Workers Compensation Florida Case Ramos-V-sedgwick-complaint

IN THE CIRCUIT COURT OF THE
NINTH JUDICIAL CIRCUIT, IN AND

FOR ORANGE COUNTY, FLORIDA
CASE NO:
eFiled in the Office of Clerk of Court, Orange County Florida 2011 May 17 02:05 PM Lydia Gardner
LEGNA RAMOS COMAS,

Plaintiff,
vs.
SEDGWICK CLAIMS MANAGEMENT SERVICES,
INC., a foreign corporation; CIGNA HEALTH
MANAGEMENT, INC., a foreign corporation;
GENEX SERVICES, INC., a foreign corporation; LEE
ANN WINTERS, a Florida resident; MARJORIE
McCLELLAND, a Florida resident; MARY WILSON,
a Florida resident,
Defendants.
__________________________________________/
COMPLAINT
Plaintiff
LEGNA
MANAGEMENT
RAMOS
SERVICES,
COMAS
INC.,
hereby
foreign
sues
SEDGWICK
corporation;
CIGNA
CLAIMS
HEALTH
MANAGEMENT, INC., a foreign corporation; GENEX SERVICES, INC., a foreign

corporation; LEE ANN WINTERS, a Florida resident; a MARJORIE McCLELLAND, a Florida
resident; and MARY WILSON, a Florida resident, and, as grounds therefore, states as follows:
JURISDICTIONAL ALLEGATIONS
1.
This is an action for damages in excess of $15,000.00 and is otherwise within the
Courts jurisdiction.
Leopold~Kuvin, P.A.
2925 PGA Boulevard, Suite 200, Palm Beach Gardens, FL 33410
Telephone: (561) 515-1400 Facsimile (561) 515-1401
Ramos Comas v. Sedgwick Claims, et. al.

Plaintiffs Complaint
Page 2
2.
Plaintiff LEGNA RAMOS COMAS is, and was at all times material hereto, a
Florida resident.
3.
Defendant SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., is an
Illinois corporation with its principal address at 1100 Ridgeway Loop Road, Memphis,
Tennessee, 38120 and its Florida Registered Agent is CT Corporation System, 1200 South Pine
Island Road, Plantation, FL 33324. Upon information and belief, Defendant Sedgwick regularly
conducts business in Orange County, Florida. Sedgwick is subject to personal jurisdiction in
the state of Florida because it is engaged in substantial and not isolated activity within the state
of Florida; and Plaintiffs action arises from Sedgwick operating, conducting, engaging in, or
carrying on a business in Florida or having an office or agency in Florida; committing a
tortious act within Florida; contracting to provide insurance within Florida; or breaching a
contract in Florida by failing to perform acts required to be performed in Florida.
4.
Defendant CIGNA HEALTH MANAGEMENT, INC., is a Delaware corporation
with its principal address at 1601 Chestnut Street, Philadelphia, Pennsylvania 19192 and its
Florida Registered Agent is CT Corporation System, 1200 South Pine Island Road, Plantation,
FL 33324. Defendant Cigna Health Management was, prior to December 7, 2010, known as
International Rehabilitation Associates, Inc., and does business under the registered service mark
Intracorp.
Upon information and belief, Defendant Cigna Health Management regularly
conducts business in Orange County, Florida. Cigna Health Management is subject to personal
jurisdiction in the state of Florida because it is engaged in substantial and not isolated activity
within the state of Florida; and Plaintiffs action arises from Cigna Health Management
operating, conducting, engaging in, or carrying on a business in Florida or having an office or
agency in Florida; committing a tortious act within Florida; contracting to provide insurance
Leopold~Kuvin, P.A.

Page 3
within Florida; or breaching a contract in Florida by failing to perform acts required to be

performed in Florida.
5.
Defendant GENEX SERVICES, INC., is a Pennsylvania corporation with its
principal address at 440 East Swedesford Road, 3050, Wayne, Pennsylvania, 19087 and its
Florida Registered Agent is CT Corporation System, 1200 South Pine Island Road, Plantation,
FL 33324. In December 2010, Defendant Genex acquired International Rehabilitation
Associates, Inc., from CIGNA Corporation and currently owns the Intracorp service mark.
Upon information and belief, Defendant Genex regularly conducts business in Orange County,
Florida. Genex is subject to personal jurisdiction in the state of Florida because it is engaged in
substantial and not isolated activity within the state of Florida; and Plaintiffs action arises
from Genex operating, conducting, engaging in, or carrying on a business in Florida or having
an office or agency in Florida; committing a tortious act within Florida; contracting to provide
insurance within Florida; or breaching a contract in Florida by failing to perform acts required
to be performed in Florida.
6.
Defendant LEE ANN WINTERS, is a Florida registered nurse, license number
RN626112, and an Orange County, Florida resident. During all times relevant to this complaint,
Defendant Winters was employed as a nurse case manager by Defendant CIGNA HEALTH
MANAGEMENT and/or Defendant GENEX.
WINTERS was the authorized agent of her
employer and was acting within the course and scope of the agency relationship at all times
material to this complaint.
7.
Defendant MARJORIE McCLELLAND is a Florida resident who, at all times
relevant to this complaint, was employed as a claims adjuster by Defendant SEDGWICK.
Leopold~Kuvin, P.A.

