Bad faith? No Bad faith? Annoyed?August 26, 2019

Medical Care of W. N.Y. v Allstate Ins. Co., 2019 NY Slip Op 06243 (4th Dept. 2019)

Greater Buffalo Acc. & Injury Chiropractic, P.C. v Geico Cas. Co., 2019 NY Slip Op 06349 (4th Dept. 2019)

This one is hard for me to fathom. The provider appears to be upset at how claims were handled without giving concrete examples of how each case improperly handled. Furthermore and assuming the claims were not properly handled, what are the damages? A medical provider can never bill in excess of the fee schedule. Thus, any damages would be limited to the fee schedule amount of the billing. Of course, policy exhaustion would not apply in a bad faith scenario.

On a direct first-party wage case or UM case, you would be able to exceed the policy limits. But on a medical bill case, it is hard for a court to award unlimited damages to a medical provider when the law constricts their recovery to a given sum.

3 Responses

  1. slick says:

    As an academic matter, I love consequential damages aka bad faith claims. For a provider, the best theory for damages I have come up with is that the damages equal the interest that would have been due had an insurer not tolled the interest with a denial or verification issued in bad faith.

    • jtlawadmin says:

      The problem with your theory is that bad faith just removes the policy limit defense. So, you as a provider I suspect can freely treat a Claimant for life and get paid under a bad faith theory. Absent that, I do not see any other benefit for the provider. I know for an EIP, bad faith would mean the three year cap on wages is gone and the policy limit disappears. Alternatively, its ugly GBL 349 sister would accomplish the same thing. Under this scenario, a bad faith wage claim could be worth a lot more than the tort claim. And, with a 349, the specter of $450 an hour attorneys fees becomes real. But as you know, the carrier has to exhibit a certain level of recklessness to get to this point. And yet, it does exist.

  2. Raymond Zuppa says:

    Oh come on. prima facie tort for denial of benefits. not a yard stick here