This class action is brought against certain members of the Liberty Mutual Group of insurance companies and a Liberty Mutual subsidiary that provides their claims administration. The complaint alleges that the companies do not provide prompt payment of workers’ compensation claims nor an explanation of why the claims are disputed.
The suit is brought by First State Orthopedics, PA (FSO), which apparently finds some of its bills, due under workers’ compensation claims, going unpaid by the defendants in this case:
- Employers Insurance Company of Wausau
- Liberty Insurance Corporation
- Liberty Mutual Fire Insurance Company
- LM Insurance Corporation
- The First Liberty Insurance Corporation
- Wausau Underwriters Insurance Company
- Helmsman Management Services, LLC
The complaint quotes the findings of an earlier court case as saying, “The philosophy of the [Workers’ Compensation] Act is to obviate the need for litigation and to give an injured employee, irrespective of fault, prompt compensation.”
The complaint adds, “Consistent with this philosophy, the Delaware Workers’ Compensation Act imposes a 30-day deadline for payment of covered medical expenses—not merely once, but in two separate provisions of the Act.”
It also quotes the Act as saying, “Denial of payment for health care services provided pursuant to this chapter, whether in whole or in part, shall be accompanied with written explanation of reason for denial.”
However, the complaint says that all FSO gets in response to some of its bills is a form Explanation of Benefits that says, “either verbatim or in substance” that “This service [is] not authorized by case manager. Please contact the case manager for further information.” The complaint says this violates the law because it does not set forth any reasons for the denial of coverage.
According to the complaint, this behavior is a means of avoiding the requirement to provide a prompt response to claims. It is “subverting the statutory 30-day deadline” and “the defendants prejudice the ability of their claimants and their care providers to assess and, if appropriate, contest coverage denials in a meaningful way…” It also creates a delay in payment.
The class for this action is all persons or entities who, at any time since January 31, 2016, sent to one or more of the defendants in this case a health care invoice for care to a Delaware workers’ compensation claimant, where (1) the defendant answered by stating, either verbatim or in substance, that “This service in not authorized by case manager. Please contact the case manager for further information”, and (2) the defendant neither paid all or part of the invoice within thirty days of receipt nor explained in writing, within that same time, any other reason for not paying the invoice.
Article Type: LawsuitTopic: Consumer
Most Recent Case Event
No Payment, No Explanation for Workers’ Comp Claims Complaint
March 14, 2019
This class action is brought against certain members of the Liberty Mutual Group of insurance companies and a Liberty Mutual subsidiary that provides their claims administration. The complaint alleges that the companies do not provide prompt payment of workers’ compensation claims nor an explanation of why the claims are disputed.
Case Event History
No Payment, No Explanation for Workers’ Comp Claims Complaint
March 14, 2019
This class action is brought against certain members of the Liberty Mutual Group of insurance companies and a Liberty Mutual subsidiary that provides their claims administration. The complaint alleges that the companies do not provide prompt payment of workers’ compensation claims nor an explanation of why the claims are disputed.
