Blog

A federal judge recently denied Hartford Ins. Co. of the Midwest’s (“Hartford”s) multiple summary judgment motions designed to dismiss plaintiff’s suit for its wrongful denial of compensation benefits.  Other defendants include Gallagher Bassett (“Gallagher”) – Hartford’s third-party claims handler, and Gallagher’s claim representative assigned to plaintiff’s case file.

Our client, a customer service representative for Stanley Steemer, tripped and fell on a set of stairs leading to her workstation within the company’s call center on January, 9, 2012. Our client injured her knees, hip, and twisted her back in the incident. After being assisted to her feet from a co-worker, she reported the injury to her supervisor who initiated a work injury report.

The following day, an examination from a nurse practitioner prescribed a week of work restrictions due to an inability for our client to sit at a desk, walk up stairs, or stand for long periods due to worsening pain. February 6, the nurse practitioner concluded our client should remain off work. This nurse then referred plaintiff to a pain clinic for further assistance, but this visit was denied by the claims adjuster who said she “didn’t believe this would benefit the employee.”

In violation of defendants’ duty to handle claims “in good faith and fair dealing,” the adjuster denied disability benefits claiming there was a “lack of documentation,” though she never asked the nurse for her findings or sought evidence to support our client’s position. Benefits were rejected though  the insurance company’s own medical examiner agreed to the suggested work restrictions. The duty of “good faith” requires a worker’s compensation insurer accept undisputed evidence and only provide denials if there is a reasonable basis or adequate investigation performed.

Within Hartford’s motions for summary judgment it sought to remove the claims processor who was charged with aiding the insurer’s unlawful actions.The Court denied this motion finding that an agent is not excused from liability when he or she assists the insurer in violating its good faith obligation.

Hartford also argued plaintiff’s punitive damage claim lacked the requisite evidence of defendants acting with ill intent or conscious disregard of the risks plaintiff was exposed to. The federal judge denied this motion and found the totality of evidence paints the picture of defendants doing all they could to avoid providing benefits while only looking to satisfy its own interests.

Given the repeated delays of payment, our client has been subjected to significant economic impact, humiliation, worry, distress, and continuing economic and physical damage. The Worker’s Compensation Attorneys of Doyle LLP have great experience in this arenaand will aggressively represent each of this client’s grievances.