Kaiser Doctor Blew Her Disability Claim, Patient Says

11-6-2013 21:30:00

     LOS ANGELES (CN) - A Kaiser patient's long-term disability claim was wrongly denied because of an inaccurate report from an unqualified Kaiser doctor who was only supposed to provide pain management, she claims in a lawsuit filed in Los Angeles County Superior Court.
     Deon Marcelin-Jackson sued Kaiser Permanente and Esther Kim, M.D. for negligence as and sued Liberty Mutual Insurance Company and The Liberty Life Assurance Company of Boston (LLAC) for breach of contract and insurance bad faith.
     Marcelin-Jackson, an administrative assistant for 23 years at the University of California at Los Angeles (UCLA), was found to be totally and permanently disabled due to work-related neck and spine injuries, according to her complaint. She says that her primary treating physician, non-party Dr. Richard Emmanuel, made the permanent disability determination and, although she was treated and evaluated by other doctors and had physical therapy, her work restrictions remained in place for a year and a half.
     When Kaiser took over her case, non-party Dr. Duane Collins became her new primary physician and “referred plaintiff to Kaiser Permanente Pain management Clinic where plaintiff was assigned to Dr. Esther Kim, who was consulted solely for pain management and medications,” the complaint says.
     However, the complaint goes on to say that Dr. Kim reported to Dr. Gail Brown, who was affiliated with the defendant insurance companies, that Marcelin-Jackson “had no major functional restrictions, from her perspective, and agreed with Dr. Brown that plaintiff could resume to full time work. However, Dr. Kim is not a disability evaluator, and subsequently reported in a correspondence dated July 18, 2011, that she had no authority to make this decision or report her opinion to Dr. Brown regarding disability and work status, because ‘it is out of [her] scope of practice and we do not make work disability determinations here in the pain clinic.’ However, defendants Liberty and LLAC relied on defendant Dr. Kim and Kaiser Pain Management’s opinion in denying plaintiff’s long term disability benefits.” [Brackets in complaint.]
     Marcelin-Jackson says she was subsequently re-evaluated by her original primary treating physician, Dr. Emmanuel, whose opinion was that she remained permanently disabled.
     Plaintiff seeks general, special, actual and compensatory damages, interest, exemplary and punitive damages, attorney’s fees and a jury trial.
     She is represented by Christopher B. Ellison of Ellison & Associates in Playa del Rey.