Page 4
McCLELLAND was the authorized agent of her employer and was acting within the course and
scope of the agency relationship at all times material to this complaint.
8.
Defendant MARY WILSON is a Florida resident who, at all times relevant to this
complaint, was employed as a claims adjuster by Defendant SEDGWICK. WILSON was the
authorized agent of her employer and was acting within the course and scope of the agency
relationship at all times material to this complaint.
9.
At all material times and pursuant to one or more contractual relationships,
Defendant SEDGWICK provided workers compensation coverage to Spartan Staffing/Labor

Ready, the employer of Plaintiff LEGNA RAMOS COMAS, which covered Plaintiffs
workplace accident that occurred on or about June 21, 2004. Plaintiff was an intended thirdparty beneficiary of these contracts because they were intended to directly and primarily benefit
her. Under these contracts, Plaintiff was entitled to receive the quick and efficient delivery of
disability and medical benefits and the prompt delivery of benefits pursuant to section
440.015, Florida Statutes.
10.
At all material times and pursuant to one or more contractual relationships,
Defendant CIGNA HEALTH MANAGEMENT and/or Defendant GENEX, under the service
mark Intracorp, acted as a service agent/third-party administrator of Defendant SEDGWICK in
adjusting and administering Plaintiffs workers compensation insurance claim. Plaintiff was an
intended third-party beneficiary of these contracts because they were intended to directly and
primarily benefit her. Under these contracts, Plaintiff was entitled to receive the quick and
efficient delivery of disability and medical benefits and the prompt delivery of benefits
pursuant to section 440.015, Florida Statutes.
Leopold~Kuvin, P.A.

Page 5
11.
At all times material hereto, Defendant CIGNA HEALTH MANAGEMENT,
Defendant GENEX, and their employees, including Defendant WINTERS, were the authorized
agents of Defendant SEDGWICK, and were acting within the course and scope of the agency
relationship at all times material to this complaint.
12.
Defendants SEDGWICK, CIGNA HEALTH MANAGEMENT, and GENEX
exercised the exclusive ability to authorize or deny coverage for, and otherwise control access to,
medical care, treatments, and devices needed by Plaintiff as a result of her workplace injury.
13.
The acts and omissions attributed to the Defendants in this Complaint were
performed and carried out by the Defendants themselves and/or by their employees and/or agents
and/or by their divisions and/or successors-in-interest and/or other entities for which the
Defendants would be legally responsible.
14.
Venue of this action is proper in Orange County under sections 47.011, 47.021
and 47.051, Florida Statutes, because Defendants LEE ANN WINTERS and MARY WILSON
reside in Orange County.
15.
By this action, Plaintiff seeks, inter alia, damages for personal injuries, severe
emotional distress, and other harm caused by the Defendants intentional acts and reckless
indifference to her plight or welfare during the course of her workers compensation claim,
subsequent to and distinct from her original workplace injury.
GENERAL ALLEGATIONS
16.
On or about June 21, 2004, Plaintiff was injured during a workplace accident in
which both her hands were caught in a dye press machine while she was working in the course
and scope of her employment with Spartan Staffing/Labor Ready.
Leopold~Kuvin, P.A.

Page 6
17.
The accident mutilated Plaintiffs hands. She was initially taken to Orlando
Regional Medical Center for emergency care, but had to be flown by helicopter transport to
Tampa General Hospital where she underwent emergency surgery.
18.
The doctors at Tampa General were unable to save Plaintiffs hands and had to
amputate all four fingers on each of her hands, leaving her with only her thumbs, as shown
below:
19.
Plaintiff was hospitalized for 23 days and underwent 7 surgeries, including the
creation of a lateral arm free flap to cover her right hand, which caused Plaintiff a large and
painful scar on her right arm.
Leopold~Kuvin, P.A.

Page 7
20.
Plaintiffs emergency surgery was supervised by Dr. Jaime Perez, who began
treating Plaintiff on a regular basis, and was authorized to do so by Defendants pursuant to

Plaintiffs workers compensation coverage.
21.
Although Defendants authorized Dr. Perez to treat Plaintiff, they repeatedly and
without justification refused to pay for Dr. Perezs services, resulting in Dr. Perez refusing to
provide further treatments to Plaintiff and terminating their doctor-patient relationship that had
existed for nearly two years.
22.
After they forced Dr. Perez off Plaintiffs case, Defendants changed Plaintiffs
authorized treating physician to Dr. George White.

23.
Plaintiffs workers compensation counsel instructed Defendant WINTERS not to
contact Plaintiff directly, but to route all communications through counsel.
Defendant
WINTERS ignored this instruction on multiple occasions by not only directly contacting
Plaintiff, but also by insisting on attending doctors visits with Plaintiff.
24.
Dr. White determined that as a result of the workplace accident, Plaintiff has a
42% impairment rating.

25.
Because Plaintiff has no fingers and only partial hands, she was unable to perform
even the most basic functions, like brushing her hair or feeding herself, and would be unable to
do so without functional prosthetic hands. Dr. White, therefore, immediately recommended,
after his first appointment with Plaintiff on or about November 17, 2005, that Plaintiff be
evaluated for an electronic prosthesis at the University of Utah, which has prosthetic specialists
with the experience and technological abilities to help someone with a severe injury like
Plaintiffs.
26.
A single functional hand prosthesis costs in excess of $100,000.

Leopold~Kuvin, P.A.

