Archive for new-filings
A Phoenix police detective has joined 10 firefighters in a RICO (Racketeer Influenced and Corrupt Organizations Act) lawsuit against York Risk Services (“York”). The lawsuit asserts that these first responders’ workers compensation claims were denied though a scheme York designed to withhold and/or wrongfully deprive these first responders of their worker’s compensation benefits.
This newly added client was transporting evidence in her police car when she was struck in a side collision by another motor vehicle. She immediately experienced debilitating pains throughout her lower back, but bypassed the emergency room to ensure the safe passage of evidence and protect the chain of custody. Our client timely reported her injury and initially received a fusion surgery of her L5-SI in June of 2010.
Though a treating physician took her off work and found additional back fusion surgery was needed, an adjuster for York ignored these medical findings, and closed her claim for benefits. York then falsely alleged that our client was released to work. This denial was a fraudulent communication as the worker’s comp providers knew our client was not capable of working.
York’s own Independent Medical Examiner (IME) along with the The Industrial Commission of Arizona (ICA) later confirmed the need for surgery and even found the injury was related to an industrial accident. Unfortunately, even after the ICA’s found in favor of our client, there was still a refusal to pay benefits owed. York instead created pretextual excuses which were once again rejected by the Commission. The denials became cyclical. In all, our client received at least three ICA awards and has fought tooth and nail against York for surgery and benefits. Ultimately, benefits were paid, but the delays in paying for these clear medical needs were unjustifiable.
The postponed surgeries caused her permanent disfigurement, even forcing her into early retirement. Our client nearly lost her home to foreclosure as a result of the failure to pay the necessary
Lloyds Underwriters Sued In Federal Court for Breaching Insurance Policy Conditions after Hail Damaged Multiple Apartment Complexes
Doyle Raizner LLP has filed a commercial property insurance lawsuit against Certain Underwriters at Lloyds of London (“Lloyds”), and their adjustment team, for multiple breaches of its insurance contract with the plaintiffs, along with violations of the Texas Insurance Code.
Our clients, two corporations, acquired insurance coverage from Lloyds for three separate apartment complexes, containing 74 distinct housing units, and they paid their premiums faithfully under the insurance contract.
On May 28, 2013, an unbelievable 2-4 feet of hail battered Amarillo, leaving paths of torn shingles and damaging exterior bricks, windows, decks, and HVAC units throughout the properties. The storm of ice opened holes in the apartment buildings, causing water to ruin insulation, plywood, ceiling tiles, and more.
Although our client, like thousands of Amarillo policyholders, honored their end of the insurance contract, Lloyds unfortunately failed to do so. An adjuster with insufficient training was assigned and concluded damage to one complex did not exceed its $4,500.00 deductible, an impossibility due to the storms record-breaking magnitude. Yet an investigation by independent experts documents over $2 million in damages across all three complexes.
Rather than giving proper consideration to the independent expert estimates, the defendants placed their interests of cutting costs above of our clients’ needs, paying only 5% of total damages. This type of conduct is a violation of the duty of good faith and fair dealing insurance companies must maintain with their customers. This duty required Lloyds to seek information that was fair and favorable to our clients and to take all reasonable steps to evaluate and settle the claims. The Texas Insurance Code requires as much, and further mandates prompt payment of claims. Due to Lloyds’ unreasonable denials, proper benefits are still being withheld, greatly exceeding the statutory prompt payment laws in Texas.
The Deceptive Trade Practices Act provides additional protection to consumers who are victims of deceptive, improper, and illegal practices. Lloyds violated his law and engaged
Travelers Insurance Is Liable for Improper Claim Handling after Two Hail Storms Destroyed Plaintiff’s Commercial Property
Doyle Raizner LLP has filed suit against The Travelers Lloyds Insurance Company (“Travelers”) and their assigned adjuster, for claim processing violations following a Dallas area hail storm.
Our client, a small business owner of a complex containing three thriving businesses, purchased property insurance for peace of mind, believing there would be protection in case catastrophe struck. In 2011 and 2012, separate hail storms tore through Dallas, hammering this industrial building and severely impacting the roofs, insulations, ceilings, windows, and HVAC units of each store and their adjoined warehouses.
Upon filing a claim, Travelers responded in ways that would be any business owner’s worst nightmare. An improperly trained and biased adjustment team assigned to the case conducted an inadequate investigation, denying obvious wind and hail damage and failing to pay benefits a reasonable carrier would accept. Though an independent team of building professionals, including engineers, confirmed the damage and provided a damage estimation of $1.6 million dollars, the defendants refused to consider this and decided to recognize only 14% of the total destruction.
This conduct is a clear violation as insurance carriers have a duty to seek out evidence that supports the insured’s claim of loss, instead of acting as adversaries. Relying on investigations that encourage delaying and denying claim benefits is a breach of an insurer’s duty of good faith and fair dealing to the insured.
Storms of any kind can produce chain reactions of property damage. Our client’s wind and hail specialists detailed how hail stones penetrated the Spray polyurethane roof (“SPR”), creating water damage to the layers of insulation and ceilings below. But to cut costs, and in violation of the Texas Insurance Code, the defendants considered the majority of damage pre-existing, blaming the roof’s installation and even innocent building tenants for the extensive water intrusions. These excuses violate the Texas Deceptive Trade Practices Act and constitute fraud.
Our client’s damages are substantial. The denials of proper benefits
Doyle Raizner Sues Safety National and Matrix For Withholding Worker’s Comp Benefits After Nurse Endures Botched Surgery
On behalf of plaintiff, Doyle Raizner LLP filed suit against Safety National Casualty Corporation (“Safety National”), Matrix Absence Management, Inc., (“Matrix”), and the assigned adjuster for their combined efforts in delaying and denying proper worker’s compensations benefits.
