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Fine Upheld against Employer who Cut Benefits with No Investigation
[06/05/09]


An employer that failed to properly investigate a claim before terminating benefits must pay $4,000 in penalties and $8,000 in attorney fees, despite the claimant's history of back problems, sketchy work history and “litigious” background, the Louisiana Court of Appeal, Third Circuit ruled.

Case: Anderson v. Best Western Suites Hotels, No. 09-78, 06/03/2009.

Facts: Jerry Anderson filed a workers' compensation claim after he was struck in the back by the door of a freight elevator, claiming he had injured his back. Anderson had a history of back problems, but he said his symptoms were different and more extreme that those exhibited before the elevator accident. The employer's insurance company, which is not identified in the record, denied benefits and refused Anderson's request to see a physician of his choice. Procedural: A workers' compensation judge awarded indemnity benefits, penalties and attorney fees and ordered that Anderson be allowed to see his choice of physician. The employer appealed.

Analysis: In its majority opinion, the Third Circuit appellate court borrowed from the workers' compensation judge's findings to support its decision. The judge said: “Mr. Anderson has an imperfect past. He has a litigious enough background to lift any reasonable gentleman's eyebrow. But flatly denying medical treatment requires a lot more than that, a whole lot more. When an employee gets jammed between an elevator gate and the door when the elevator is improperly moved by a fellow employee, the fact that the injured worker who is struck in this situation has a history of back problem is of little moment.” The judge also noted that the claims adjuster who handled Anderson's claim did not appear to conduct any investigation before cutting off benefits and did not testify during the hearing.

Disposition: The appellate court affirmed the judge's decision to award benefits, $8,000 in attorney fees, a $2,000 penalty for improper termination of benefits and a $2,000 penalty for failing to allow the claimant to see his choice of physician.

Source: WorkCompCentral

 

 

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