Page 8
27.
Dr. White also recommended on or about November 17, 2005, that Plaintiff be
referred to Pilet Prosthetic Company for cosmetic prostheses, which would costs tens of
thousands of dollars.
28.
When Defendants failed to refer Plaintiff to the University of Utah for a
functional prosthesis evaluation, Dr. White again, on or about January 5, 2006, recommended
that Plaintiff be sent to the University of Utah, stating in his report: I think she would be a good
candidate for functional prosthesis. They may be able to spare her thumbs and actually just
create a hand prosthesis for her and I still think the Utah orthopedic department at the University
of Utah is the best choice for her where they do extensive prosthetic work.
29.
When Defendants had still failed to arrange for Plaintiff to be evaluated for a
functional prosthesis per Dr. Whites prior orders, Dr. White recommended on or about February
2, 2006 that Plaintiff be evaluated at either the University of Utah or the University of
Massachusetts for custom myoelectric functional prostheses.
30.
Defendants LEE ANN WINTERS and MARJORIE McCLELLAND, as agents of
Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well as other agents/employees of

Defendants SEDGWICK, CIGNA HEALTH, and GENEX, refused to follow Dr. Whites
recommendations because they did not believe it was a medical necessity that Plaintiff receive
functional prostheses to replace the hands that she lost in the workplace accident.
31.
Dr. White ordered on or about March 2, 2006 that it was a medical necessity for
Plaintiff to receive hand prostheses in order to return function and limit her disability.
32.
Despite Dr. Whites clear order that functional prosthesis were a medical
necessity for Plaintiff, Defendants LEE ANN WINTERS and MARJORIE McCLELLAND, as
agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well as other
Leopold~Kuvin, P.A.

Page 9
agents/employees of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, continued to

refuse to send Plaintiff to either the University of Utah or the University of Boston for
evaluation.
Instead, they forwarded Plaintiffs records to different universities (such as
University of Miami and Emery Universityneither of which make custom prostheses) and
attempted to convince Plaintiff and Dr. White that Plaintiffs thumbs would have to be
amputated in order for her to be fitted with functional prostheses.
33.
In a letter dated January 9, 2007, James Birmingham, Esq., workers
compensation counsel and agent for Defendant SEDGWICK, misrepresented to Plaintiff that Dr.
White had determined that there was no myoelectric hand . . . currently available on the market
that does not involve amputation of the thumb.
34.
Just days later, in a January 17, 2007 deposition, Dr. White testified that he had
repeatedly recommended that Plaintiff be sent to the University of Utah or the University of
Massachusetts to be evaluated for and fitted with a custom myoelectric functional prosthesis. He
testified:
[A] myoelectric type of prostheses . . . are basically prostheses that can fit
onto the arm and basically provide [Plaintiff] with some grasp and release
type of activity. Theres several issues with her that make her a
particularly difficult candidate to fit for that. One is that she has a thumb
still and her fingers arent there. So we basically are not looking to
replace her thumb, were only looking to replace the fingers. Typically,
these prostheses are designed for patients that have total amputations,
usually at the mid-forearm level and higher. So she would need some kind
of custom housing that that prosthesis would go in. They do make such a
thing except you just have to realize its all custom.
35.
Because of the uniqueness of Plaintiffs amputation injury, Dr. White specifically
recommended that she be evaluated at two specific places: I thought she had really two places
that I knew of that were doing custom housings, which is what she would require. [O]ne is in
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Page 10
Boston at the University of Massachusetts. They have a prosthetic laboratory thats doing it.
The second was at the University of Utah. Theyre the most well-known myoelectric prostheses
institution. They have whats called the Utah Arm. Its just a fancy version of a myoelectric
prosthesis. [B]ecause they make them there, they can do the custom housing that would preserve
her thumb.
36.
Defendants LEE ANN WINTERS and MARJORIE McCLELLAND, as agents of

Defendants SEDGWICK, CIGNA HEALTH, and GENEX, continued to refuse to send Plaintiff
to either of the two recommended universities for evaluation for custom myoelectric prostheses.
Instead, they decided, based on their own limited and insufficient research, that neither university
could help Plaintiff obtain functional prostheses.
37.
In October 2007, Plaintiffs workers compensation counsel received an opinion
from Chris Lake, CPO, LPO, FAAOP, of Advanced Arm Dynamics, that Plaintiff was likely a
candidate for a functional myoelectric prosthesis without undergoing thumb amputation.
Defendants LEE ANN WINTERS and MARJORIE McCLELLAND, as agents of Defendants
SEDGWICK, CIGNA HEALTH, and GENEX, as well as other agents/employees of Defendants
SEDGWICK, CIGNA HEALTH, and GENEX, refused to send Plaintiff for an evaluation,
however.
38.
As of May 2009, Defendants LEE ANN WINTERS and MARJORIE
McCLELLAND, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well

as other agents/employees of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, were
still refusing to send Plaintiff to Advanced Arm Dynamics for an evaluation.
Leopold~Kuvin, P.A.

