Floyd vs Zurich American Insurance CO. of Illinois (Aug 2017)
2017 MTWCC 4; WCC No. 2016-3748
DANIAL FLOYD, Petitioner vs. ZURICH AMERICAN INSURANCE CO. OF ILLINOIS, Respondent/Insurer.
FINDINGS OF FACT, CONCLUSIONS OF LAW, AND JUDGMENT
Summary: Petitioner claims that he is not at MMI from his December 2014 injury, and that he is entitled TTD and medical benefits from the time Respondent terminated them. Petitioner further claims that he is entitled to reasonable costs, attorney fees, and a penalty. Although Respondent accepted liability for Petitioner’s injury, Respondent argues that Petitioner’s current complaints are not a result of the incident at work, Petitioner has achieved MMI, and Respondent is no longer liable for benefits.Respondent also contends that its conduct has been reasonable because Petitioner’s presentation has been unique.
Held: Petitioner proved by a preponderance of the evidence that he suffered a compensable injury and that he has not reached MMI. Petitioner is entitled to TTD and medical benefits from the time Respondent terminated them, and, as the prevailing party, Petitioner is entitled to reasonable costs. Respondent’s actions in terminating Petitioner’s benefits were unreasonable because it disregarded the treating physician’s opinions and seized upon the IME physician’s opinions despite their obvious faults. Respondent’s actions in failing to reinstate Petitioner’s benefits after the IME physician’s deposition were unreasonable because the IME physician testified on a more-probable-than-not basis that Petitioner’s injury was compensable. Therefore, Petitioner is entitled to attorney fees and a penalty.