Worker Denied Insurance Benefits After Sustaining Traumatic Brain Injury
WORKER DENIED INSURANCE BENEFITS AFTER SUSTAINING TRAUMATIC BRAIN INJURY
While working as a Residential Carpenter for TK Brooks Contracting, Doyle Dennis Avery LLP’s client fell approximately fourteen feet from a ladder and sustained a traumatic brain injury. He was then placed in an induced coma and spent four months in the hospital. Due to the severity of his traumatic brain injury, he permanently requires care 24-hours per day.
Arizona law provides that an industrially-injured claimant is entitled to receive compensation for all “medical, surgical[,] and hospital benefits or other treatment, nursing, [etc.] reasonably required at the time of the injury, and during the period of disability.” Sometimes, an injured worker’s family member may be the one providing the home health aide services, including bathing, dressing, performing home exercises, and monitoring the worker’s activities. In those situations, the family member is entitled to compensation for rendering the services in lieu of a third-party caregiver.
After Doyle Dennis Avery LLP’s client was injured, his family was informed that he would need help walking around, getting dressed, and with other daily life activities. Because of the severity of his traumatic brain injury, his Board-certified neurologist determined he cannot be left alone, needs a caregiver to supervise and monitor his activities, and needs a caregiver to be with him to make sure he does not wander away or cause harm to himself.
The Residential Carpenter sought workers’ compensation benefits, including compensation for his wife for the home health and supportive services she provided him. In February 2021, the Industrial Commission of Arizona ordered the workers’ compensation insurance carrier (Carolina Casualty Insurance Company) to pay the long overdue benefits. But still, Carolina Casualty Insurance Company and its third-party administrator, Berkley Net Underwriters, LLC, disputed the amount the Residential Carpenter and his wife were entitled to. Thirteen months later, the Industrial Commission of Arizona correctly determined that Doyle Dennis Avery ’ clients should be compensated at $12.50 per hour for 7 days per week because the Residential Carpenter’s wife assists her husband 49 hours per week. However, the wrongful conduct did not stop there. Even though the insurance carrier and third-party administrator were ordered to pay, they continued disputing the benefits owed.
On March 10, 2022, Doyle Dennis Avery LLP filed suit in Arizona federal court against Carolina Casualty Insurance Company, Berkley Net Underwriters, LLC, and the insurance adjuster. The bad faith insurance lawsuit alleges that the defendants breached the duty of good faith and fair dealing and aided and abetted the breach. Arizona law prohibits insurance carriers and third-party administrators from denying workers’ compensation insurance benefits without conducting an adequate investigation. If your workers’ compensation benefits were unjustifiably denied, call us for a free evaluation of your case.