Page 11
39.
Plaintiffs workers compensation counsel also determined by contacting Phil
Stevens at the University of Utah that Plaintiff was a candidate for functional prostheses from the
University without amputation of her thumbs.
40.
Defendants did not approve Plaintiff for an evaluation at the University of Utah
for myoelectric prostheses until July 15, 2009, almost 4 years after first recommended by Dr.
White. Plaintiff was finally fitted with functional prostheses in October 2009.
41.
Although Plaintiff had no functional prostheses, and was unable to perform even
the most basic functions for herself or her three children, Defendants LEE ANN WINTERS and
MARJORIE McCLELLAND, as agents of Defendants SEDGWICK, CIGNA HEALTH, and
GENEX, as well as other agents/employees of Defendants SEDGWICK, CIGNA HEALTH, and
GENEX, refused to provide Plaintiff with any attendant care for approximately 17 months,
forcing Plaintiff to turn to her minor children for help with all activities, including the
maintenance of her feminine hygiene.
42.
During the January 17, 2007 deposition, Dr. White testified that Plaintiff needed
attendant care.
Despite this, Defendants LEE ANN WINTERS and MARJORIE
McCLELLAND, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well

as other agents/employees of Defendants SEDGWICK, CIGNA HEALTH, and GENEX,
continued to deny her any attendant care until August 3, 2007, when Defendants finally relented
the day the matter was scheduled to be heard by the Judge of Compensation Claims.
43.
Defendants conduct in depriving Plaintiff of functional prostheses for nearly 4
years was a constant source of severe emotional distress for Plaintiff.

44.
Plaintiff received mental health counseling and treatment from Maria Lozano,
M.D., and others, on a frequent basis. Plaintiff repeatedly expressed in counseling that the
Leopold~Kuvin, P.A.

Page 12
Defendants failure to provide her with functional prostheses caused her severe emotional
distress:
a. On or about June 28, 2006, Plaintiff, in a depressed mood, expressed
to Dr. Lozano her frustration with Defendants claims that her need for
prostheses was merely cosmetic.
b. On or about July 11, 2006, Plaintiff, in a depressed mood, expressed to
Dr. Lozano her frustration with trying to get Defendants to approve her
new prostheses.
The doctor noted this is an ongoing source of
depressive thoughts for Plaintiff.

c. On or about August 23, 2006, Plaintiff, in a depressed mood,
expressed to Dr. Lozano that she was depressed and upset because
there was no progress towards getting her prosthetic hands.
d. On or about September 12, 2006, Plaintiff, in a depressed mood,
expressed to Elias Gongora, Ph.D., her frustration regarding
Defendants failure to approve her prosthetic hands and their claims
that new prostheses were not medically necessary.
e. On or about June 15, 2007, Plaintiff, in a depressed mood, expressed
to Dr. Gongora her frustration with Defendants failure to provide her
with permanent prostheses and their failure to even pay for her
temporary prostheses.
f. On or about September 11, 2008, Plaintiff, in a depressed mood,
expressed to Dr. Lozano her stress and frustration over the fact that she
still did not have functional prostheses.
Leopold~Kuvin, P.A.

Page 13
45.
Another great source of emotional distress for Plaintiff was Defendants failure to
timely approve and provide her with scar revision surgery performed by a qualified plastic
surgeon.
46.
On or about April 24, 2008, Dr. Lozano gave Plaintiff a referral for scar revision
consultation, finding Plaintiff was suffering psychologically due to the large and noticeable scar
on her right arm caused by the free flap surgery.
47.
Defendants LEE ANN WINTERS, MARJORIE McCLELLAND, and MARY
WILSON, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well as

other agents/employees of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, refused to
authorize Plaintiff to see a plastic surgeon for a scar revision evaluation. Instead, Defendants
referred Plaintiff to Dr. Jerry Rubin, a hand doctor with a disciplinary history with the Florida
Department of Health.
48.
After Defendants LEE ANN WINTERS, MARJORIE McCLELLAND, and
MARY WILSON, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as

well as other agents/employees of Defendants SEDGWICK, CIGNA HEALTH, and GENEX,
failed to authorize Plaintiff for a scar revision consultation with a plastic surgeon, Laurence
Brenner, MD, in October 2008, referred Plaintiff to plastic surgeon Frank Steig for revision of
the scar.
49.
Defendants LEE ANN WINTERS, MARJORIE McCLELLAND, and MARY
WILSON, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well as

other agents/employees of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, did not
authorize Dr. Steig to perform Plaintiffs scar revision surgery because he does not accept
Leopold~Kuvin, P.A.

Page 14
workers compensation patients. Instead, Defendants advised Plaintiff in January 2009 that Dr.
Mark McDonough was authorized to evaluate and treat her.
50.
Dr. McDonough was not certified as a health care provider for the treatment of
Florida workers compensation patients and had a history of failing to meet the expectations of
his patients.
51.
Because Dr. Steig was not available, Dr. Brenner referred Plaintiff to Dr.
Bhupinder Gupta as an alternative plastic surgeon.

52.
Instead of authorizing Plaintiff to see Dr. Gupta, one of the few plastic surgeons
possessing the qualifications to correct Plaintiffs scar, Defendants LEE ANN WINTERS, and
MARY WILSON, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, tried
to pressure Plaintiff to undergo surgery with Dr. McDonough, despite their knowledge that he
was not a certified workers compensation health care provider.
53.
After causing unnecessary delay of almost 2 years by refusing to authorize a
certified workers compensation health care provider to treat Plaintiff, Defendants LEE ANN
WINTERS and MARY WILSON, as agents of Defendants SEDGWICK, CIGNA HEALTH, and
GENEX, finally, in December 2009, approved Dr. Gupta to treat Plaintiff.
54.
After Dr. Gupta evaluated Plaintiff and found her to be a good candidate for the
scar revision surgery, Defendants LEE ANN WINTERS and MARY WILSON, as agents of
Defendants SEDGWICK, CIGNA HEALTH, and GENEX, began harassing Dr. Gupta by
frequently contacting his office and pressuring him to limit his fees to those provided in the
workers compensation fee schedule, and caused Dr. Gupta to terminate his doctor-patient
relationship with Plaintiff and refuse to perform her surgery. Thus, Dr. Gupta was the second
Leopold~Kuvin, P.A.

