Archive for January, 2011
Doyle Raizner filed suit against Travelers Insurance Company and its adjuster on January 31, 2011, in a workers’ compensation bad faith action. The suit was filed on behalf of an employee who was injured while working in January 2009. Without any appropriate investigation, Travelers denied that the employee had been injured, delaying his medical and income benefits. Even after agreeing that the employee had been injured at work, Travelers continued to deny the severity of his injury, forcing him to go through an administrative hearing with the Texas Department of Insurance and unreasonably delaying his recovery from the injury and his return to work.
Doyle Raizner stands with this injured employee in his continuing struggle against Travelers and its adjuster.
The Texas Department of Insurance on January 14, 2011, released final disciplinary decisions for violations of Division of Workers’ Compensation rules. Among these fines were the following insurer violations:
-American Guarantee & Liablity Insurance Company ($30,000): Failure to comply with TDI orders; Failure to pay for preauthorized medical services; Failure to initiate income benefits.
- Hartford ($78,000): Faiure to comply with TDI orders; Failure to pay benefits according to Designated Doctor; Failure to timely pay medical bills; Failure to pay for preauthorized medical services.
- AIG / Chartis [New Hampshire Insurance Company] ($40,000): Failure to pay ordered income benefits; Failure to comply with TDI orders; Failure to timely pay medical bills.
- Old Republic Insurance Company ($41,000): Failure to timely respond to medical bill inquiry; Failure to pay for preauthorized medical services; Failure to submit accurate medical bill information to DWC; Failure to timely dispute medical bill; Failure to timely pay medical bills.
- Travelers ($55,000): Failure to take final action or dispute medical bills; Failure to timely initiate income benefits; Failure to pay for preauthorized medical services; Failure to pay for medical bills under DWC rules.
- Travelers ($60,000): Failure to take action on medical bills; Failure to explain medical benefit denial; Failure to attend Contested Case Hearing without good cause; Failure to timely initiate benefits; failure to comply with TDI medical orders; Failure to pay Temporary Income Benefits; Failure to timely respond to prescription expenses.
- Travelers ($20,000): Failure to comply with TDI medical orders; Failure to pay for preauthorized medical serices; Failure to explain medical benefit denials.
These are fines paid to the state for violations of DWC rules and the Texas Insurance Code. Doyle Raizner is committed to helping individuals who have been harmed by such violations when they amount to bad faith activity by an insurance carrier. Click here for more information about the wrongful handling of workers compensation cases.
The complete list
On January 21, 2011, Doyle Raizner filed suit against Zurich American Insurance Company and its adjusters on behalf of an injured employee who was denied medical care under his employers’ workers’ compensation policy. Zurich approved surgery for the employee’s hernia, but then denied follow-up treatment that his doctors requested, leading to severe and permanent damage to his reproductive system.
Doyle Raizner is proud to stand with the injured employee and hold Zurich and its adjusters accountable for their denial of medical care.
On January 6, 2011, the Texas State Office of Administrative Hearings (SOAH) ordered that insurers cannot avoid the Prompt Payment Statute of the Texas Insurance Code. The Prompt Payment Statute requires insurers to decide whether they will accept or deny a claim within 15 days after recieving proof of the claim from the insured homeowner. Under special circumstances, the period can be extended to a total of 60 days. The Texas Windstorm Insurance Association (TWIA) petitioned SOAH to consider whether they would be permitted to extend this period further in order to request documents from third parties, such as claim adjusters, fact witnesses, and experts. This extension process has been repeatedly abused to avoid timely payment to homeowners in desperate straits.
Upon the review of submitted briefs from TWIA and the Texas Department of Insurance, Richard R. Wilfong, the SOAH administrative judge presiding, ruled that the Texas Insurance Code does not permit an insurer to delay its obligaitons to pay claims promptly by simply claiming they need further documents by third parties.
TWIA is an insurer heavily involved in Hurricane Ike claims. The decision, however, could have ramifications beyond property insurance claims. It helps to eliminate an avenue for insurance carriers to delay payment to people in need after a disaster or accident and avoid their prompt payment obligations by making unlimited demands for “additional information” from third parties.
The decision is available here.
Today, Jeff Raizner participated in a panel discussion entitled Hurricane Litigation: Homeowner’s Update. The co-panelist was Brian Chandler and the discussion was moderated by Barrie Beer. The panel focused on the background of the special dockets for Hurricane Ike related litigation in Galveston and Houston, and brought both plaintiff and defense perspectives on the status of the Hurricane Ike docket, the management of discovery, mediations and appraisal of hurricane related cases.
Doyle Raizner filed a workers’ compensation bad faith lawsuit on January 14, 2011, against Wal-Mart (a self-insured employer) and its adjuster on behalf of an employee who was injured while working when she fell in June 2009. Instead of providing appropriate medical treatment, Wal-Mart denied the extent of the employee’s injury, delaying her ability to return to full-duty work. To make matters worse, Wal-Mart then fired the employee for her inability to return to full duty work.
Doyle Raizner remains committed to helping this injured employee in holding responsible Wal-Mart and its adjuster for their actions against her.