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Man who suffered mental breakdown can sue comp claims handlers


A man who was injured in an explosion at a building materials and equipment company and suffered a multitude of injuries including post-traumatic stress disorder can sue those who handled his workers compensation claim on allegations they ignored his mental injury, an appeals court in Alabama ruled Friday.

Reversing and remanding back to lower court, which dismissed in entirety No. 2180336 on the grounds that the injured worker could not back his tort claim alleging conspiracy and fraud, among other allegations, and that he needed to comply with the state’s workers compensation statutes on medical care, the Court of Civil Appeals of Alabama ruled that the case could have merit, according to documents filed in Montgomery, Alabama.

The worker, who was injured in 2017 when a large electrical circuit at a property operated by Imerys USA Inc., was connected with a nurse case manager working for one of the defendants,  Coventry Health Care Workers’ Compensation Inc., who was hired by defendants AIG Claims Inc. and The Insurance Co. of the State of Pennsylvania to manage the claim.

The nurse case manager, also named a defendant, allegedly told the worker she would handle his claim and “would handle making all of his necessary doctor appointments, and would generally make sure he received the care he needed to treat his work-related injuries,” according to the complaint, which also states that the nurse informed the man that “she was working on his behalf and not the insurance company's or his employer's behalf.”

The man was seen by a doctor for his physical injuries and was referred to specialists for other injuries, not including his mental injury, according to records that state the doctor ordered him back to work with restrictions.

The worker “contends that he was unable to do anything at work other than sit in a chair throughout the workday and that his working conditions exacerbated his mental-health issues” and that he “became concerned that he was not receiving the treatment he needed, and (in early 2018 he) retained legal counsel to assist him with his workers' compensation claim.”

The lawyer “began sending letters and e-mails to the defendants with increasing urgency regarding (the worker’s) mental and emotional state and requesting that (the man) be seen by a neurologist or a neuropsychologist. The defendants were informed that (he) was suffering from obvious symptoms of PTSD, was under extreme distress, and was in need of treatment,” documents state.

One month later, the man was referred by the defendants to a neurologist, who one month after that referral examined him and “determined that he required treatment by a psychiatrist or a neuropsychiatrist.”

The worker’s lawyer “made numerous attempts to secure approval from the defendants for the referral made by the neurologist by means of telephone and electronic correspondence, but his calls and e-mails were met with no response from the defendants.” The lawyer “informed the defendants in telephone messages and e-mails that (the man) was suffering and urgently needed psychiatric or neuropsychiatric care,” documents state.

In May 2018, he was seen again by the first physician who “despite being informed (by the worker) of his continuing symptoms and the neurologist's determination that (he) required psychiatric or neuropsychiatric treatment” the doctor placed the worker at maximum medical improvement and sent him back to work without restrictions.

That same day, “and allegedly as a result of the defendants' and (the doctor’s) actions,” the worker suffered a mental breakdown and was treated at the emergency department of a local hospital, where he was admitted to the behavioral health-care unit and treated for nine days. The worker alleges that he is now required to see a psychiatric specialist on an outpatient basis and that medical professionals have directed him not to return to work, according to documents.

In filing his lawsuit, the worker “alleges that his mental breakdown and his ongoing need to receive specialized psychiatric treatment is the result of the defendants' handling of his workers' compensation claim” and “contends that the defendants, by their conduct, are guilty of the intentional infliction of emotional distress or, as it is commonly referred to in our caselaw, the tort of outrage.”

He is also accusing the defendants of fraud relating to the nurse case manager who allegedly told him that she was “working on his behalf” when she was hired to serve the insurance companies.  

In reversing the dismissal, the appeal court judge wrote “(b)ecause I believe that (the worker) did allege sufficient facts to sustain his tort-of-outrage and fraud claims, I agree that the judgments should be reversed to allow (the worker) to proceed with a claim of civil conspiracy.”

The attorneys and companies involved could not immediately be reached for comment. 






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