Injured workers' claim that employer and doctor conspired to deny benefits is reinstated
The Sixth Circuit Court of Appeals recently reinstated a claim by six workers against their employer, the employer's workers compensation adjuster, and the doctor hired to perform so-called "independent medical examinations": the employees claimed that these parties conspired together to deny their legitimate disability claims, thereby violation the federal RICO [Racketeering Influenced and Corrupt Organizations Act]statutes. The Court of Appeals reversed the trial court's holding that several technical defenses precluded applying the RICO statute to the Defendants' activities.
It is refreshing to see someone take vigorous action against doctors and adjusters who regularly issue boilerplate medical opinions denying the fact of injury or causation, and for a court to protect the victims' right to have their allegations heard. Dr. Saul Margules and his buddies who trade on their medical license to secure a half-million-dollar income by routinely rejecting victims' claims will need to be a little more careful in the boilerplate opinions they pull off the computer.
Sadly, since the Michigan Courts have fallen so completely under the influence of the Chamber of Commerce and the insurance industry, most Michigan insureds and victims are denied any recourse against their insurer--no matter how unreasonable its actions. As the Court in Brown, et al. v. Cassens Transport Co., et al., pointed out, Michigan's Supreme Court has refused to recognize that improper insurance behavior can constitute the illegal intentional infliction of emotional distress, and Michigan Courts have subsequently held that neither a delay of six months and an improper denial, the bad faith termination of benefits, nor the wrongful denial of benefits for an ulterior motive are "sufficiently outrageous" to support a claim against the insurer.