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Doyle Sues Krogers and Sedgwick Claims Management For Worker’s Comp Bad Faith Following Unlawful Claims Processing Actions

Doyle LLP has filed suit against Krogers and Sedgwick Claims Management Services, Inc., (“Sedgwick”) and its assigned claims adjuster for defendants wrongful acts in handling plaintiff’s claim for an on-the-job injury.

Our client, a devoted and diligent employee of a store owned by Krogers, was in the process of lifting a 50 pound container of frozen bread when sharp lower back pain caused her to drop the box. Since the incident our client has been experiencing spinal pain that radiates through her thighs and calves.

Upon receiving plaintiff’s workers’ compensation claim, Sedgwick placed as adjuster in charge that ultimately caused a Notice of Claim Status form to be filed with the Industrial Commission of Arizona (ICA), Claims Division. This action resulted in the delay and denial of all medical and income benefits.

After Sedgwick’s Independent Medical Examiner (IME) concluded our client only suffered a minor strain, our client sought a second opinion through her private insurance which revealed a herniated disk and the need of surgery. Sedgwick responded by requiring our client see another IME but failed to provide the examiner complete medical records, including the EMG Study that showed a left side L-5 radiculopathy.  The IME premised his conclusions on the inadequate information and concluded the claim was not compensable.

Sedgwick violated its duty to address our client’s needs in “good faith and fair dealing” by doing all it could to delay and deny payment for treatment. Good faith requires worker’s compensation insurers accept undisputed evidence regarding a claim and not ignore or refuse to weigh information favorable to the insured. The claims adjuster is also liable for aiding and abetting as she substantially assisted Sedgwicks’ claim rejections, without any reasonable basis.

Even after the Industrial Commission of Arizona (ICA) ordered the payment of overdue benefits, Sedgwick refused to pay, forcing our client to go through the process twice. The insurer then limited treatment to only company physicians that would continue to deny surgery. Our client has yet to receive the needed medical treatment and the delay of benefits has caused severe economic distress, humiliation, worry, and continuing economic and physical damage.

For decades, the Worker’s Compensation Bad Faith Practice of Doyle LLP has forced insurers into compliance with the law and has restored to lives of many workers harmed by improper claims handling tactics. If you or someone you know has experienced similar treatment when attempting to obtain worker’s comp benefits, contact the attorneys of Doyle LLP, today.