Jury Finds Pinnacol Benefits Denial "Unacceptable"

Pinnacol E-mails Celebrated Denial Of Denver Man's Workers Compensation Claim

The state’s largest worker’s compensation insurance company denied a Denver man’s claim, celebrating the denial in e-mails, a CALL7 Investigation found.

Workers comp provider Pinnacol Assurance lost a lawsuit by Michael Schuessler claiming the company improperly denied his claim.

“I got denied,” Schuessler told CALL7 Investigator Tony Kovaleski. “And I got unjustly denied.”

Schuessler, a construction and maintenance worker who was injured in 2007, said it took him three years to get to court. Pinnacol claimed Schuessler was not injured.

“Michael, essentially they said you were faking it?” Kovaleski asked.

“Yes,” Schuessler said. The claims adjuster said, “You’re denied. As far as I am concerned you are faking it. You are sitting at home on the couch, eating bon-bons and trying to collect a big check. Period. And it crushed me."

Schuessler was installing a 100-pound swamp cooler at work when it slipped and hit him in the head and shoulder, herniating two discs in his spine.

“I am not the man I use to be,” he said. “It makes it really difficult. There's no milking here.”

Pinnacol has been the center of controversy and the focus of a series of CALL7 Investigations. Last year, the legislature tried to take the agency’s surplus to help fill a budget gap and Pinnacol fought the move. Pinnacol, which was set up by the state and operates as a quasi-public agency, was criticized for large bonuses and lavish spending.

Last year, CALL7 Investigators showed Pinnacol spent hundreds of thousands of dollars on booze-filled trips and luxury golf vacations. When Kovaleski followed Pinnacol employees to a golf outing at Pebble Beach earlier this year, Pinnacol Chief Operating Officer Ken Ross threatened Kovaleski and had to be restrained. Kovaleski was asking whether it was a conflict to have the company pay for the luxury trip for the company’s board members, who are appointed by the governor and are tasked with overseeing expenses and compensation for top executives.

A committee investigating Pinnacol also heard from employees who say they were improperly denied benefits. Schuessler’s case exposed a culture inside the company that encourages denying legitimate claims, Schuessler’s attorney Jennifer Bisset said.

Bisset pointed to a series of e-mails she obtained after Pinnacol denied Schuessler’s claim.

“It reflects an internal attitude of actually celebrating over denying the claim,” she said.

The e-mails between two Pinnacol employees talk about D1, which means a claim will be denied.

“Ha, ha! Ok, sounds good to me. D1 it is,” said the memo that ends with the word “smile” and a smiley face.

After the adjuster called to tell Schuessler he was denied, the adjuster wrote in an email: “OOOOOOOOOHHH, is he pissed.”

“What do you think of Pinnacol Assurance?” Kovaleski asked.

“I don't think very highly of them,” Schuessler said. “Because they are in a deny, deny, deny posture.”

Jurors awarded Schuessler $325,000 in emotional distress after a two-week trial, saying Pinnacol improperly denied Schuessler’s claim. Kovaleski spoke to three jurors who criticized Pinnacol for unfair treatment of an injured worker.

“Pinnacol, to deny this man coverage and to make him go through all these legal channels, is just absolutely absurd,” said Tom Borak, one of the jurors. “I would like them to take away the fact that this type of behavior is unacceptable. This is not something that the State of Colorado is going to stand for.”

During a deposition Pinnacol officials said no one was disciplined for the memo, but after the verdict the author of the memo was released from his employment.

Schuessler said he hopes his victory will show other workers they need to fight for their benefits.

“I want people to know (if) you are legitimately hurt, there are people out there who can help you and you can win," Schuessler said.

But Pinnacol is asking for a new trial, saying the award is excessive and the judge should have dismissed the case.

Pinnacol and their attorney declined comment on the case.

"As you are aware, the Michael Schuessler case remains in the courts," Pinnacol said in written statement. "It is Pinnacol’s long-standing policy not to comment on matters that are in litigation nor do we comment on personnel matters."