Page 15
doctor to terminate his medical relationship with the Plaintiff due to the harassment instituted by
Defendants.
55.
Defendants failure to timely appoint an appropriate plastic surgeon, and their
harassive behavior towards Dr. Gupta, has prevented Plaintiff from undergoing the scar revision
surgery, thereby prolonging and exacerbating for a period of 3 years the emotional distress
Plaintiff has as a result of the scar.
56.
Defendants accepted Plaintiff as permanently and totally disabled as a result of
the workplace accident on or about June 21, 2006, two years after the amputation of Plaintiffs
fingers.
57.
Despite that fact that they accepted Plaintiff as permanently and totally disabled,
Defendants LEE ANN WINTERS and MARJORIE McCLELLAND, as agents of Defendants

SEDGWICK, CIGNA HEALTH, and GENEX, as well as other agents/employees of Defendants
SEDGWICK, CIGNA HEALTH, and GENEX, began a campaign of subjecting Plaintiff to
vocational assessments in order to try and send her back to workeven before they had provided
her with the functional prostheses she needed to conduct even the most basic activities of daily
living.
58.
Defendants even attempted to put Plaintiff back to work at Spartan Staffing/Labor
Readythe employer she worked for when she suffered to horrific accident that resulted in the
amputation of her fingers.
59.
Defendants conduct in delaying and denying medical care, attendant care,
medical treatment, and medically necessary devices to Plaintiff has caused her to suffer injuries
subsequent to and distinct from her original workplace injury.
Leopold~Kuvin, P.A.

Page 16
60.
Plaintiff has suffered severe emotional distress as a result of the Defendants
conduct. She has had to endure years without functioning prosthetic hands, during which time
she could not perform even the most basic tasks and was dependent on help from others.
Despite her dependence, Defendants failed to provide any attendant care for Plaintiff for
almost two years, causing her to depend on her 3 minor children for assistance.
And,
Defendants have failed to provide Plaintiff with authorization to undergo scar revision surgery
with a qualified plastic surgeon, thereby compounding her severe emotional distress.
61.
Defendants refused to provide Plaintiff with the medical care, attendant care,
medical treatment, and medically necessary devices that she so desperately needed and to
which she was legally entitled, and shamelessly used the workers compensation system as a
tool to cause Plaintiff harm that is independent of and subsequent to her workplace injury.
COUNT I
INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS
AGAINST ALL DEFENDANTS
62.
Plaintiff realleges paragraphs 1 - 61 as if fully set forth herein.
63.
As an insured under the policy of insurance with Defendant SEDGWICK,
Plaintiff was entitled to receive workers compensation benefits, including, but not limited to,
prompt receipt of medicines and healthcare.
64.
Defendants are liable for the intentional infliction of emotional distress that was
committed by its employees and/or agents and/or apparent agents, who committed the following
intentional and outrageous acts and/or omissions:
a. Delayed and denied authorization for essential and medically necessary care,
treatment, and devices;
b. Delayed and denied referral to appropriate medical specialists;
Leopold~Kuvin, P.A.

Page 17
c. Delayed and/or denied paying benefits to Plaintiff;

d. Wrongfully attempting to deprive Plaintiff of necessary medical treatment,
care and devices;
e. Denying authorization for attendant care services; and
f. Aggressively subjecting Plaintiff to vocational assessments despite accepting
Plaintiff as permanently and totally disabled and refusing to provide Plaintiff
with functional hand prostheses to enable her to perform even the most basic
of functions.
65.
Defendants CIGNA HEALTH and GENEX are vicariously liable for the actions
of Defendant WINTERS because Defendant WINTERS was the agent of Defendants CIGNA
HEALTH and GENEX and was acting within the course and scope of the agency relationship at
all times material hereto.
66.
Defendant SEDGWICK is vicariously liable for the actions of Defendant CIGNA
HEALTH, Defendant GENEX, Defendant WINTERS, Defendant McCLELLAND, and

Defendant WILSON because CIGNA HEALTH, GENEX, WINTERS, McCLELLAND, and
WILSON were the agents of Defendant SEDGWICK and were acting within the course and
scope of the agency relationship at all times material hereto.
67.
Defendants knew or should have known that their actions would cause Plaintiff to
suffer severe emotional distress.

68.
Defendants took such tortious actions without any justification and for the sole
purpose of increasing their profits or pleasing their client, Spartan Staffing/Labor Ready, by
avoiding expenditures for care undeniably due Plaintiff under workers compensation law.
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Page 18
69.
Defendants tortious actions were unwarranted, outrageous, and extremely
dangerous to the health of Plaintiff, and are utterly intolerable in a civilized community.
70.
The conduct of the Defendants is the type of conduct that would cause the average
person to exclaim outrageous.

