Ninth Circuit Denies York Risk’s Effort To Withhold Documents Evidencing The Company’s Fraudulent Claims Processing Actions

Jeffrey Raizner

The Ninth Circuit Court of Appeals today rejected York Risk Services’ (“York”) attempts to conceal disclosure of internal documents regarding the wrongful denial of workers’ compensation benefits owed to 10 City of Phoenix firefighters and a member of the Phoenix police department.  The decision is a major development in the RICO and Bad Faith case filed by the Plaintiffs because it ensures that York’s wrongful claim handling practices will be brought to light.

On September 3, 2014, Judge John W. Sedwick of the United States District Court for the District of Arizona found that York was not entitled to withhold from production various communications York and its adjusters had with attorneys retained by York to assist in the handling and denial of the Plaintiffs’ claims.  The Court found that York was not allowed to claim that its actions were reasonable, while at the same time refusing to produce communications with York’s attorneys that may be used to establish that the adjusters’ actions were in bad faith.

York attempted to reverse Judge Sedgwick’s order by appealing to the 9th Circuit.  The 9th Circuit summarily rejected York’s appeal on October 29, 2014 holding that York had not “demonstrated that this case warrants the intervention of this court.”

The experienced worker’s compensation lawyers of Doyle Raizner LLP will proudly continue fighting for these 11 emergency responders and their families. Our worker’s compensation bad faith team has a record of success in fighting against insurance company and third-party administrators who place profits over individuals and their medical needs. If you or someone you love has experienced bad faith tactics in their Arizona worker’s compensation claim, contact our firm immediately.

 

Congratulations To Attorneys Jeff Raizner and Mike Doyle For Best Lawyer Awards!

Jeffrey Raizner

Doyle Raizner LLP proudly recognizes founding partners Jeff Raizner and Mike Doyle upon receiving recognition from the most respected peer-review publications in the legal profession. Best Lawyers awarded Attorney Jeff Raizner Best Attorney in Texas for this year and Best Lawyers of America awarded Attorney Mike Doyle in the practice areas of Admiralty and Maritime Law, Plaintiff Personal Injury Litigation, and Transportation Law.

Both publications are known for their credibility as lists are compiled by conducting exhaustive surveys in which tens of thousands of leading lawyers evaluate their professional peers. Nominations are combined with third party research and and weighed against the attorney’s professional achievement for that year.

 

Doyle Raizner LLP Carves Paths Of Relief Against Insurers and TPA’s For Worker’s Compensation Bad Faith Actions in Arizona

Jeffrey Raizner

The JDSupra Business Advisor released an article highlighting the legal theories our attorneys’ designed to hold both a worker’s compensation insurer and its Third Party Administrator (“TPA”) liable for improper claims processions actions. In growing fashion, insurance companies “outsource” claims processing to TPAs in order to underwrite risks but still benefit from a TPA’s profit-driven tactics. In turn, the TPA escapes liability because it  doesn’t enter into a contractual agreement within the policyholder; but times are changing.

Our client, a customer service representative for Stanley Steemer, fell in a staircase leading to her desk, injuring her knees, hip, and twisting her back. A nurse practitioner later provided a knee brace and issued work restrictions.  The nurse practitioner found that, due to worsening pain, this plaintiff was unable to sit at a desk, walk up stairs or stand for long periods.

Through Hartford is Stanley Steemer’sworker’s comp insurer, the company contracted a TPA, Gallagher Bassett (“Gallagher”), to handle the claim. Gallagher’s assigned claims handler began eviscerating the claim. The handler interviewed our client and without speaking to the nurse practitioner concluded the work restrictions listed were “unreasonable.”

This adjuster then denied the nurse’s request that our client visit a pain clinic,  and instead hired a private investigator so she could “utilize the results to push for a light duty work release.” She also demanded our client see the insurance company’s medical examiner, but this examiner validated the nurse’s findings. Given the repeated delays of payment, our client has been subjected to significant economic impact, humiliation, worry, distress, and continuing physical damage.

