The California Court of Appeal, 2nd District granted former San Francisco 49ers George Visger a key victory last month against Travelers Insurance when it rejected Travelers’ appeal petition, and thereby, affirmed the findings of the Workers’ Compensation Appeals Board (WCAB) in favor of Visger.
Visger’s attorneys said that the ruling compels Travelers to pay for long-overdue medical care to this former NFL player.
In the 1980-81 season, Visger played for the 49ers as a defensive lineman. In time, and after multiple concussions, Visger was diagnosed with hydrocephalus, which is the building up of fluid in cavities deep within the brain. The pressure of the fluid can damage brain tissue and cause a large spectrum of impairments in brain function.
In 1984, after three shunt surgeries to drain this fluid, the WCAB “awarded” Visger with 35 percent permanent disability, which amounted to a payment of $10,552.50 for the impairment. However, the award also compelled Travelers Insurance to provide “further medical care as is necessary to cure or relieve from effects of his industrial injury,” according to the plaintiff’s attorneys. However, they claimed, the defendants failed to satisfy the requirement of further care.
In 2012, after six additional shunt surgeries, Visger sued to obtain “meaningful medical treatment” to offset what had become a “gradual decline.”
Plaintiff’s attorney Jonathan Perez, of Asvar Law, alleged that “we contacted Travelers and their counsel to find a way forward, so that the parties could work together to help this injured former player.
“In response, Travelers hired Paradigm, a catastrophic consultancy company to assess Visger’s condition,” according to the firm. “Travelers even hand-picked the Paradigm nurse case manager, Douglas Ardley, to provide the report. On April 10, 2013, Ardley, who himself holds a law degree, met with Chris Asvar and Visger at Zachary’s Pizzeria in Berkeley, California, where he personally assessed Visger based on the extensive medical reports in his possession. Ardley asked whether Visger would agree to an intensive brain injury treatment program. Visger said he was ready to do whatever it takes to get better.
“Ardley would later testify that once Travelers learned about the costly brain injury treatment recommended in his report, Travelers immediately asked Ardley to bury the report and not issue it. Unfortunately for Travelers, Paradigm had already generated the report that would become the basis for the ensuing litigation over treatment.”
Chris Asvar noted that “in any other branch of insurance industry, except worker’s compensation, this would be the very definition of ‘bad faith’ with serious consequences.
“But Travelers has gotten away with nearly three years of denials and delays of life-saving care that their own experts believe is necessary, because of our broken system here in California.”
Nevertheless, Visger got his legal victory on March 12, 2015. Specifically, the court found that Traveler’s handling of Visger’s physicians’ requests for medical authorizations compelled Travelers to furnish the medical treatment at issue.
Travelers appealed. The WCAB’s 3-judge Appeal Board affirmed, denying reconsideration on October 29, 2015.
Travelers appealed again, this time to the California Court of Appeal, 2nd District (case B268862), but was denied once.
