Opinion ID: 1556580
Heading Depth: 1
Heading Rank: 2

Heading: The sufficiency of the evidence supporting the verdict in favor of Malone for bad-faith delay of payment.

Text: ¶ 30. Malone sought to prove that Gallagher Bassett's bad-faith failure to investigate and pay his legitimate workers' compensation claim caused him to delay having skin-graft surgery, which proximately caused the amputation of his leg. His expert, Dr. Keith Melancon, testified to a reasonable degree of medical certainty that the delay caused an increase in infection that necessitated aggressive surgery, and caused or contributed to the eventual leg amputation. While there was voluminous evidence surrounding Gallagher Bassett's handling of Malone's claim, the only relevant evidence pertains to what occurred in August 2000, because it was Gallagher Bassett's conduct during precisely that time frame that Malone claimed to have delayed his skin-graft surgery. The appropriate analysis focuses on Gallagher Bassett's conduct in light of what Gallagher Bassett knew or reasonably should have known at that time. ¶ 31. The evidence of Gallagher Bassett's role in the delayed payment of workers' compensation benefits centered upon the conduct of a claims adjuster, Deborah Robichaux. Robichaux's only source for notice of a workers' compensation injury was Nabors. The evidence was that Robichaux had received notification from Nabors that Malone had a work-related injury and a pre-existing condition. Then, she had initiated a conversation with Malone's supervisor, Bobby Wallace, who had confirmed that Malone had cut his leg at work, that he had a pre-existing condition that affected the area of the cut, that he needed skin-graft surgery, and that the need for the skin graft was due either to the cut or to the pre-existing condition. ¶ 32. After her conversation with Wallace, Robichaux did nothing. She testified that it was Gallagher Bassett's practice not to investigate a Nabors workers' compensation claim until Nabors had transmitted a B-3 form, and she expected that a B-3 form would be submitted. Nabors's claims coordinator, Alice Lankford, and Nabors's counsel, Laura Doerre, both agreed that a B-3 form was required for Gallagher Bassett to set up a claim file. Lankford testified that if a claim is reported by phone, the claim file should be set up after the B-3 form is obtained by the claims adjuster. Nabors's policy was to complete a B-3 form and transmit it to Gallagher Bassett any time a first-aid-only injury necessitated surgery or lost time; yet, it did not do so in this case. Nevertheless, Robichaux admitted that, when she did not receive a B-3 from Nabors, she should have requested one. ¶ 33. It is vital to evaluate Robichaux's conduct in light of the applicable law governing the compensability of workers' compensation claims. Workers' compensation benefits are payable for a work-related injury that aggravates, accelerates, or lights up a pre-existing condition, but no benefits are due for disability that is solely attributable to a pre-existing condition, or when the work-related injury no longer combines with the pre-existing condition to produce disability. Rathborne, Hair & Ridgeway Box Co. v. Green, 237 Miss. 588, 594, 115 So.2d 674, 676 (1959). A federal court has recognized that in Mississippi, a pre-existing condition may be a complete defense to workers' compensation benefits, and an adjuster placed on notice of a pre-existing condition has a valid legal basis... to spend some time investigating the relationship between the Plaintiff's prior injury and his work-place injury. McLendon v. Wal-Mart Stores, Inc., 521 F.Supp.2d 561, 566 (S.D.Miss.2007). Thus, Robichaux's conversation with Wallace only placed her on notice of a possibility that Malone had suffered a compensable injury. Further investigation was needed for Robichaux to determine compensability. Viewing the evidence in the light most favorable to Malone, Robichaux's next step should have been to commence an investigation of the claim. ¶ 34. Considering all of the evidence in the light most favorable to Malone, I do not find that Robichaux's failure to investigate after her conversation with Wallace rises to the level of malice, reckless disregard for Malone's rights, or gross negligence. No evidence suggests that Robichaux acted maliciously or with reckless disregard for the consequences to Malone. Nor is there sufficient evidence of gross negligence. `Gross negligence' is that course of conduct which, under the particular circumstances, discloses a reckless indifference to consequences without the exertion of any substantial effort to avoid them. Dame v. Estes, 233 Miss. 315, 318 101 So.2d 644, 645 (1958). Simple negligence is the failure to exercise due care, and signifies conduct that amounts to heedlessness, inattention, or inadvertence. Turner v. City of Ruleville, 735 So.2d 226, 229 (Miss.1999) (citing Beta Beta Chapter of Beta Theta Pi v. May, 611 So.2d 889, 895 (Miss.1992)); Green v. Ingram, 269 Va. 281, 608 S.E.2d 917, 923 (2005). ¶ 35. In August 2000, Robichaux lacked any knowledge that, without the immediate receipt of benefits, Malone would delay the surgery against medical advice. What she knew was that Malone needed skin-graft surgery for a possible work-related injury, and she expected further contact from Nabors. Although Robichaux should have followed up with Nabors, her failure to do so amounts to mere inadvertence when considered in light of the facts that: (1) Nabors's admitted practice was to send a B-3 form to prompt Gallagher Bassett to investigate a claim; (2) Robichaux had no notice that a claim definitely was going to be made; and (3) Robichaux commenced an investigation once she received a B-3 form in November 2001. At worst, it appears that, in August 2000, Robichaux failed to follow up on a possible claim due to her own thoughtlessness. Her omission constituted mere inadvertence, heedlessness, or inattention, which constituted simple negligence. In my opinion, viewing the evidence in the light most favorable to the verdict, Malone proved that Gallagher Bassett's conduct amounted to nothing more than simple negligence. [7] Therefore, not only was Gallagher Bassett's conduct insufficient to support a finding of bad faith, but recovery against Gallagher Bassett for simple negligence was barred by the exclusivity clause of the Workers' Compensation Act. Miss.Code Ann. § 71-3-9 (Rev.2000). The evidence was insufficient to support the verdict against Gallagher Bassett in favor of Malone. ¶ 36. I point out that a delay of virtually any length in the payment of workers' compensation benefits invariably will cause damages of some kind to the injured employee, such as a slight worsening of the work-related injury, emotional distress, or the like. The Workers' Compensation Act has established a balance between the interests of employers and employees: the employer provides compensation for work-related injuries without regard to fault, and the Act is the employee's exclusive remedy. See 9 John R. Bradley, Jr., Encyclopedia of Mississippi Law (Jeffrey Jackson & Mary Miller eds.) § 76:1 (2002). This balance is threatened if minor misconduct by the employer, carrier, or adjuster that causes a delay in payment is sufficient to permit an employee to recover damages at law. On this point, a California appellate court aptly has stated: [M]inor delays in getting medical service, such as for a few days or even a few hours, caused by a carrier, could become the bases of independent suits, and these could be many and manifold indeed. The uniform and exclusive application of the law would become honeycombed with independent and conflicting rulings of the courts. The objective of the Legislature and the whole pattern of workmen's compensation could thereby be partially nullified. Taylor, 420 So.2d at 566 (quoting Noe v. Travelers Ins. Co., 172 Cal.App.2d 731, 342 P.2d 976, 979 (1959)). ¶ 37. I would reverse and render the verdict against Gallagher Bassett in favor of Malone.