My Fiance has his own construction company. He was asked to help another contractor (who was licensed and insured) to complete putting on a metal roof of a church. He fell off the church and landed on his fee,t but it broke his tendons and tibial plateau bone in his knee.
He finally got surgery 6 months after the incident, to reattach the tendons. He is still waiting 2 1/2 years now on the surgery for the broken knee cap. He got MRSA and Staff infections from his surgery, which caused a bone infection in his knee.
They have been paying him weekly $400, which is 60% less than what he used to make if he was working. He still kept his company going, with the crew working (from his own company, prior to working for another contractor).
The only thing he can do is drive the truck to the job sites and do bids. He can’t get on a ladder or pick up a hammer now, because he contracted Rheumatoid Arthritis in the highest degree. He is on Humira for this now.
The insurance company has now stopped paying him his weekly checks, stating he can work if he can drive to and from a job site or do bids. And now they want him to pay them back a percentage of what they paid him.
If he owned his company prior to working for another contractor to complete the job, then why can’t he still keep his company rolling? He has a crew and customers who depend on him to come back yearly do do work as he has done before.
If you were working for a contractor who has insurance, and get hurt on the job, doesn’t the insurance company need to keep paying you until you can get back to doing the same work you used to do? Like get on a ladder? A roof? Pick up a hammer?
He is paying 2 people to do the work he used to do, just to keep the company going. He isn’t making anything on this. He was just surviving on what the insurance company was paying him. What can he do? Thank you.
Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.
Read the insurance policy. If you don’t have it, contact the insurance company and ask for a copy. Go through it carefully and review the section(s) related to payments when the insured is unable to work. If the policy concludes the insurance company has a right to cease payments at a certain time, and/or the right to reimbursement for payments made, then make sure you understand the contingencies.
If, after reviewing the policy, you are confused (and that’s altogether possible as policies are written by attorneys in attorney language), then you should seek the advice and counsel of a local attorney.
There is a legal theory called “bad faith denial of a claim.” This means if an insurance company willfully, maliciously, or recklessly denies a rightful claim, they are subject to court-imposed damages. Those damages can be substantial, as juries are normally permitted to render verdicts in just about any amount they feel is appropriate.
Few people like insurance companies. You can be confident if the case goes to trial and bad faith is a proved, the jury will not be pleased, and will reflect their displeasure in a substantial verdict in your husband’s favor.
Learn more here: Denied Workers' Comp? What to Do
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.
Best of luck with your claim,
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