I was injured at work, work comp claim going on for more than 3 years, in the mean time I got diagnosed with critical illness which has nothing to do with my work related injury, now that I am trying to settle this case with lump sum, work comp insurance declining to pay assuming my life acpectance is short and i die and i don't need the money for my surgory. can i sue the insurance company for assult. No one knows if I am dying in a specific time, I have no plug to unplug it and die. is this a law to assume i might die in a few years that's why they don't want to pay for my work related injury and i am permanent disable due to the injuries.
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1 Answer from Attorneys
Can you sue the Insurance Company for 'assault'? Nope. Assault requires fear of an imminent battery (unwelcome touching) and nobody's touching you.
Is this a law to assume I might die in a few years? nope. But there IS a law that the insurer is only required to pay for medical treatment 'reasonably necessary to relieve the effects of an industrial injury.'
NOTHING IN THE CALIFORNIA LABOR CODE requires any insurer to pay you in advance for medical care you might need in the future... it only requires they pay for it when a physician requests the treatment and the treatment is found to be 'reasonably necessary.'
THE WORST MISTAKE YOU MADE was letting an insurance adjuster know you had a terminal illness. But we can't 'unring' the bell. The damage is done, just let all other injured workers out there know, never EVER tell an insurance company you can't get an approved procedure due to a terminal illness...or that insurer will never pay for that procedure until the person is in front of the judge with a doctor's demand to authorize the surgery immediately.
A STRATEGY; start treating LIKE CRAZY instead of surgery, get tons of acupuncture and chiropractic bills piling up on the adjuster's desk. Tell the adjuster you are in remission and actively treating the work injury so you can rush back to work.
IF THE ADJUSTER is getting requests for Chiropractic Therapy and Acunpuncture and Pain Patches and canes and support belts and perscription medicine, they will prefer to pay you some cash to get rid of you and stop those irritating bills and 'requests for authorization'.
If you just stay home on the phone and beg in phone messages, you'll get zero up front for your future medical.