Court documents reveal the lengths that
Over the past 15 years, Key Risk has made multiple trips to courts and before the
When the company lost those fights, it kept appealing -- and losing.
When all else failed, says veteran
First, it had the idled worker followed and videotaped for weeks, court documents say. A private investigator then took what a detective would describe as misleading information to
The charges were thrown out in 2014, drawing a withering rebuke from the
Now, Seguro-Suarez and his attorneys are suing Key Risk and others for malicious prosecution. In September, the
"I have seen some outrageous abuses of the system by insurance companies, but this is the most outrageous," Connette told the Observer.
J.D. Prather, the company's
"I've never seen something this bad," Jernigan said of the case, "and this is really, really bad."
Company's fight called 'unfounded'
Only a relatively few of these cases lead to disputes.
Legal fights in worker's comp cases often arise when an insurer faces the payout of long-term or lifelong benefits, says
"Fairly or unfairly, if you get hurt, you're guilty of something. You become a presumptive criminal out to game the system," says Duff, who reviewed some of the Seguro-Suarez documents at the Observer's request.
While fraudulent worker's comp cases do occur, Duff says, Key Risk provided no proof that Seguro-Suarez was among them. "Administrators, courts, doctors ... nobody thought this guy was malingering."
Seguro-Suarez' fall in
Following emergency brain surgery at
A doctor who treated Seguro-Suarez described him as "childlike." One of his workers' comp attorneys,
Southern Fiber and Key Risk, one of the state's largest carriers of workers' comp insurance, both initially acknowledged that the injuries, were "compensable," court and
Yet, the company quickly began taking steps to limit what it paid.
After his release from the hospital, doctors said Seguro-Suarez needed 24-hour care. Rather than pay for him to have it, Key Risk arranged for his 17-year-old daughter, who had immigrated to the country two months earlier, to attend to her father for free, documents say.
Key Risk did send weekly checks of
When Key Risk appealed, the full commission upheld the earlier ruling and described the company's case against Seguro-Suarez as "stubborn, unfounded litigiousness." It also ordered the insurer to reimburse his daughter and a family friend for years of unpaid caregiving, and to cover the cost of daily attendant care for the worker.
Two court appeals by Key Risk failed. In 2013, a decade after Seguro-Suarez's fall, Key Risk tried something new.
Insurance fraud arrest
According to the
The footage showed Seguro-Suarez doing manual labor. The investigating police detective would later say he was never shown medical reports that corroborated the worker's injuries and was never told that his disabilities were mental, not physical.
The criminal case against him began crumbling early on. After his first court appearance, a psychologist with the state prison system found Seguro-Suarez mentally incapable of standing trial, documents say.
Key Risk, the judge concluded, had Seguro-Suarez arrested "for continuing to receive the checks they were ordered to pay," the transcript says.
"There are some personal injury lawyers out there ... that are drooling over this case," Bridges said. "I would be very surprised if they aren't waiting at the courthouse steps."
Key Risk appealed. In
In June, the
Seguro-Suarez no longer lives in
The family sent word through its attorneys that it did not want to comment.
(c)2018 The Charlotte Observer (Charlotte, N.C.)
Visit The Charlotte Observer (Charlotte, N.C.) at www.charlotteobserver.com
Distributed by Tribune Content Agency, LLC.