71.
The extreme and outrageous character of the conduct also arises from the unequal
position of the parties and Plaintiffs complete reliance on Defendants for her ability to receive
medical care and treatment. The outrageousness of Defendants conduct is heightened because
they asserted and had the power to severely damage Plaintiff by restricting her access to
necessary medical care, treatment, and devices, and by delaying and restricting her access to the
monetary compensation she was entitled to under the workers compensation system.
72.
The extreme and outrageous character of the conduct also arises from Defendants
specific knowledge that Plaintiff was peculiarly susceptible to emotional distress due to her
physical and emotional disabilities and dire financial condition.
The outrageousness of
Defendants conduct is heightened because they proceeded on a course of conduct in wrongfully

denying and delaying Plaintiffs access to necessary medical care and treatment despite this
knowledge.
73.
Defendants tortious actions constitute an actionable tort, separate and apart from
the statutory obligation of Defendants, by and through their agents, to provide and authorize
medical benefits for Plaintiff under the Florida Workers Compensation Act.
74.
Defendants tortious actions resulted in injuries to Plaintiff that are separate and
distinct from the workplace injury she suffered on or about June 21, 2004, while working for
Spartan Staffing/Labor Ready.
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Page 19
75.
In conducting these tortious actions, Defendants engaged in unlawful, fraudulent,
and outrageous conduct that goes beyond all bounds of decency and is extreme, outrageous,
shocking, atrocious and utterly intolerable in a civilized society.
76.
Defendants acted with intent to cause Plaintiff severe emotional distress and
physical injury or with reckless disregard of the high probability of causing her severe emotional
distress and physical injury such that Defendants knew or should have known that their actions
would cause Plaintiff severe emotional distress.
77.
As a direct and proximate result of Defendants conduct, Plaintiff suffered severe
emotional distress, personal injury, damage, and loss. The losses are either permanent or
continuing and Plaintiff will suffer the losses in the future.
78.
As a direct result of Defendants conduct, Plaintiff was obligated to retain
attorneys to represent her interests in this matter, to whom she has agreed to pay reasonable
attorneys fees and costs.
79.
Any and all conditions precedent to bringing this action have been met or waived.
WHEREFORE, Plaintiff LEGNA RAMOS COMAS demands judgment against

SEDGWICK
CLAIMS
MANAGEMENT
SERVICES,
INC.;
CIGNA
HEALTH
MANAGEMENT, INC.; GENEX SERVICES, INC.; LEE ANN WINTERS; MARJORIE

McCLELLAND; and MARY WILSON for damages, attorneys fees pursuant to section
627.428, Florida Statutes, costs, pre-judgment and post-judgment interest, and for such other and
further relief that this Court deems just and proper.
Leopold~Kuvin, P.A.

Page 20
COUNT II
BREACH OF THE IMPLIED DUTY OF GOOD FAITH
AGAINST THE CORPORATE DEFENDANTS
80.
Plaintiff realleges paragraphs 1-61 as if fully set forth herein.
81.
At all material times, Defendant SEDGWICK and its employees administered
Plaintiffs workers compensation claims pursuant to a contract with Spartan Staffing/Labor

Ready.
82.
At all material times, Defendants CIGNA HEALTH and GENEX, and their
employees, administered Plaintiffs workers compensation claim pursuant to one or more

contracts with Defendant SEDGWICK.
83.
Plaintiff was an intended third-party beneficiary of all of these contracts because
they were intended to directly and primarily benefit Plaintiff.

84.
By virtue of Plaintiffs status as a third-party beneficiary under these contracts,
Defendants were contractually obligated to provide Plaintiff with legally guaranteed workers
compensation benefits.
85.
Defendants SEDGWICK, CIGNA HEALTH, and GENEX had an implied duty to
administer Plaintiffs claim and provide these benefits in good faith.

86.
Defendants SEDGWICK, CIGNA HEALTH, and GENEX breached their
contractually implied good faith duties by:

a. Delaying and denying authorization for essential and medically necessary
care, treatment, and devices;
b. Delaying and denying referral to appropriate medical specialists;
c. Delaying and/or denying paying benefits to Plaintiff;
Leopold~Kuvin, P.A.

Page 21
d. Wrongfully attempting to deprive Plaintiff of necessary medical treatment,

care and devices;
e. Denying authorization for attendant care services; and
f. Aggressively subjecting Plaintiff to vocational assessments despite accepting
Plaintiff as permanently and totally disabled and refusing to provide Plaintiff
with functional hand prostheses to enable her to perform even the most basic
of functions.
87.
As a direct result of these breaches, Plaintiff has sustained damages. Plaintiff has
been unable to receive the necessary care, treatment, and devices needed to treat her workplace
injuries, has suffered extreme pain and severe emotional distress, and has suffered injuries
subsequent to and distinct from her original workplace injury. The losses are either permanent or
continuing and Plaintiff will suffer the losses in the future.
88.
As a direct result of these breaches, Plaintiff was obligated to retain attorneys to
represent her interests in this matter, to whom she has agreed to pay reasonable attorneys fees
and costs.
89.

SEDGWICK
CLAIMS
MANAGEMENT
SERVICES,
INC.;
CIGNA
HEALTH
MANAGEMENT, INC.; and GENEX SERVICES, INC. for damages, attorneys fees pursuant to
section 627.428, Florida Statutes, costs, pre-judgment and post-judgment interest, and for such
other and further relief that this Court deems just and proper.
Leopold~Kuvin, P.A.