The article discusses our causes of action which were against Hartford’s for breaching its good faith duty to process our client’s claims fairly and equitably, and against Gallagher for aiding and abetting the insurer’s breach. The Arizona federal court agreed with our argument that “the unlawful tactics of a TPA may be imputed to the insurer since good faith is

Doyle Raizner Sues Indemnity Insurance and Gallagher Bassett for Insurance Bad Faith In Arizona

Jeffrey Raizner

Doyle Raizner LLP has initiated suit against Indemnity Insurance  (“Indemnity”), Gallagher Bassett Claims, Inc. (“Gallagher”), and the assigned claims adjuster for defendants combined efforts in wrongfully processing plaintiff’s claim for workers’ compensation benefits following his at-work injury.

 

Plaintiff, a hardworking driver for Waste Management Inc., was carrying a heavy hose to and from sanitation sites when he suffered a crushing injury to his right hand. He continued working as pain radiated through his hand, shoulder, and back. The strenuous routine of handling the hose later caused spinal pain forcing him to report his extent of injuries.

 

Upon receiving our clients claim for workers’ compensation, Indemnity and Gallagher placed an adjuster over the case that performed an unreasonable investigation and caused a Notice of Claim Status form to be filed with the Industrial Commission of Arizona (ICA) –  which directly denied our client all benefits.

 

Our client sought a medical examination through his own insurance due to continuing spinal pain along with right arm numbness that continued into his hand. Internal medicine physician Dr. John Post recommended Maricopa Integrated Health Systems perform an MRI which later revealed large disc herniations and severe cord deformity.

 

The defendants violated the duty to process our client’s claim “in good faith and fair dealing” by ignoring Maricopa’s medical documentation which found our client’s industrial at-work accident now required surgical intervention. With no other option, the plaintiff underwent fusion surgery through use of his own insurance and retained an attorney to continue the fight for wage and medical compensation.

 

A proceeding before the ICA finally secured long overdue benefits from Indemnity, but the defendants continued to withhold funds. The extensive delay and denial of assistance has caused this client continuing mental and financial distress, along with permanent disfigurement due defendant’s refusal to provide rehabilitation therapy. Our client has also been sued by a collection agency for surgery bills after the adjuster

Doyle Raizner Sues Truesdell Corporation and Salt River Project For Breaches In Safety That Lead To Plaintiff’s Injuries At The Horse Mesa Dam in Arizona

Jeffrey Raizner

Doyle Raizner LLP has filed suit against Truesdell Corporation (“Truesdell”) and Salt River Project Agricultural Improvement And Power District (“SRP”) for negligent acts and omissions  during reconstruction to portions of the Horse Mesa dam.

 

Our client was an employee of Safway, a subcontractor assigned to construct system scaffolding between a exterior staircase and elevator at the third floor of the  dam. In an effort to complete the task our client attached his personal fall arrest system (PFAS) to the handrail of the maintenance platform of the elevator to satisfy the 100% tie-off requirement because he was not provided rappel gear or safety equipment such as lifelines. In addition, a  protective safety net did not sufficiently cover the area below where he was suspended.

 

While attached to the elevator more than four stories in the air, an unauthorized user called the elevator to the ground floor. Unfortunately, SRP and Truesdell did not have an “authorized-personnel only” sign at the elevator call station and also did not maintain lock out/ tag out procedures. Our client began yelling for an immediate shut-off of the elevator, but the call station did not contain emergency shut-off devices.

 

The force of the elevator slammed our client into the safety cage of the elevator, then over the top of the cage. As the force continued to pull him down the face of the dam, he repeatedly slammed into the elevator and staircase before the handrail snapped and our client was left suspended in mid-air until co-workers reached him and provided medical care.

 

Our client suffered six broken ribs,  three spinal fractures, tore his right meniscus and MCL, endured 25% tears in him forearm, lateral tears in his shoulder and  also punctured his skull.  Even after anticipated surgeries have been performed, physicians believe our client will not be able to return to scaffolding.

 

Because SRP is the owner and operator of the dam,

The Division of Texas Workers’ Compensation Has Not Been Charting The Race Of Applicants As Required

Jeffrey Raizner

The Texas Tribune recently released an article inquiring into what could be systematic discrimination from insurance companies against minorities attempting to obtain workers’ compensation benefits.

The article focuses on a case handled by an Austin Lawyer who became convinced his client was treated unjustly due to the color of his skin. This caused the lawyer to wonder about the many African American and Hispanic workers seeking legal assistance and their rate of receiving assistance. The reply he received from the Texas Division of Workers’ Compensation was disheartening and provided no real answer.

