signed authorization
form with details of her treating doctors.
-Meanwhile the carrier pays $18500 for the repairs to the
damage to her vehicle.
-The adjuster from the Insured's insurance company follows
up with the insured every now and than to see how the
insured's treatment is coming along. On her part the insured
keeps the adjuster abreast of her treatment and loss of
income status.
-The injuries claimed by the insured are soft tissue in nature
and confined to the neck,shoulders and low back area.The
injured insured is employed by a major US Airline company.
The job duty includes opening the airplane door upon the
plane's landing and also unload baggage of passengers
arriving. Because of her injuries, she is precluded from doing
this type of work and is put on disability for a period of upto
4 months, by her treating physician. The employer has no
problem with the insured being out on disability.
-In January 2004, the insured provides the adjuster with her
medical records from the treating doctor. She tells the
adjuster,she does not have the records from the HMO facility
where she was also seen by a physician eight times.The
adjuster tells her he will obtain her records from the HMO
and her employer via her signed authorization provided.
-The total amount of the medical bills sent to the adjuster is
$6000 and excludes bills from the ER and HMO.The insured
tells the adjuster the total bills including an estimated
$2000 from the HMO should be approx $8000. The insured
also claims 600 hours of wage loss of approx $15,000. The
total amount of special damages are approx $23,000. The
maximum the policy will pay is $30,000 and the insured
in January 2004, makes a policy limit demand of $30,000.
-The Adjuster does obtain the employment records which
indicates the insured was away from work for 3-4 months.
-The adjuster between 1/04 thru 9/04 sends letters to the
insured saying he is trying to verify her loss of earnings
but is having difficulty reaching the employer's payroll
Supervisor.
- A total of 2-3 such generic letters are sent to the insured
between the above mentioned period.
-In September 2004, the insured asks the adjuster why is she
not being compensated for her longstanding claim?
-The adjuster says he is still having trouble getting her
employer verify her earnings claim.
-The insured asks the adjuster, what is he trying to verify
when the records, as per the adjuster himself, indicates she
was out for 4 months because of her injuries.
-Than the insured is told is that there is a new adjuster
assigned to her claim(a senior adjuster).
-The Sr Adjuster informs the insured that the prior adjuster
never ordered her records from the HMO to understand her
injury better.Plus,they also need for her to get a letter from
the employer, explaining her time away from work because
of this accident.
-The insured than makes a policy limit demand on September
15, 2004, and gives the carrier one week to respond.
-On the day the time limit demand is to run,the adjuster
request a week's extension.The insured agrees.
-Than again a week later, the adjuster calls the insured and
requests another weeks extension.Again the insured agrees.
-On the day the demand is to expire, the adjuster calls the
insured and leaves a message on her machine saying he
discussed the case with her superiors and wishes to discuss
the case with the insured with the possibility of making an
offer.Not making a policy limit offer but a offer.The insured
does not get this message till late in the night, the demand
was to expire.
It appears from the phone message that the carrier is not interested in resolving this case for the policy limits as demanded by the insured.
Based on the above scenerio, does the insured have
1.A cause of action for bad faith against the insurer.
2.Should the insurance carrier have made an offer based on
what they believed to be a fair settlement offer and failed
to do so?
3.Does the Insurer have a right to request the insured
provide a letter from the employer explaining her earnings
claim, when in fact the records from the employer in the
Insurer's possession does indicate the insured was out due
to the injuries from the accident-with a note from the
treating doctor?
The following chronology details the underlying issue of the insured's claim against his own Insurance Compan.
- Date of accident was in July 2003. The insurance carrier confirms their insured has a valid uninsured motorist bodily injury claim. The carrier ask the insured to sign a medical and wage authorization form for the carrier to obtain copies of the insured's medical and employment records for purpose of evaluating the insured's UMBI claim.
-In August 2003, the insured returns the signed authorization
form with details of her treating doctors.
-Meanwhile the carrier pays $18500 for the repairs to the
damage to her vehicle.
-The adjuster from the Insured's insurance company follows
up with the insured every now and than to see how the
insured's treatment is coming along. On her part the insured
keeps the adjuster abreast of her treatment and loss of
income status.
-The injuries claimed by the insured are soft tissue in nature
and confined to the neck,shoulders and low back area.The
injured insured is employed by a major US Airline company.
The job duty includes opening the airplane door upon the
plane's landing and also unload baggage of passengers
arriving. Because of her injuries, she is precluded from doing
this type of work and is put on disability for a period of upto
4 months, by her treating physician. The employer has no
problem with the insured being out on disability.
-In January 2004, the insured provides the adjuster with her
medical records from the treating doctor. She tells the
adjuster,she does not have the records from the HMO facility
where she was also seen by a physician eight times.The
adjuster tells her he will obtain her records from the HMO
and her employer via her signed authorization provided.
-The total amount of the medical bills sent to the adjuster is
$6000 and excludes bills from the ER and HMO.The insured
tells the adjuster the total bills including an estimated
$2000 from the HMO should be approx $8000. The insured
also claims 600 hours of wage loss of approx $15,000. The
total amount of special damages are approx $23,000. The
maximum the policy will pay is $30,000 and the insured
in January 2004, makes a policy limit demand of $30,000.
-The Adjuster does obtain the employment records which
indicates the insured was away from work for 3-4 months.
-The adjuster between 1/04 thru 9/04 sends letters to the
insured saying he is trying to verify her loss of earnings
but is having difficulty reaching the employer's payroll
Supervisor.
- A total of 2-3 such generic letters are sent to the insured
between the above mentioned period.
-In September 2004, the insured asks the adjuster why is she
not being compensated for her longstanding claim?
-The adjuster says he is still having trouble getting her
employer verify her earnings claim.
-The insured asks the adjuster, what is he trying to verify
when the records, as per the adjuster himself, indicates she
was out for 4 months because of her injuries.
-Than the insured is told is that there is a new adjuster
assigned to her claim(a senior adjuster).
-The Sr Adjuster informs the insured that the prior adjuster
never ordered her records from the HMO to understand her
injury better.Plus,they also need for her to get a letter from
the employer, explaining her time away from work because
of this accident.
-The insured than makes a policy limit demand on September
15, 2004, and gives the carrier one week to respond.
-On the day the time limit demand is to run,the adjuster
request a week's extension.The insured agrees.
-Than again a week later, the adjuster calls the insured and
requests another weeks extension.Again the insured agrees.
-On the day the demand is to expire, the adjuster calls the
insured and leaves a message on her machine saying he
discussed the case with her superiors and wishes to discuss
the case with the insured with the possibility of making an
offer.Not making a policy limit offer but a offer.The insured
does not get this message till late in the night, the demand
was to expire.
It appears from the phone message that the carrier is not interested in resolving this case for the policy limits as demanded by the insured.
Based on the above scenerio, does the insured have
1.A cause of action for bad faith against the insurer.
2.Should the insurance carrier have made an offer based on
what they believed to be a fair settlement offer and failed
to do so?
3.Does the Insurer have a right to request the insured
provide a letter from the employer explaining her earnings
claim, when in fact the records from the employer in the
Insurer's possession does indicate the insured was out due
to the injuries from the accident-with a note from the
treating doctor?