In the recent case of Centeno v. American Liberty Insurance Company, No. CV-18-01059-PHX-SMB, 2019 WL 4849548 (D. Ariz. Oct. 1, 2019), the U.S. District Court for the District of Arizona expounded upon the evidentiary burden a plaintiff must satisfy to demonstrate insurer bad faith. Centeno was a traveling nurse employed by Beech Home Care (“Beech”) and was covered under a policy issued by American Liberty Insurance Company (“American Liberty”) providing workers’ compensation coverage. On August 5, 2016, while retrieving medical supplies from her vehicle to continue treatment of a patient, Centeno allegedly fell and injured her back. No one witnessed the injury. Centeno, along with fellow nurse Jeuckstock, continued treating patients that day following Centeno’s alleged injury.
Centeno reported her alleged injury to Beech three days later and began receiving medical care at Chandler Regional Medical Center that same day. The reports of Centeno’s attending physician and radiologist, who both administered treatment that day, differed as to whether Centeno’s injury occurred during or after work. Three weeks passed before Centeno next sought medical treatment by visiting her personal physician. After complaining of continued back and neck pain to her supervisors, Centeno visited a workers compensation clinic, after which she was recommended for light duty. Then, nearly a month after the alleged accident, Centeno reported her injury to American Liberty for the first time.
After conducting an investigation, American Liberty’s claims adjuster determined that Centeno’s claim was initially compensable. Shortly thereafter, however, the initial approval of Centeno’s claim was thrown into doubt by two co-workers’ independent reports indicating that Centeno’s injury was not job-related. One of those reports came from Jueckstock, who insisted that Centeno did not exhibit any signs or symptoms of injury, nor complain of an injury either before or after the time of the alleged accident. The claims adjuster asked a third party adjuster to investigate these reports while continuing to approve Centeno’s medical treatment. Centeno’s medical treatment included the scheduling of therapy sessions, preoperative surgical appointments, and the setting of a tentative surgery date of October 20, 2016.
On October 13, 2016, noting the final claim determination deadline of October 18, 2016, the adjuster denied Centeno’s claim, in part due to the conflicting accounts of Centeno’s co-workers indicating that the injury occurred outside of work and was therefore non-compensable. The adjuster also cited the minimal medical treatment sought in the three-week period immediately following the alleged accident and Centeno’s delay in reporting the claim to American Liberty as additional support for the denial. The adjuster maintained that the timing of the denial – five days before the claim determination deadline – was motivated by a desire to meet the deadline and to allow Centeno to pursue other surgery options given her fast approaching surgery date. Following the claim denial, Centeno postponed her surgery and contested the denial. The Arizona Industrial Commission ultimately reversed the claim denial and Centeno’s claim was found compensable.
Centeno thereafter filed a bad faith action against American Liberty and the claims adjuster, arguing, among other things, that they failed to conduct an adequate investigation and terminated her workers’ compensation benefits without a reasonable basis. More specifically, Centeno argued that American Liberty unreasonably denied her claim in order to save money. As support for this theory, Centeno presented an excerpted section from the claims handler’s website entitled “Philosophy,” which outlined the adjuster’s responsibilities and goals to both employers and their injured workers. These responsibilities and goals included approving meritorious claims and assured that the claims handler “is fully aware of the fact that every dollar spent on workers’ compensation comes directly off the employers’ bottom line. We are committed to working closely with employers and risk management to save every dollar that is legally possible.” 2019 WL 4849548, at *4 (citing Plaintiff’s Response to Defendant’s Motion for Summary Judgment, Exhibit 3).