Insurance Company Good Faith

It May Not Feel Like It At Times, But Your Insurance Company Has An Obligation To Handle Your Claim In Good Faith

July 28, 2017

We have all been entertained by the funny and clever insurance company commercials we see on tv. Some of us may have even purchased insurance after seeing the many advertisements that constantly remind us of how a company offers cheap premiums while providing great service to its customers. Once we purchase the policy, we expect that if anything happens, our insurance company will have our back. But what happens when they don’t?

Example Scenario

It’s the middle of summer, and you are headed back to Fargo from your family reunion in Medora. As you approach Valley City, a car entering Interstate 94 fails to yield, causing a crash, and sending you into the median. After you realize what happened and your vehicle is stopped, your adrenaline is pumping and you are thankful to be alive. The Highway Patrol arrives at the scene, cites the other driver, and you call your insurance company to make a claim. In that initial telephone call from the scene, the adjuster asks “are you ok”, to which you respond “I think so.”

Your vehicle is not able to be driven from the scene, but luckily your husband and kids were trailing in a vehicle behind you. You can’t help but think how thankful you are that your kids were not in the car with you. On your ride back home with your family, you realize that you are becoming really stiff and sore. “No big deal,” you think, I took a pretty hard impact when I hit the bottom of the ditch, “I’m sure it will go away.” The next morning, you can hardly get out of bed. Your kids are up early with places to be. You take Billy to swimming lessons, Maddy to tee-ball, and your youngest, Jill, to a doctor appointment.

While at the appointment, you mention to the doctor that you had an accident the day before, and are feeling very stiff and sore. The doctor tells you it’s normal, and it should go away in a few days, but that if it is still there in a week you should go see someone. Of course, there is no record generated for this advice, because you were not the one treated during the visit.

A week goes by, and the pain continues to get worse. You finally can’t take it anymore, and head to a walk-in clinic, where x-rays are taken. They tell you nothing is broken, and that you have suffered a “sprain-strain” injury in your neck. They prescribe some medications to relax your muscles and for the pain, and send you on your way.

Another week goes by, and it is still not feeling any better. You decide to visit a chiropractor whom your husband saw in the past. The chiropractor does an initial examination and creates a treatment plan consisting of therapy three times per week for the next couple of weeks to try and improve your condition.

After those first few weeks, you are improving, and feeling about 50% better. In the meantime, you have informed your car insurance company that you are treating, and they told you that you have $30,000 in no-fault PIP insurance to cover related medical bills.

Your chiropractor reduces your treatments to two times per week for a couple of weeks. You still are seeing improvements, but the chiropractor recommends increasing the therapy again because he feels you have taken a step backward in your recovery somewhat after reducing treatments.

Shortly thereafter, you receive a letter from your insurance company informing you they are requiring you to attend an “Independent Medical Examination” (IME).

You visit the “IME” chiropractor, who writes a report essentially accusing you of lying about your condition and injuries. Apparently, the IME chiropractor believes you somehow should have magically improved in the first four weeks. He even says he didn’t think that you were injured in the first place since you didn’t report the injury at the scene and didn’t start treating for a week.

Your insurance company says they are no longer paying for your treatment, but you know that the treatment is working and only want to get better. You know you aren’t trying to game the system, and your doctor agrees. You wonder, can they get away with this?

Your Insurance Company’s Responsibility To You

First, let’s start with what the “duty of good faith and fair dealing” means. The North Dakota Supreme Court has recognized that we all buy insurance for peace of mind. Not only does the law require that we carry insurance, but we all worry how we would pay medical bills resulting from an accident, if we severely injure ourselves, one of our passengers, or someone else.

Because you pay a premium in exchange for insurance coverage, there is a contractual relationship that is formed, called a “first-party” relationship. In discharging its responsibilities under the insurance contract, the insurance company you have paid must act fairly and in good faith.

Back to the story: As was previously stated in There is Nothing “Independent” About An “Independent Medical Examination,” in the insurance contract, the insurance company has a right to request an IME. However, in your case, your own chiropractor read the IME report and wrote his own letter to the insurance company disputing all of the findings. He then had one of his colleagues conduct an examination of you and write an independent report, and you forwarded that to the insurance company. Both of those opinions were that you were injured in the accident, that the treatment was effective, and it should continue.

You think, ‘Ok my insurance company will definitely step up to the plate now because two chiropractors are reporting that the treatment is working and is necessary to fix my injuries from the accident.’ But in the meantime, you have stopped treating, because you can’t personally afford the treatment, and you are worried if your insurance doesn’t cover the treatments, you won’t be able to pay, especially since you have three kids!

Weeks go by, and you finally get a letter from the insurance company. You open it up, read the words, but can’t believe what they say. Your insurance company has decided to stick by their prior decision, and even state that their “Independent” report says you are not injured. Now what?

Breach Of Contract

One way to force the insurance company to pay for your continued treatment is to file an action for breach of contract. In that case, you would present evidence from your own doctor, possibly their colleague, and other experts in the field, to discuss how the treatment you have received and were scheduled to receive is related to the accident.

But you have no legal training and are overwhelmed by the thought of taking your insurance company to court. You are worried about hiring an attorney because you can’t even pay the medical bills, let alone a lawyer.

Finally, you come across this very blog article on the internet and set up a free consult with our team. We explain that the insurance company may not have only breached its contract with you, but may have done so in bad faith.

Bad Faith

In North Dakota, if an insurance company fails to act in good faith (acts unreasonably) in its relationship with policyholders, it may be subject to liability for damages caused by that breach. Well, what damages might that include?

While not an exhaustive list, damages include economic and non-economic. Economic damages include things such as attorney’s fees and costs for having to bring a lawsuit to make the insurance company abide by its obligation. But the bigger damage often is the non-economic damages associated with worry, distress, and mental anguish (to name a few). This relates to the fact that we all buy insurance for peace of mind. If you pay each month for insurance, you expect that the company will be there for you when you need it. If the company turns its back on you, you’ll lose sleep at night wondering if you will ever be able to afford to get better, or clear your good name (since they called you a liar), and worrying if other insurance companies will see the report of the IME doctor. You’ll also still have the general anxiety associated with not knowing what is going to happen next and your financial future since you can’t afford to pay for treatment on your own. Worst of all, this accident was not even your fault. You are the victim here in the first place, and the one company you paid to stick up for you, has now re-victimized you. Additionally, in some cases, the jury can award punitive damages to punish the insurance company for acting in bad faith against its own insured.

Unfortunately, this kind of conduct by an insurance company happens far too often. Clients often tell me they could never have imagined this was even going on in the insurance world. But it happens every day. Good people get abused by their insurance companies, and it is the classic David vs. Goliath scenario.

What You Can Do

I learned in grade school, there is only one way to fight a bully to make sure they don’t continue to bully others, stand up to them and fight back. Every day I meet with great folks who are victims of accidents, only to be taken advantage of by the one company they paid to protect them: their insurance company. They tell the same story, for the most part, are not litigious folks by nature, but know a wrong when they see one.

If you have been mistreated by your insurance company related to a claim, I would love to talk with you. My consultations are completely free, meaning you don’t pay me a dollar to discuss your case to see if something should be done. If you would like to schedule a free consultation with our Personal Injury Team, please call 701-297-2890 or send us an email below.