In this case, an injured worker sought penalties for an insurance company’s unreasonable actions in closing a claim. The case involved a carpal tunnel syndrome and a degenerative condition of the wrist, and the injured worker argued that when the claim was closed, it improperly considered other medical conditions, not just the accepted medical condition.
In reviewing the request for penalties, the Board found that claim closure was not unreasonable. The Board explained that in order for a penalty to issue, there must be a claim closure or a refusal to close the claim, the issue of whether the closure was cracked must be raised at hearing, and there must be a finding that the closure or the refusal to close the claim was unreasonable.
In determining whether an insurance company was unreasonable, the Board only looks at what the carrier knew about when it closed claim. Otherwise, it would be unfair to find that an insurance company was unreasonable for something it did not even know about at the time it closed the claim. The Board found that because the insurance company requested additional information after a Reconsideration Order had been issued, the insurance company was not unreasonable in the way it closed the claim.
Penalties in workers’ compensation claims present special challenges. This is because the term “unreasonable” has special meaning. It is almost misleading, because from an injured worker’s perspective, insurance carriers are unreasonable on a regular basis. However, the rules and statutes will give the insurance company the benefit of the doubt in many instances, and pursuit of penalties requires a detailed knowledge of the rules, as well as the facts of each case.
If you have a workers’ compensation claim, and you feel that the insurance company is acting unreasonably, call us at 503-325-8600. We can review your claim file, and let you know whether you have a valid claim for penalties, or some other basic benefits.