Sedgwick Claims Management, one of the country’s largest workers compensation claims adjustment companies, can be liable under RICO for fraudulent deprivation of workers compensation benefits the Sixth Circuit has ruled in Jackson v. Sedgwick Claims Management Services, No 10-1453 (November 2, 2012). This case is the latest in a series of cases originating in Michigan in which the Sixth Circuit has ruled that injured workers may sue under RICO employers, claims adjusters and doctors that fraudulently deprive them of workers compensation benefits. Earlier posts have discussed these decisions: Damages Recoverable under RICO for Fraudulent Deprivation of Workers Compensation Benefits; A Claim for Workers Compensation Benefits Is Property Under RICO, Sixth Circuit Rules; and Injured Workers May Sue Under Racketeering Law Based On Scheme To Deny Them Workers Compensation Benefits.
Clifton Jackson was employed by Coca-Cola when he injured his back while at work. His treating doctor concluded that he was disabled. Sedgwick then requested that Jackson be examined by a Dr. Terry Weingarten, who Sedgwick paid and who also concluded that Jackson was disabled. Sedgwick wasn’t satisfied so it had Jackson examined again by Dr. Weingarten, who again concluded that Jackson was disabled. After these three examinations and conclusions that Jackson was disabled, Sedgwick again had Jackson examined this time by Dr. Paul Drouillard, who reported that Jackson was not disabled. Dr. Drouillard mailed a report alleged to contain three statements by Jackson regarding his pain that Jackson claims never to have made and conclusions regarding Jackson’s injury “wholly unsupported by the medical evidence.” And so Sedgwick terminated Jackson’s workers compensation benefits.
Here are the racketeering acts identified by the Sixth Circuit:
- Dr.
Drouillard’s evaluations were not objective medical reports and were
allegedly fraudulently slanted to beat Jackson and others out of workers
compensation benefits
- Personnel
in Coca-Cola’s workers compensation department worked with Sedgwick
falsely to administer the claims by Coca-Cola employees
- Coca-Cola routinely used and relied on the false medical reports of doctors such as Dr. Drouillard fraudulently to terminate benefits and regularly communicated with Sedgwick concerning the desires of both to obtain a false medical report so that workers compensation benefits could be cut off
- Coca-Cola
and others then misrepresented to injured workers through use of the mails
that the doctors were independent
These cases do not strike a new theme. Read this report in
the New York Times: "That's the game, baby" Explains Workers'
Compensation Insurance Company Expert Witness.
Robert L. Abell
www.RobertAbellLaw.com