Page 22
COUNT III
BREACH OF FIDUCIARY DUTY
AGAINST CORPORATE DEFENDANTS
90.
91.
Defendant SEDGWICK, CIGNA HEALTH, and GENEX owed Plaintiff a
fiduciary duty by virtue of their exclusive ability to authorize or deny Plaintiffs workers
compensation claim and her receipt of medical care, treatment, and devices for the injuries she
sustained in the workplace accident. This fiduciary duty required Defendants to place the
interests of Plaintiff above their own financial interests.
92.
This fiduciary duty required Defendants SEDGWICK, CIGNA HEALTH, and
GENEX to authorize coverage for Plaintiff in good faith and to protect her health and well-being.
93.
Defendants SEDGWICK, CIGNA HEALTH, and GENEX breached their
fiduciary duty by denying Plaintiffs claim for workers compensation coverage and provision of
benefits, including medical care, treatment, and devices without reasonable basis and despite
their knowledge that Plaintiff, due to her dire financial circumstances and the high costs of
functional prostheses, was completely dependent on Defendants for access to any medical care,
treatment, or devices.
94.
Defendants SEDGWICK, CIGNA HEALTH, and GENEX acted in this manner
although they knew or should have known that without the requested care, treatment, and
devices, Plaintiffs condition would deteriorate, she would suffer extreme pain and suffering, she
would suffer injuries subsequent to and distinct from the workplace injury, and she would suffer
extreme emotional distress.
95.
As a direct and proximate cause of Defendants SEDGWICK, CIGNA HEALTH,
and GENEXs breach of fiduciary duty, Plaintiff has sustained damages. Plaintiff has been
Leopold~Kuvin, P.A.

Page 23
unable to receive the necessary care, treatment, and devices needed to treat her workplace
injuries, has suffered deteriorated health, has suffered injuries subsequent to and distinct from
her original workplace injury, and has endured extreme pain and suffering and suffered severe
emotional distress. The losses are either permanent or continuing and Plaintiff will suffer the
losses in the future.
96.
As a direct result of Defendants SEDGWICK, CIGNA HEALTH, and GENEXs
breaches, Plaintiff was obligated to retain attorneys to represent her interests in this matter, to
whom she has agreed to pay reasonable attorneys fees and costs.
97.

SEDGWICK
CLAIMS
MANAGEMENT
SERVICES,
INC.;
CIGNA
HEALTH
MANAGEMENT, INC.; and GENEX SERVICES, INC. for damages, attorneys fees pursuant to
section 627.428, Florida Statutes, costs, pre-judgment and post-judgment interest, and for such
other and further relief that this Court deems just and proper.
COUNT IV
GROSS NEGLIGENCE
AGAINST ALL DEFENDANTS
98.
99.
Defendants had a duty to process Plaintiffs workers compensation claim and
authorize coverage for medical care, treatment, and devices needed as a result of Plaintiffs
workplace injury in accordance with Floridas workers compensation law.
100.
Defendants breached this duty by denying Plaintiffs claim for workers
compensation coverage, including medical care, treatment, and devices without legitimate
justification.
Leopold~Kuvin, P.A.

Page 24
101.
Defendants committed these actions in the face of the clear and present danger
posed by the situation in that Defendants knew that Plaintiff could not function without
functional prostheses and that the lack of such prostheses was causing Plaintiff great and
prolonged depression and severe emotional distress.
102.
Defendants were aware of the clear and present danger posed by the situation, but
refused to authorize Plaintiff to be evaluated for functional prostheses for 4 years, and continued
to deny and delay other necessary medical care or treatment, such as delaying for 3 years the
revision of the scar that was also causing Plaintiff to suffer depression, pain, and severe
emotional distress.
103.
Defendants acted in this manner although they knew or should have known that
without the requested care and treatment, it was likely that Plaintiffs condition would
deteriorate, she would suffer extreme pain and suffering, she would suffer injuries subsequent to
and distinct from the workplace injury, and she would suffer extreme emotional distress.
104.
Defendants CIGNA HEALTH and GENEX are vicariously liable for the actions
of Defendant WINTERS because Defendant WINTERS was the agent of Defendants CIGNA
HEALTH and GENEX and was acting within the course and scope of the agency relationship at
all times material hereto.
105.
Defendant SEDGWICK is vicariously liable for the actions of Defendant CIGNA
HEALTH, Defendant GENEX, Defendant WINTERS, Defendant McCLELLAND, and

Defendant WILSON because CIGNA HEALTH, GENEX, WINTERS, McCLELLAND, and
WILSON were the agents of Defendant SEDGWICK and were acting within the course and
scope of the agency relationship at all times material hereto.
Leopold~Kuvin, P.A.

Page 25
106.
As a direct and proximate cause of Defendants breach of this duty, Plaintiff has
sustained damages. Plaintiff has been unable to receive the necessary care, treatment, and
devices needed to treat her workplace injuries, has suffered deteriorated health, has suffered
injuries subsequent to and distinct from her original workplace injury, and has endured extreme
pain and suffering and severe emotional distress. The losses are either permanent or continuing
and Plaintiff will suffer the losses in the future.
107.
Defendants conduct was so reckless or wanting in care that it constituted a
conscious disregard or indifference to the life, safety, or rights of Plaintiff.

108.
As a direct result of Defendants breach of duty, Plaintiff was obligated to retain
attorneys to represent her interests in this matter, to whom she has agreed to pay reasonable
attorneys fees and costs.
109.