Though a 1993 law requires the Texas Worker’s Comp agency to maintain information of the race and gender of every valid claim, it has failed to comply. The department responded to the inquiry stating; “Please note that race and ethnicity are rarely reported and, as discussed, [are] inaccurate and incomplete. Therefore, these numbers cannot be extrapolated for analysis.” The agency further says it does maintain records of the workers that report their race, though it’s a small percentage.

The article provides that this news prompted State Rep. René Oliveira, the Brownsville Democrat overseeing the agency as chairman of the House Business & Industry Committee, to press for immediate collection of this data. Rep. Oliveira also notes, “This is the second time in recent months that the department has not complied with its legal duties.”

The Division of Workers’ Compensation can’t claim charting this information is too daunting a task as records indicate the majority of claims were successfully tracked and included race data when the requirement was set in place in the early 1990’s. Today, some claims don’t have fields so a worker may provide it.

But why is charting race important? The article states that the U.S. Bureau of Labor Statistics found Hispanics have a greater chance of dying compared to other workers. Foreign workers  not fluent in English or familiar with American safety regulations are also

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

Jeffrey Raizner

Doyle Raizner 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

Judge Denies Hartford Ins. Co.’s Attempts to Escape Responsibility after Delaying Worker’s Compensation Benefits to Injured Worker

Jeffrey Raizner

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

Doyle Raizner Obtains Verdict For Commercial Plaintiff Harmed By American Family Mutual’s Improper Claims Processing Actions Following Arizona Hailstorm

Jeffrey Raizner

The massive October 5, 2010, Arizona hailstorm spawned significant damage to consumers and business owners across Maricopa County, as well as jury verdicts against those insurance companies that refused to live up to their promises to timely and properly pay for the full amount of damages sustained by their insureds.  American Family Mutual Insurance Company (“American Family”), one of the largest property insurers in Arizona and across the western United States, was recently unanimously found guilty by a federal jury in Phoenix of breaching its contract for full replacement coverage of our client’s commercial office building in the Scottsdale Airpark business park owned after undervaluing the damage by over $210,000.  The jury’s verdict confirmed that American Family’s adjusters at Pacesetter, as well as its home office adjusters and managers, undervalued the damage caused by the wind, hail, and rain to our client’s property by insisting that no more than $30,000 worth of damage to the building’s roof, windows, and exterior was sustained in the storm, despite overwhelming evidence of much more significant losses.

Our client depended on American Family to keep its promises to provide full replacement coverage in return for the premiums paid.  The storm caused roof damage that led to serious leaking inside the building that began on the date of the storm and continued with every significant rain thereafter, resulting in ongoing interior damage.  The storm also caused leaking through windows, marred the building’s exterior and damaged the carports.  The building’s air conditioning (HVAC) units also required  replacement after the storm, and American Family refused to pay for more than minor repairs.  The evidence at trial confirmed that American Family’s initial adjuster spent less than 90 minutes at the property before issuing his evaluation, and refused every effort to secure a more thorough and comprehensive evaluation of the impact on the  property.

The jury found that American Family breached its contract with our client and that as

Supreme Court May Take Up The Jones Act Again

Jeffrey Raizner

The Jones Act is an extremely important law for anyone who works on the sea. It allows people who work as seamen and are injured on the job to have a trial by jury to sue for damages. It’s very similar to the same rights that railroad workers have. However, not everyone that works on the sea is classified as a seaman by the law.

According to a Supreme Court decision in 1995, a worker has to be out on the sea more than 30% of the time to be classified as a seaman. This means that many people who work on the docks and face many of the same dangers do not get the benefits of the Jones Act.

This issue may be taken up again by the Supreme Court soon. In 2008, a worker sued his employer after getting silicosis from sandblasting vessels. The fine sand got into his lungs and caused him to lose his job. His employer claimed that he didn’t qualify for Jones Act protections since he spent most of his time on the docks. In 2012, the worker died and his widow is now trying to take the case to the Supreme Court.

The worker did spend time out on the sea. When he wasn’t doing dock duties, he was taking pilots out to commercial vessels so local pilots could drive the boats out of Chesapeake Bay. The question is whether his boat maintenance work counts as being out on the sea.

Courts around the country are split about whether dock work counts as being out on the sea for the purposes of the Jones Act. The justices are scheduled to discuss whether to take the case or not. Resolving this issue in favor of the workers could open many companies to lawsuits.

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