Court awards $12 million in workers' compensation case
RAPID CITY, S.D. - A former nursing home worker has been awarded more than $12 million in a judgment against three insurance companies that denied her workers' compensation claim.
The Rapid City jury returned its verdict - $60,000 in compensatory damages and $12 million in punitive damages - last week after a a four-day trial in federal court.
In 1999, Alice Torres, a cook at Meadowbrook Manor nursing home in Rapid City, filed a workers' compensation claim for carpal tunnel syndrome. She had sought about $8,000 for medical bills, lost time and physical impairment. But insurance adjusters denied the claim.
The defendants in the case were Travelers Insurance Co., Insurance Company of the State of Pennsylvania, and Constitution State Services, a subsidiary of Travelers. All were involved as claims administrators or insurers for Beverly Enterprises, parent company of Meadowbrook Manor.
Initially, Beverly Enterprises was also a defendant, but the company reached an out-of-court settlement and was dismissed from the suit on Jan. 8.
Torres, 57, now lives in Colorado.
"I feel great. There is such thing as justice after all," she said. "I work very hard, and I don't think nobody should go through what I went through. I was within my right to get my treatment, and they just denied me."
The suit was originally filed in U.S. District Court in Rapid City in July 2001. Torres' attorneys, Michael Abourezk and Glen Johnson of Rapid City, accused the companies of bad-faith dealing with Torres, barratry, abuse of process, and interference with business and contract relations.
For Abourezk, the case centered around a Travelers Insurance incentive program that offered bonuses to claims workers who lowered payouts on claims. Called the Claim Professional Incentive Program, it offered workers end-of-year bonuses of as much as 20 percent of their pay if they reduced overall payouts from one year to the next.
Abourezk argued that the program created an improper conflict of interest for claims adjusters, who are supposed to be motivated by fairness to claimants, not cost control for insurance companies.
"An insurance adjuster is supposed to be like a judge, fair and impartial. ... If you bribe a judge, you get thrown in jail. But they bribe these claims adjusters with bounties that are tied directly to their performance in paying claims."
In court papers, the insurance companies said Torres' workers' compensation claim was properly denied because there was a lack of proof that her hand problems were caused by her work. According to court papers, Torres reported to Meadowbrook Manor administrators in March 1998 that she was having pain, numbness and other symptoms in her hand. She underwent a series of medical treatments. At one point, she took three weeks off from work.
In April of 1999, Torres underwent surgery for carpal tunnel syndrome. Her doctor sent a workers' compensation report to Meadowbrook Manor, asserting that her work "aggravates and makes her carpal tunnel syndrome clinically significant so that it interferes with her activity and function."
But defense attorneys noted that there were a number of inconsistencies in Torres' accounts of what caused her pain, how long it had been bothering her or whether it was caused by repetitive stress or a specific injury from lifting a pot of soup.
The insurance companies also said her hand problems were likely the result of a 1998 home injury, not her work in the kitchen of the nursing home. Torres sought medical treatment for that injury but, at that time, did not mention numbness or tingling in her fingers, the attorneys noted. And tests in December of that year, the defense contended, did not show carpal tunnel syndrome.
Torres now works in a private home caring for a 97-year-old woman.
"I told her family that no matter what happened, I will stay with her until she don't need me no more. I love this old lady," Torres said.
However, her lawsuit is far from over. Federal courts must review jury verdicts involving punitive damages, and judges may reduce or eliminate the awards. The legal wrangling likely will continue.
And no matter what happens, Torres will not keep the entire $12.06 million. Attorney fees in this case equal 45 percent of the award, Abourezk said.
Information from: The Rapid City Journal