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Denying Workers’ Compensation: How Far an Insurance Company Is Willing to Go

If you sustain a job-related illness or injury, you have a legal right to file for workers’ compensation benefits. However, it’s important to contact an attorney before you start this complicated legal process because each state has its own laws and regulations that determine an employee’s eligibility. An experienced workers’ compensation lawyer at Pierce, Petho & Anderson can explain what benefits you’re entitled to and help you complete an accurate claim.

In North Carolina, thousands of employees receive workers’ compensation benefits each year. But because insurance companies are in the business of making and saving money, it’s not unusual for employees to fight tooth and nail just to obtain the benefits their illnesses and injuries warrant. But what happens when an insurance company goes too far to deny eligibility?

The Case

In 2003, one of our clients, Mario Seguro-Suarez, fell 18 feet and suffered a disabling traumatic brain injury. Key Risk Insurance Co., his employer’s insurance provider, initially acknowledged that his injury qualified him for workers’ compensation. Then even sent weekly checks of $345.35 to cover some of Seguro-Suarez’s lost wages. However, when the company couldn’t cut his benefits, they started engaging in fraudulent activities.

Michael Gordon, a writer at The Charlotte Observer, wrote an article about this case, and interviewed Mike Duff, a law professor at the University of Wyoming, who explained, “Legal fights in workers’ comp cases often arise when an insurer faces the payout of long-term or lifelong benefits. With some insurance companies, that can lead to a hyper-vigilant atmosphere in which every injured worker is suspect.”

Key Risk Insurance Co. hired a private investigator to follow and videotape Seguro-Suarez. The investigator took footage of our client doing manual labor and submitted it to Lincolnton police as proof of insurance fraud. In 2014, Seguro-Suarez was arrested on 25 felony counts. Fortunately, a Lincoln County judge rightfully dismissed these charges. The investigating police detective claimed that he never received a medical report stating that our client’s disability is considered cognitive and not physical.

Our very own Rick Anderson, who is Seguro-Suarez’s workers’ compensation lawyer, clarified to Michael Gordon that “multiple tests place Seguro-Suarez’s current IQ at around 70, in the bottom 1 percent of all North Carolinians.” In 2016, Seguro-Suarez and his legal team pursued justice by suing Key Risk Insurance Co. for malicious prosecution. In June of this year, the Industrial Commission rejected Key Risk Insurance Co.’s latest appeal and secured Seguro-Suarez’s lifetime benefits.

Schedule a Consultation & Pursue Workers’ Compensation Benefits

In an ideal world, people like Mario Seguro-Suarez wouldn’t have to engage in legal battles just to obtain necessary benefits. At Price, Petho & Anderson, our trial-tested Charlotte workers’ compensation attorneys have been representing clients since 1979. If you’re ready to pursue benefits, contact our legal team to safeguard your legal rights. We can guide you through each step of this legal process and even litigate in court on your behalf.

Contact Price, Petho & Anderson at (704) 350-2630 to schedule a consultation.

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Awards

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  • American Association for Justice
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