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.
