District court's dismissal of neck injury claim affirmed
Reprints
The 9th U.S. Circuit Court of Appeals on Monday affirmed the district court's dismissal of a case against Indemnity Insurance Co. of North America.
David Clark argued that Indemnity Insurance and Gallagher Bassett Services Inc. acted in bad faith by denying his January claim for a neck injury without reviewing his medical records instead of a summary. The appeals court in San Francisco, California, ruled to affirm the district court’s dismissal of this part of Mr. Clark’s claim, stating that he did not explain how examination of his medical records, rather than a summary, might have revealed facts supporting coverage for his injury, according to court records.
The court also agreed with Indemnity Insurance’s reasoning in rejecting Mr. Clark’s claim, stating that the injury was raised more than a month after it was sustained, Mr. Clark informed the hospital where the fusion surgery was performed that his injury was not suffered during his employment, and Mr. Clark used his own group health insurance policy, according to court records.
“The Employer’s Report of Industrial Injury, which stated that (Mr.) Clark sustained a ‘blown disk in unknown area of back due to unknown cause,’ did not clarify matters. On the basis of what was known at that time, and with a statutory deadline looming, Indemnity's denial of (Mr.) Clark’s January claim could not have been unreasonable,” according to records.
Read Next
-
Worker's latest insurer must cover neck injury comp, disability
Gallagher Bassett Services Inc. is responsible to pay for a health care worker's surgery for a degenerative cervical disc condition that worsened after a 2011 injury, even though she suffered previous neck injuries that had been covered under a workers compensation policy issued by Liberty Mutual Insurance Co., a Connecticut appeals court has ruled.
