Compassionate Guidance For Workers’ Compensation and Social Security Disability

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Appellate Ruling Establishes Carriers Must Investigate a Claim Before Denying It

On Behalf of | Aug 19, 2019 | Workers Compensation |

We’re coming up on the one-year anniversary of an Arizona Court of Appeals decision that held it’s bad faith in workers’ compensation if a claims adjuster denies a claim without first conducting even a basic investigation. In Tapia v. Indus. Comm’n, 245 Ariz. 258 (App. 2018), the Banner University Medical Center claims adjuster, who denied the injured workers’ claim, failed to conduct the insurance-industry standard three-point investigation – that’s an unreasonable denial of a claim, said the court of appeals in a published decision. Attorney Laura Clymer litigated the underlying compensability issue in the Tapia case, as well as the administrative bad faith claim at the Industrial Commission.

Longtime workers’ compensation attorney Brian Clymer said, “The decision is an important one for injured workers because it establishes that claims adjusters must conduct adequate investigations before denying a claim for benefits. Defendant insurance carriers will likely try to argue that the case’s holding is limited to self-insured carriers who get to direct medical care. But the Tapia decision establishes an important precedent that applies to all carriers.”

“It will help injured workers who pursue bad faith claims against insurance carriers who deny valid claims without first conducting an adequate investigation. And we’ll be glad to fight any carrier who pretends that the standard established in the Tapia case doesn’t apply to them,” Clymer said.