Appeals Court Allows Lawsuit Against Fraudulent Conduct of AIG

A lawsuit filed against the American Insurance Group (AIG) over fraudulent handling of a workers’ compensation claim has now been given the go-ahead by an Alabama appellate court. The lawsuit against fraudulent conduct of AIG was filed by Orethaniel Swain.

Swain suffered mental and psychological problems after a large explosion happened close to him at workplace. The explosion took place in 2017 when Swain was working at Imerys USA Inc. He had to undergo extensive mental and psychological rehabilitation in the wake of the explosion. Multiple assessments by doctors revealed that Swain suffered from post-traumatic stress and was unable to continue regular work.

However, the claims adjuster assigned to Swain’s case took a different view. Swain’s employer was insured for workers’ compensation by Insurance Co. of the State of Pennsylvania, an insurance entity that belongs to AIG. The adjuster referred Swain to a nurse case manager. Swain then saw a neurologist who recommended that he see a psychiatrist.

In May, 2018, it was recommended that Swain resume work as he had reached maximum medical improvement levels. This was in contrast to the fact that Swain couldn’t work or focus. When forced to work, he had a mental break down and was forced to seek further treatment.

Currently, Swain’s attorney is pursuing workers’ compensation benefits on his behalf. At the same time, civil action lawsuit has been launched against AIG for fraudulent conduct in the investigation of Swain’s claim. The lawsuit was previously dismissed by the Jefferson County Circuit Court over ‘exclusive remedy’ principle that applies to workers’ compensation injuries.

However, the Court of Civil Appeals has now ruled that the exclusive remedy limitation doesn’t apply to the way an employer handles workers’ compensation claims. In addition, the plaintiff in the case claims that the fraudulent conduct resulted in new injuries or harm which mandates a separate case. The case is now returned to the Circuit Court for further hearing.

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