Plantz v. Gallagher Bassett Services, Inc.

CourtDistrict Court, S.D. West Virginia
DecidedSeptember 30, 2020
Docket2:19-cv-00631
StatusUnknown

This text of Plantz v. Gallagher Bassett Services, Inc. (Plantz v. Gallagher Bassett Services, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. West Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Plantz v. Gallagher Bassett Services, Inc., (S.D.W. Va. 2020).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF WEST VIRGINIA AT CHARLESTON

CHARLES E. PLANTZ,

Plaintiff,

v. Civil Action No. 2:19-cv-00631

GALLAGHER BASSETT SERVICES, INC.,

Defendant.

MEMORANDUM OPINION AND ORDER

Pending are defendant Gallagher Bassett Services, Inc.’s (“Gallagher Bassett”) motion to dismiss the complaint (ECF No. 6), filed October 17, 2019, motion to stay discovery (ECF No. 19), filed January 8, 2020, and motion for leave for additional time to join parties (ECF No. 23), filed January 31, 2020. Additionally, pending is plaintiff Charles Plantz’s motion to amend the scheduling order (ECF No. 25), filed May 8, 2020, and motion to modify the scheduling order (ECF No. 27), filed September 22, 2020. I. Background On September 3, 2015, Plantz injured his left shoulder while repositioning 55-gallon drums on pallets as an employee of Express Services, Inc. Compl. ¶¶ 7-8. A January 13, 2016 MRI revealed no rotator cuff tear, but it was recommended that the plaintiff undergo shoulder surgery. Id. ¶¶ 9-11. Dr. Soulsby performed arthroscopic surgery on the plaintiff’s left shoulder on August 17, 2016, noting a 50% tear of the biceps tendon but no rotator cuff tear.1 Id. ¶¶ 11-13. Dr. Soulsby indicated on

January 13, 2017 that Plantz’s shoulder had reached “maximum medical improvement.” Id. ¶ 25. Dr. Murphy conducted a separate independent medical examination on February 6, 2017, found no rotator cuff tear, and concluded that the plaintiff had reached maximum medical improvement. Id. ¶¶ 14-16. The plaintiff reinjured his left shoulder on April 17,

2017 while working as an employee for Total Distribution, Inc. (“Total Distribution”). Id. ¶¶ 3, 17. An April 25, 2017 MRI revealed that Plantz had torn his rotator cuff. Id. ¶ 17. On an unspecified later date, the plaintiff filed a claim for workers’ compensation benefits relating to this injury. Id. ¶ 6. Plantz alleges that Gallagher Bassett oversaw the initial workers’ compensation proceedings as a third-party claims administrator and agent of Total Distribution, his employer who is not a party to this case. See Compl. ¶ 2.

1 As the complaint does not provide the first names of all relevant doctors, this opinion will refer to them by their last To aid the proceeding, Dr. Azzo composed a September 5, 2017 report on the plaintiff’s injury after a review of his medical records. Id. ¶¶ 20, 24, 32. Plantz asserts that this report contained multiple inaccuracies. Specifically, the plaintiff alleges that Dr. Azzo incorrectly: (1) concluded that

the April 2017 injury resulted in a sprain rather than a tear of the plaintiff’s rotator cuff; (2) stated the April 25, 2017 MRI occurred on April 17, 2017; (3) ascribed findings from the January 13, 2016 prior injury MRI to the April 25, 2017 MRI; (4) failed to explicitly document that he was relying on the January 2016 MRI; and (5) relied on medical records that do not exist. Id. ¶¶ 18, 20, 24, 32, 33, 34, 43, 44, 46.