SEDGWICK
CLAIMS
MANAGEMENT
SERVICES,
INC.;
CIGNA
HEALTH
MANAGEMENT, INC.; GENEX SERVICES, INC.; LEE ANN WINTERS; MARJORIE

McCLELLAND; and MARY WILSON, for damages, attorneys fees pursuant to section
627.428, Florida Statutes, costs, pre-judgment and post-judgment interest, and for such other and
further relief that this Court deems just and proper.
Leopold~Kuvin, P.A.

Page 26
DEMAND FOR TRIAL BY JURY

Plaintiff hereby demands a trial by jury.
Dated this 17th day of May, 2011.
Respectfully Submitted,
LEOPOLD~KUVIN, P.A.
2925 PGA Blvd., Suite 200
Palm Beach Gardens, FL 33410
Phone: 561-515-1400
Fax: 561-515-1401
s/Theodore J. Leopold
THEODORE J. LEOPOLD, Esq.
Florida Bar No. 705608
Email: tleopold@leopoldkuvin.com
DIANA L. MARTIN, Esq.
Florida Bar No. 624489
Email: dmartin@leopoldkuvin.com
Leopold~Kuvin, P.A.

Workers Compensation Florida Case Ramos-V-sedgwick-complaint

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Workers Compensation Florida Case Ramos-V-sedgwick-complaint

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IN THE CIRCUIT COURT OF THE

NINTH JUDICIAL CIRCUIT, IN AND

LEGNA RAMOS COMAS,

MANAGEMENT, INC., a foreign corporation; GENEX SERVICES, INC., a foreign

Ramos Comas v. Sedgwick Claims, et. al.

Defendant SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., is an

Defendant CIGNA HEALTH MANAGEMENT, INC., is a Delaware corporation

Upon information and belief, Defendant Cigna Health Management regularly

Ramos Comas v. Sedgwick Claims, et. al.

within Florida; or breaching a contract in Florida by failing to perform acts required to be

Defendant GENEX SERVICES, INC., is a Pennsylvania corporation with its

Defendant LEE ANN WINTERS, is a Florida registered nurse, license number

WINTERS was the authorized agent of her

Defendant MARJORIE McCLELLAND is a Florida resident who, at all times

relevant to this complaint, was employed as a claims adjuster by Defendant SEDGWICK.

Ramos Comas v. Sedgwick Claims, et. al.

At all material times and pursuant to one or more contractual relationships,

Defendant SEDGWICK provided workers compensation coverage to Spartan Staffing/Labor

At all material times and pursuant to one or more contractual relationships,

Ramos Comas v. Sedgwick Claims, et. al.

At all times material hereto, Defendant CIGNA HEALTH MANAGEMENT,

Defendants SEDGWICK, CIGNA HEALTH MANAGEMENT, and GENEX

Ramos Comas v. Sedgwick Claims, et. al.

Ramos Comas v. Sedgwick Claims, et. al.

treating Plaintiff on a regular basis, and was authorized to do so by Defendants pursuant to

authorized treating physician to Dr. George White.

Plaintiffs workers compensation counsel instructed Defendant WINTERS not to

contact Plaintiff directly, but to route all communications through counsel.

42% impairment rating.

A single functional hand prosthesis costs in excess of $100,000.

Ramos Comas v. Sedgwick Claims, et. al.

When Defendants failed to refer Plaintiff to the University of Utah for a

Defendants LEE ANN WINTERS and MARJORIE McCLELLAND, as agents of

Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well as other agents/employees of

Ramos Comas v. Sedgwick Claims, et. al.

agents/employees of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, continued to

Instead, they forwarded Plaintiffs records to different universities (such as

In a letter dated January 9, 2007, James Birmingham, Esq., workers

Because of the uniqueness of Plaintiffs amputation injury, Dr. White specifically

Ramos Comas v. Sedgwick Claims, et. al.

Defendants LEE ANN WINTERS and MARJORIE McCLELLAND, as agents of

Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well as other agents/employees of

In October 2007, Plaintiffs workers compensation counsel received an opinion

As of May 2009, Defendants LEE ANN WINTERS and MARJORIE

McCLELLAND, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well

Ramos Comas v. Sedgwick Claims, et. al.

Plaintiffs workers compensation counsel also determined by contacting Phil

Despite this, Defendants LEE ANN WINTERS and MARJORIE

McCLELLAND, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well

Defendants conduct in depriving Plaintiff of functional prostheses for nearly 4

years was a constant source of severe emotional distress for Plaintiff.

Ramos Comas v. Sedgwick Claims, et. al.

The doctor noted this is an ongoing source of

depressive thoughts for Plaintiff.

Ramos Comas v. Sedgwick Claims, et. al.

Defendants LEE ANN WINTERS, MARJORIE McCLELLAND, and MARY

WILSON, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well as

After Defendants LEE ANN WINTERS, MARJORIE McCLELLAND, and

MARY WILSON, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as

Defendants LEE ANN WINTERS, MARJORIE McCLELLAND, and MARY

WILSON, as agents of Defendants SEDGWICK, CIGNA HEALTH, and GENEX, as well as

Ramos Comas v. Sedgwick Claims, et. al.

Bhupinder Gupta as an alternative plastic surgeon.

After causing unnecessary delay of almost 2 years by refusing to authorize a