On October 18, 2019, the Alabama Court of Civil Appeals released an opinion holding that Plaintiff Orethaniel Swain’s (“Plaintiff”) outrage, fraud and conspiracy claims against Defendants AIG Claims, Inc., Insurance Company of the State of Pennsylvania, Coventry Health Care Workers’ Compensation, Inc. and Jackie Angeles (“Defendants”), based on the handling of his worker’s compensation claim were not barred by the exclusive remedy provisions of Ala. Code § 25-5-53 and stated a valid claim. Swain v. AIG Claims, Inc., 2019 WL 5284748, at *10 (Ala.Civ.App. 2019).
On December 11, 2017, Plaintiff allegedly suffered physical and mental injuries in the line and scope of his employment with Imerys USA, Inc. when a large electrical circuit breaker exploded. Plaintiff was initially provided treatment by an authorized treating physician, Dr. Bruce Romeo, and Ms. Angeles was assigned as his nurse case manager. Dr. Romeo treated Plaintiff’s respiratory injuries and referred him to an eye doctor, but allegedly did not treat injuries to Plaintiff’s head, neck, back and pelvis. Dr. Romeo also did not refer Plaintiff for psychological treatment for his reported anxiety and post-traumatic stress disorder (“PTSD”). In February 2018, Plaintiff hired an attorney who contacted the Defendants requesting that Plaintiff be provided psychological treatment. Plaintiff was evaluated by a neurologist on April 24, 2018 who determined Plaintiff required treatment with a psychiatrist. However, Defendants did not provide Plaintiff psychiatric treatment despite several requests.
On May 21, 2018, Dr. Romeo released Plaintiff to return to work without restrictions and placed him at maximum medical improvement (“MMI”), despite knowledge of his psychological condition. On the same day, Plaintiff suffered a “mental breakdown”, which he attributed to the denial of psychological treatment and was admitted to a local hospital’s behavioral health unit where he remained for nine days.
Plaintiff filed suit against Defendants alleging that the denial of medical and psychiatric treatment amounted to outrage and that Ms. Angeles and the other Defendants fraudulently told him they would obtain the medical care Plaintiff required for his injuries. Plaintiff also alleged Defendants conspired amongst themselves, and with Dr. Romeo, to deny Plaintiff the medical and psychiatric care he needed in order to save money. Defendants moved to dismiss Plaintiff’s Complaint arguing that Ala. Code § 25-5-77(a) required Plaintiff to request a panel of four before seeking judicial intervention for medical treatment and that the Complaint failed to state a claim for outrage, fraud or conspiracy. The trial court granted Defendants’ motion and dismissed Plaintiff’s tort claims.
On appeal, the Court of Civil Appeals reversed the trial court and held that neither Ala. Code § 25-5-77(a) nor the exclusive remedy provisions Ala. Code § 25-5-53 prevented Plaintiff from asserting tort claims for outrage, fraud and conspiracy. Id. at 5 (citing Lowman v. Piedmont Executive Shirt Manufacturing Co., 547 So.2d 90, 95 (Ala. 1989)). The Court found that the Plaintiff would be required to prove that his “new” non-physical, psychological injuries were proximately caused by Defendants’ wrongful conduct which occurred after Plaintiff’s injury in order to avoid the exclusive-remedy provisions of Ala. Code § 25-5-53. Because the determination of proximate cause was not appropriate for resolution on a motion to dismiss, the Court reversed the trial court’s decision.
The Court also found that the trial court erred in dismissing Plaintiff’s claims for outrage, fraud and conspiracy because it was possible that Plaintiff could prove the elements of outrage and fraud based on the allegations in the Complaint. Furthermore, the Court held that Plaintiff could potentially prove a conspiracy claim based on his underlying tort claims. The Court noted that nearly all cases addressing fraud and outrage claims in the context of worker’s compensation claims were decided based on summary judgment motions and not the much more lenient motion to dismiss standard. Because it was possible Plaintiff could prove his outrage, fraud and conspiracy claims, the Court allowed these claims to proceed against all Defendants.
The Swain decision is significant for employers, carriers and claims analysts handling worker’s compensation claims because it illustrates the Court of Civil Appeals willingness to allow intentional tort claims, such as outrage, fraud and conspiracy, to proceed through discovery and at least to the summary judgment phase. This decision also further defines the limits of the exclusive remedy provisions of Ala. Code § 25-5-53 to work related psychological injuries.