According to Business Insurance, the court threw out a lower court ruling in Nancy R. Summers vs. Zurich American Insurance Co. and asserted that Summers could move forward with claims against the insurer over its decision not to authorize procedures ordered by the state Workers’ Compensation Court.
The Supreme Court ruled a benefit claimant had the prerogative to go to court if an insurer such as Zurich declined to authorize treatment procedures. The high court also ruled that the lower court judge had erred in sending Summers back to a post-judgment certification process because, the high court said, there was confusion over the exact role the procedure played in the overall benefits consideration.
According to the opinion, the Workers’ Compensation Court had awarded medical and wage benefits to Summers for a 2004 work-related injury. However Zurich declined the treatment authorization request and Summers sued.
The lower court ruled Summers did not follow the certification procedure that allows insurers to show why benefits remain unpaid.
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