Court Slams Insurance Company’s Bad Faith Tactics
Two insurance carriers quickly settled a catastrophic injury claim while a third one “sat on its thumbs,” according to a unanimous decision from a federal appeals court.
In reaching this conclusion, the Eleventh Circuit Court of Appeals rejected the insurance company’s excuse that a key witness was not fully cooperative. “American Builders did everything when it came to investigating Guthrie’s claim and deciding whether the insured should make a payment, all while Southern-Owners sat back and watched,” the 3-0 opinion stated. “The Florida Supreme Court has been clear on this point: without good faith, an insurer may not avail itself of an affirmative defense based on an insured’s failure to cooperate.”
Beck Construction had hired this job injury victim to replace the wood trim around two rooftop decorative windows. On April 1, 2019 he fell off the roof of the luxury home that was being renovated, “while two spotters focused on their phones,” according to the opinion. He will never walk again, the court noted.
Insurance Company Legal Requirements
Usually, everyone wants job injury victims to get back to work as quickly as possible. Employers don’t want their teams to be short-handed and families don’t want to miss paychecks. However, insurance companies often don’t count as “everyone” in these situations. Despite what TV commercials imply. Insurance companies generally don’t care about their policyholders. They certainly don’t care about injury victims. Instead, they only care about their own profits.
To spur insurance companies into action, Florida has some of the strongest bad faith insurance laws in the country. If insurance companies act in bad faith, a Tampa workers’ compensation attorney can take them to court and force them to do the right thing.
In this context, doing the right thing begins with a prompt, thorough, and transparent investigation.
Generally, after they receive workers’ compensation claims, insurance companies must begin their investigations within a month. Insurance companies cannot rush through investigations, but they cannot drag their feet either. This balance is part of a thorough investigation. Furthermore, adjusters cannot rubber-stamp claims as “paid” or “denied.” Finally, these investigations must be transparent. Insurance investigators cannot work behind closed doors.
The process is set in stone, but the results are subjective. An insurance company’s idea of reasonable benefits, especially a reasonable amount of medical bills, is often much different from what a job injury victim needs. Disagreements also arise regarding the length of disability. Frequently, employer and insurance company doctors try to force job injury victims to return to work earlier than they should.
Tampa workers’ compensation attorneys advocate for job injury victims in both these situations. An attorney, unlike an insurance company, is clearly on your side.
Nonsubscriber Job Injury Claims
Florida law requires most employers to purchase valid workers’ compensation policies. Employers commonly disregard this legal requirement.
Some employers flaunt this law and refuse to buy insurance. Usually, Florida officials don’t aggressively investigate these insurance fraud matters. If they do look into the matter and assess punishment, that punishment is usually a fine which barely exceeds the amount of money the company saved by not paying premiums.
In other words, insurance companies play the odds. Since the chances of getting caught are low and the penalties are low, skirting the law is worth the risk.
Speaking of premiums, many companies lie on official forms to reduce their risk and therefore reduce their premiums. Misclassification is a good example. If Company A has twenty roofers (high-risk job) and ten secretaries (low-risk job), it may claim it has twenty secretaries and ten roofers. When insurance companies uncover these false statements, they usually deny coverage.
In these situations, a Tampa workers’ compensation attorney may be able to file a civil damage claim in court. If the victim/plaintiff proves employer negligence caused the injury, additional compensation may be available. To punish them for not buying insurance, employers typically cannot use some key negligence defenses in these situations. So, it’s easier to prove negligence in court.
Connect With a Thorough Hillsborough County Attorney
Injury victims are entitled to important financial benefits. For a free consultation with an experienced job injury lawyer in Tampa, contact Kobal Law. You have a limited amount of time to act.
Source:
media.ca11.uscourts.gov/opinions/pub/files/202113496.pdf
