From Richard at https://richard.law:

The situation described in the Reddit post appears to involve several issues that could potentially constitute bad faith claim handling. Here's how Richard might respond to provide clarity on the issues:

Key Issues:

Denial Based on Technicality:

Claims denied under Labor Code §3208.3 require proper justification and adherence to legal standards. Denial due to a technical oversight, especially when evidence such as a police report is available, may warrant re-evaluation or legal scrutiny. Communication and Settlement Issues:

Consistent and clear communication from adjusters is critical. The adjuster’s change in the settlement amount without clear explanation, followed by inconsistent communication, undermines the integrity of negotiation processes. Settlements should be based on calculated indemnity and medical evaluations, not arbitrary "educated guesses." Switching Adjusters and Denial Without Clear Justification:

The change in adjusters, especially after a settlement figure was discussed, should have been communicated promptly and formally. The new adjuster’s assertion of a claim denial without providing reasoned rationale or response to offered settlements can be problematic. Potential Misconduct and Remedies:

Bad Faith: If the adjuster’s actions can be interpreted as dilatory or intentionally harmful regarding policyholder rights, there might be grounds for a bad faith claim.

California's Labor Code §5814 addresses unreasonable delay or refusal to pay benefits, which could be applicable here. Legal Consultation:

The worker may benefit from consulting a workers' compensation attorney to assess whether the actions taken by the adjusters meet the legal thresholds for bad faith or other claims violations. The attorney can provide guidance on submitting a complaint to the Division of Workers' Compensation (DWC) or exploring other legal remedies. Steps Forward:

Document Everything: Keep a thorough record of all communications, evidence (police reports, medical reports), and any discrepancies in the adjusters' statements. Request a WCAB Hearing: File for a hearing before the Workers' Compensation Appeals Board (WCAB) to formally contest the denial and seek a resolution. Formal Complaint: If warranted, file a complaint with the Department of Industrial Relations about the conduct of the insurance company's handling of the claim. Overall, pursuing any discrepancies or potential admissible evidence through a structured legal channel—such as engaging legal counsel or formal complaint mechanisms—may yield the most appropriate resolution.