Any options when the claim administrator not complying with medical care

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Any options when the claim administrator not complying with medical care

We are located in Sacramento California. I am researching on behalf of my brother as it’s his case. Essentially him and the Hartford insurance company agreed to a settlement where the Hartford agreed to provide him lifetime medical support for his injury. He has been going to all his appointments, check-ups, fully compiling on his end. The Hartford is denying him a surgery that his workman comp doctor says he desperately needs. They requested 2nd and 3rd opinions and all say the same thing he needs surgery and medical evidence to support it. The issue is the company is denying his surgery, other treatments and medications for pain. Is it possible to either reopen the case or sue in a new case because they are not complying with the court ordered medical care he was approved for?

Asked on July 9, 2019 under Personal Injury, California

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 1 year ago | Contributor

You write that your brother and the insurer "agreed to a settlement": that means there must be an actual settlement agreement, which is a contract and therefore which is enforceable. If your brother believes that the other side is violating the terms of the agreement, by not paying for treatment which under the plain language of the settlement they should, he could sue them for "breach of contract" to force them to pay.


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