Case Law Update – Bad Faith in Workers’ Compensation Claims

August 29, 2017 by on News

Carmen Urrea vs. Sedgwick Claims Management Services, (Case No. 010273-CA 01) 11th Circuit Court, Miami-Dade County, Feb. 13, 2017.

In Urrea, the Circuit court Dismissed Plaintiff’s Third Complaint with Prejudice which included claims for intentional infliction of emotional distress against the third party administrator of Plaintiff’s workers’ compensation claim. Plaintiff alleged the adjuster’s intentional and improper delay in the authorization of a recommended surgery was in bad faith and “outrageous,” and caused Plaintiff extreme anxiety and distress. The Defendant filed a Motion to Dismiss for failure to properly state a cause of action upon which relief can be granted. The Plaintiff filed 2 prior complaints for the same claim that were dismissed for failure to state a cause of action. The Court dismissed the Third Complaint, finding that even accepting all allegations as true, the facts alleged did not rise to the level of outrageousness necessary to sustain a claim for intentional infliction of emotional distress under Florida Law.

These types of claims are commonly known in the workers’ compensation industry as Aguilera claims, after its’ Florida Supreme court case namesake. Aguilera v. Inservices, Inc., 905 So. 2d 84 (Fla. 2005). In Aguilera, the Court held that the Florida’s workers’ compensation scheme does not immunize carriers from wrongdoing who use the process of administering benefits to intentionally injure a worker. Id. at 91. Opinions that followed establish that a mere delay is not an actionable tort simply by calling it outrageous, fraudulent, deceitful or an intentional infliction of emotional distress. Sheraton Key Largo v. Roca, 710 So. 2d 1016, 1017 (Fla. 3d DCA 1993). Based on the recent Urrea decision, it appears the courts are still maintaining a high burden for the allegations of such claims. Urrea also reminds us that carriers’ first, and at times most effective defense to these claims, are asserted on a Motion to Dismiss.

Boyd & Jenerette – Workers’ Compensation & Employment

Kelly M. Brannon, Associate

Kelly M. Brannon
Direct: 904.520.7803
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