On September 13, 2017, Gallagher Bassett’s claim administrator issued a decision denying the claim. Id. ¶ 34. In doing so, the defendant allegedly intentionally relied on Dr. Azzo’s false reports and misquoted deposition testimony from Dr. Soulsby, who, contrary to the defendant’s opinion, had actually indicated that the plaintiff needed an additional arthroscopic surgery to repair the rotator cuff tear. Id. ¶¶ 19, 20, 29, 31, 34, 49. Gallagher Bassett found that no further medical treatment was necessary. Id. at 34. Gallagher Bassett then instructed Dr. Azzo to complete an addendum to his report. Id. The doctor did so on September 18, 2017. Id. ¶ 35. Plantz alleges that the addendum: (1) falsely states the plaintiff had a MRI on both April 17, 2017 and April 25, 2017; (2) again attributes findings from the January 2016

prior injury MRI to the April 25, 2017 MRI; and (3) concludes that the plaintiff experienced on April 17, 2017 a partial, but not complete, tear of his rotator cuff, rather than a sprain as stated by him in his September 5, 2017 report. Id. ¶¶ 38, 44-48. Dr. Azzo’s addendum concluded that Plantz “had reached [the] maximum degree of medical improvement and required no work restriction as a result” of his injury. Office of Judges Opinion 5, ECF No. 8.2 After this addendum was completed, Dr. Soulsby objected to Gallagher Bassett’s consideration of Dr. Azzo’s report and asked Gallagher Bassett to “re-evaluate and authorize a repeat

2 Gallagher Bassett has filed the decision of the Office of Judges as an exhibit to the pending motion to dismiss. ECF No. 8. Documents attached to motions to dismiss may be considered without converting the motion to that for summary judgment “so long as they are integral to the complaint and authentic.” Philips v. Pitt Cnty. Mem. Hosp., 572 F.3d 176, 180 (4th Cir. 2009). The opinion is integral to the complaint because Plantz also alleges that Gallagher Bassett committed fraud while misrepresenting evidence to the Office of Judges, and such a claim requires reliance by the appellate body on the allegedly false representations, presumably in its decision. See Cobb v. E.I. duPont deNemours & Co., 549 S.E.2d 657, 661 (1999). Further, Plantz does not challenge the document’s authenticity. See Zak v. Chelsea Therapeutics Int’l, Ltd., 780 F.3d 597, 607 (4th Cir. 2015). Accordingly, the court will consider the document as it relates to the pending motion. arthroscopy, so we can try and correct his shoulder problem and get him back into a productive mode.” Compl. ¶¶ 51-55.

Plantz states that he protested the September 13, 2017 denial of his claim to the West Virginia Workers’ Compensation Office of Judges on October 2, 2017. Id. ¶ 56. Plantz alleges financial problems forced him to return to work while injured and states that he had to request pain medication from Dr. Soulsby during the pendency of the protest. Id. ¶ 57.

Plantz asserts that “Gallagher Bassett knowingly relied on false information from Dr. Azzo and submitted his [initial and addendum] reports to the Office of Judges . . . .” Id. ¶ 58. He also states that an agent hired and controlled by Gallagher Bassett, attorney Jeffrey Brannon, was primarily responsible for presenting these misrepresentations to the Office of Judges while representing Total Distribution during the protest. Id. ¶¶ 19 n. 1, 40. Plantz indicates that his counsel objected to Gallagher Bassett’s submission of Dr. Azzo’s reports during the protest, to

which Gallagher Bassett did not respond. Id. ¶¶ 19 n. 1, 40, 58. The Office of Judges reversed Gallagher Bassett’s decision in an opinion dated December 19, 2017. Office of Judges Opinion. In doing so, the appellate body stated that “[t]he [initial] report of Dr. Azzo is not found to be reliable.” Id. 10. The Office of Judges further found that Dr. Azzo’s “maximum medical improvement” determination was contradicted by the opinion of Dr. Soulsby. Id. Plantz’s complaint does not discuss the decision of the Office of Judges.

After the conclusion of the administrative appellate proceedings, Plantz filed the present action on September 3, 2019. Compl. He specifically asserts one count of workers’ compensation fraud against Gallagher Bassett but essentially alleges two separate types of fraud allegations: (1) fraud relating to the third-party administrator’s consideration of findings of Dr. Azzo and Dr. Soulsby when it denied the workers’ compensation claim (the “denial-related allegations”); and (2) fraud relating to

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Plantz v. Gallagher Bassett Services, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/plantz-v-gallagher-bassett-services-inc-wvsd-2020.