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Soti v. Lowe's Home Centers1/14/2005
sation medical benefits in an effort to pressure a settlement. See Griner, supra; Continental Cas. Ins. Co. v. McDonald, 567 So. 2d 1208 (Ala. 1990). In Griner, an employee, Griner, sustained serious on-the-job injuries. 809 So. 2d at 809. However, the employer's workers' compensation carrier and claims administrator either delayed payment or refused payment altogether for Griner's reasonable and necessary medical expenses. Specifically, funds to provide certain necessary medical devices as well as treatment for depression were denied for approximately five years. The defendants knew that they were obligated to provide those devices and treatment and knew that Griner was in pain, but continued to deny this care in an effort to pressure Griner to agree to a nominal settlement. 809 So. 2d at 811-12. This Court held that the defendants' actions were sufficient to support a jury's finding that their conduct was extreme and outrageous. Id. at 812.
In McDonald, a workers' compensation carrier, CNA, delayed appropriate payments and authorization for medical services for McDonald, an injured employee. 567 So. 2d at 1210. This Court has subsequently described the evidence presented in that case as follows:
"McDonald had numerous problems with CNA's failure to authorize the most basic of claims for over five years. CNA then used the results of its failure to pay to coerce McDonald into settling with CNA for an amount much smaller than his medical needs would have required. McDonald presented evidence demonstrating that he faced severe pain every day and that CNA took advantage of his pain by ceasing to pay for his pain medication. The evidence supported the finding that CNA intentionally caused McDonald severe emotional distress and that it attempted to use that distress for its gain."
ITT Specialty Risk Servs., Inc. v. Barr, 842 So. 2d 638, 645 (Ala. 2002).
Soti likens the facts of his case to Griner and McDonald. Soti alleges that his hernia was extremely painful and life threatening. Soti further asserts that SRS knew that his hernia was painful, yet, without a reasonable basis, it refused to authorize his referral for possible surgery to correct the hernia. Moreover, Soti maintains that at the time he needed the surgery, settlement negotiations were underway on his workers' compensation claim and that SRS's refusal to treat him was an attempt to coerce a more favorable settlement. Finally, Soti alleges that SRS has engaged in a pattern and practice of denying benefits in an attempt to gain leverage in settlement negotiations.
However, the facts of this case differ dramatically from those of Griner and McDonald. In those cases, the defendants engaged in a pattern of delay or denial of numerous benefits to the claimants for over five years. SRS, however, provided extensive and continuing medical treatment for Soti for three years, including three back surgeries. The only dispute over benefits arose over the hernia surgery. As the claims log indicates, Sherman clearly did not understand how Soti's hernia was a compensable injury, because at the time treatment for the hernia was requested Soti had not been working for two years. Moreover, Soti filed this action only six weeks after the first referral request was forwarded to SRS. Importantly, for over three weeks of that six-week period, Dr. Dempsey delayed sending his second referral request--the June 21, 2002, letter was not sent until July 12. Unlike the defendants in Griner and McDonald, SRS did not engage in a longstanding practice of denying or delaying Soti's benefits.
Additionally, Soti's claim that SRS knew that he was in pain when it denied the referral request is not supported by the record.
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