Gross Negligence - Inadequate Claims Handling

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Irish

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My question is can an insurance carrier be liable for extra contractual damages, if the insurance carrier acted negligently & in bad faith?

Are they immune from liability when they are negligent in handling the claims process resulting in further injury.
 
No they are not immune from liability but we will need a great deal more than that to answer you thoroughly. If it is long be sure to break it up into paragraphs for readability.
 
Additional Info

Ok, to start my husband suffered an injury to his wrist while at work. He filed the required paperwork with his employer and they gave him a list of doctor's he was allowed to see. The Doctor we choose also happened to be our family doctor. Before the doctor's appointment I did some online research on what might be the problem. My husband explained the pain he was having & the symptoms he felt when the injury occurred when I found information on a TFCC tear.

Once we went to the doctor we told him that we thought it might be a TFCC tear. He ordered an X-Ray & scheduled a follow up appointment. Once he went back for the follow up appointment they said the x-ray did not show any broken bones and that he should have an MRI, but that Workers Compensation would not approve an MRI until they tried Physical Therapy first. He gave my husband a short wrist brace and told my husband to try the physical therapy and to come back for a follow up appointment.

After about a month of PT we went back to the doctor with no improvement and the doctor recommended my husband see an Orthopedic Surgeon. (We feel the physical therapy did nothing but make the tear worse) Workers Comp again gave him a list of doctor's & we made an appointment. This doctor ordered the MRI & told my husband the wrist splint he was wearing was too short & gave him a prescription for a half arm splint.

After the MRI we returned to the doctor & he stated it was in fact a TFCC tear, but that he does not do that type of surgery & we would have to find another doctor.

That is around the time when we began having problems with the Workers Comp insurance carrier. We called to let them know he needed to see a wrist specialist and they told us they would call us back with a doctor. Mean time a month in a half went by with no word.

Finally, they found a doctor he could see and his first surgery was scheduled. During the first surgery the TFCC tear, ulnar head osteoplasty & a lunate repair was performed. They inserted pins in his wrist to hold everything together & he had a full arm cast for three months. The next surgery was scheduled to have the pins (which looked like roofing nails) removed by the surgeon. Workers Compensation despite numerous calls by the doctor's office did not approve the surgery to have the pins removed. Due to them stalling on this, the pins began protruding from his hand pushing into his cast causing him extreme pain. We had to make an emergency visit to the doctor because his arm began swelling causing circulation problems.

While there, the cast was removed & we were able to view the pins coming through my husband's skin. My husband had to hold up his arm with his other hand because he was in such extreme pain. It was decided because the pins were coming through the skin they would have to be removed then & there. The doctor's assistant attempted to numb the area, but it was not enough to escape the extreme pain he had while this was being done. I was in the room while this was being done and had to turn the other way when I saw the blood squirting out of his wrist. My husband had beads of perspire all over him & looked like he was going to pass out right there. Once the pins were removed they put on another half arm cast & we were sent on our way. My husband was pale as a ghost leaving that office. Needless to say, the surgery was a failure & my husband now has nerve damage in his hand which was not there before the surgery.

My husband has Physical Therapy done and he returned to work with light duty for almost a year. We asked Workers Compensation to see another Doctor since my husband was still having pain in his wrist. It took an entire year before they finally agreed. They tried to pull a quick one on us and told us we could see another Doctor, which I just happened to know was in the same office as the first doctor. We all know what would have happened there.

So, we found a wonderful Doctor who said she would try to help my husbands pain and put in for another surgery with WC. During her X-Rays she found that there was a bone rubbing against another bone in his wrist, which was a result of his first surgery. She said she might not be able to fix the TFCC tear, but that she would be able to help with the bones rubbing together. She also told my husband the only way stop the nerve pain was to clip the nerve, but there are hundreds of nerves in the wrist & there was a chance they would clip the wrong nerve leaving him with no feeling in his wrist for the rest of his life.

Workers Comp. denied the surgery saying it was not necessary and that we did not try other options, which we did, because they were paying for some if it. The Doctor insisted the surgery was needed and they finally approved the surgery.

Second surgery was performed and after the surgery we were told by the Doctor there was no way to fix the TFCC tear....that there was so much scar tissue surrounding the area she did not even try. She fixed the bones that were rubbing against each other, but the nerve damage we had decided not to chance.

Cast was put on and we scheduled follow up appointments with the doctor. Once it was decided that Physical Therapy was needed to be started the doctor put in orders for Physical Therapy to begin. We did not hear from the doctor so the next appointment was made & she asked how PT was going. We told her we had not been approved for PT, again she put in an order.....again we heard nothing. This went on for several months, at which point the Doctor told the insurance carrier that if PT was not completed the chances of recovery were severly limited.

Again PT was not approved. The doctor called the insurance carrier during my husbands appointment asking why PT was not approved. PT was finally approved, but his Doctor believes the reason he has not made a full recovery was due to the negligence of the insurance carrier and she sent us home with paperwork stating that. She is behind us 100%....in regard to their negligence.

My complaint is that them not approving the pins to be removed in the first surgery caused nerve damage that was not previously present. I also believe because of their blatant disregard of consequences, they disregarded Doctor's orders causing permanent damage that might have healed if this case was handled correctly.

 
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