Phoenix Firefighters Allege Fraud By Comp Provider

Eight Phoenix firefighters have filed suit against the city’s workers compensation claims adjusting firm alleging fraud, conspiracy and racketeering (RICO) violations.

The 31 page complaint was filed in US District Court by Laurie Miller, Brian Dimas, Kim Mills, Anthony Soza, Bruce Campbell, Michael Schamadan, Kellie Bowers, and Tim Hunter accusing York Risk Service Group of engaging in a “long term and ongoing scheme to delay and deny timely payment of critically needed workers compensation medical and other payments owed to legitimately injured firefighters of the City of Phoenix.”

Among the highlights in the complaint:

• “This case is based upon a long term and ongoing scheme to delay and deny Arizona workers compensation benefits to plaintiffs when York and Phoenix knew that they did not have a sound basis under the law and facts of each case for doing so."

• “York routinely and improperly chooses to hurl frivolous and legally unsound roadblock after roadblock to wrongfully  deny care to Phoenix’s firefighters, with the assistance of some Phoenix administrators. As a result, injured firefighters, and their families, endure significant delays in medical care, often severe financial distress, and deleterious impacts on their ultimate physical and financial condition. After being hurt on the job, these firefighter Plaintiffs, and others, have been met with abuse and worry, rather than the basic medical care and living expenses so necessary after an on the job injury.”

• “The workers compensation personnel at the workers compensation claims departments at York who handled Arizona workers compensation claims and personnel at the City of Phoenix associated in fact formed an “enterprise” for purposes of the Racketeer Influenced and Corrupt Organizations Act (RICO) claims in this case.”

• “York conspired to violate 18 U.S.C. 1962, and conspired with one or more other parties or the employees of the City of Phoenix to violate 18 U.S.C. 1962. York, and Phoenix through the actions of their employees involved in the handling of Arizona workers compensation claims, and physicians chosen by Phoenix and York to examine claimants, agreed to participate in the commission of the predicate acts which are alleged in this complaint.”

• “In every instance complained of herein York and Phoenix, as part of an ongoing enterprise and scheme more particularly described in the remaining paragraphs refused to pay workers compensation benefits to workers in bad faith. They denied benefits without reasonable investigation and without forming a good faith belief that the standards for compensable disability had not been met when evidence of entitlement to benefits had been provided by the workers.”

While pleading the RICO violations, the complaint contains only two counts: one alleging fraud and the other aiding and abetting the city of Phoenix in the breach of the duty of good faith and fair dealing.

However in the prayer for relief the complaint seeks “compensatory damages for physical pain and suffering, mental and emotional distress, anxiety, and all other general damages alleged and proved at the time of trial all tripled in accordance with RICO.”

In other words, the complaint is demanding that the damages be tripled as permitted under the RICO statute. It also demands costs, attorneys fees and interest.

Here is a copy of the complaint. Miller v York

Update: Here is news coverage of the suit