On June 4, 2009, our client tore her left meniscus while at work as a full-time nurse for the Yuma Regional Medical Center. Initially, the defendants responded to her claim appropriately, providing payments for surgery and the weeks of physical therapy that followed. Afterwards however, she began experiencing excruciating pain in the area, along with weakness and significant muscle atrophy above the knee.
Apparently deciding that they had paid all that they ever wanted to pay for needed medical care, the defendants sent our client to an Independent Medical Examiner (IME) who provided cortisone injections and concluded the knee “just needs time to heal.” The adjuster then closed the case, noting only a 2% disability. Our client continued facing pain that greatly restricted her ability to walk or engage in any activity requiring normal movement capabilities. Two years later, client’s personal physician discovered that a non-absorbable device from the initial surgery was left inside her knee.
The adjuster responded by requiring her to see yet another IME, who again performed an inadequate examination and determined there was nothing present hindering mobility. In violation of the duty of good faith and fair dealing owed to beneficiaries of worker’s compensation, the defendants failed to consider medical reports favorable to our client and used the IME’s report and other procedural methods to prevent reopening the case and providing proper benefits.
The initial surgery was scheduled for January of 2013, but the defendants refused authorization or payment until the Industrial Commission of Arizona ordered Safety National to provide those benefits. Even after this order, the defendants further suspended treatment by requesting reconsideration of the award. Fifteen months after the initial request, our client finally received authorization for
Doyle Raizner Files Worker’s Comp Bad Faith Suit against New Hampshire Insurance and Aiding Entities
Doyle Raizner LLP filed a worker’s compensation lawsuit against New Hampshire Insurance Company (“New Hampshire”), Helmsman Management Services (“Helmsman”) which is a subsidiary of Liberty Mutual, and the assigned claims adjuster, together (“defendants”), after their wrongful acts in handling plaintiff’s injury claim.
In March of 2012, our client, a devoted and diligent employee of Associated Retina Consultants, fell and injured her knee in the parking lot of her employer’s place of business. A short time after being assigned light duty, she was discharged due to an unavailability of further light duty tasks.
Upon receiving our client’s workers compensation claim, New Hampshire placed an adjuster on the case that deliberately engaged in improper claim processing actions. Our client’s physician recommended knee surgery, but authorization was denied, causing her to ultimately pay for the procedure through her personal insurance more than a year later.
Rather than properly investigate and ensure our client would receive the medical, financial, and other benefits promised to employees of Associated Retina Consultants, this adjuster ignored favorable information to our client, created pre-textual excuses for underpayment, and failed to timely recognize the extent of injury.
The insurance company also assigned Helmsman, a claims management service, which is liable for aiding and abetting New Hampshire in its violations of the Arizona Worker’ Compensation Act and the duties of good faith and fair dealing.
Our client was forced to hire a lawyer to help her secure benefits. After a hearing, The Industrial Commission of Arizona ordered New Hampshire to pay an award covering costs of surgery, medical maintenance, and deductibles, but the insurance agency still has not paid this portion of relief.
Due to a loss of employment, permanent disfigurement, and delayed payments of medical necessities, our client endures needless and preventable sufferings, even facing eviction from her home. The worker’s compensation bad faith lawyers of Doyle Raizner LLP will vigorously fight to protect the rights of this client. Our
Lawsuit Filed Against Commerce and Industry Insurance and AIG Claims for Worker’s Compensation Bad Faith Actions
Doyle Raizner LLP files worker’s comp bad faith lawsuit against Commerce And Industry Insurance Company (“Commerce and Industry”), AIG Claims Inc., (“AIG”), and the assigned claims adjuster for depriving the plaintiff benefits owed after his on-the-job injury.
Our client was a committed commercial truck driver for Western Dairy Transportation. On September 28, 2012, after pulling his trailer across a trucking scale and starting to exit, he felt a profound punching pain in what felt like his kidney. Our client was later diagnosed with severe spinal damage in the form of a left-sided herniated.
Upon receiving our client’s worker’s comp claim, Commerce and Industry and AIG placed an adjuster in charge of processing the claim. Despite physicians noting the dire need of surgery, the defendants’ denied that the injury was work related, though clear documentation provided otherwise, including that of our client’s supervisor. The adjuster then filed a denial – called a Notice of Claim Status form – with the Industrial Commission of Arizona, Claims Division. This improper denial resulted in all medical and income benefits coming to a halt.
In all, the defendants breached their duty of good faith and fair dealing by failing to conduct a reasonable investigation to ensure our client would receive the medical, financial, and other benefits entitled as a beneficiary of workers’ comp. The law requires that worker’s compensation insurers consider information favorable to the insured, and this includes accepting undisputed evidence regarding the claim. The defendant’s instead chose to create pretextual reasons to delay and deny payments to our client, engaging in “outcome-driven” approaches to cut costs.
After a lengthy and completely unnecessary administrative dispute of the improper denial, in March of 2014, the Worker’s Compensation Commission ruled in our client’s favor, ordering payment of all medical, surgical, and hospital benefits beginning from the date of injury. Though our client finally started to receive payments, even these were delayed, causing yet more stress and
Commercial Property Lawsuit Filed Against Mid-Century For Improper Claim Handling After Hidalgo County Hailstorms
Doyle Raizner LLP has filed suit against Mid-Century Insurance Company (“Mid-Century”) and its claims adjuster (together, “defendants”) due to violations of the Texas Insurance Code, Deceptive Trade Practices Act, and other consumer protection laws.
Our client acquired insurance coverage for two apartment complexes, consistently paying premiums to protect these investments in the case of natural disaster. Unfortunately, after the properties were damaged during two hailstorms in the Spring of 2012, the defendant’s sought excuses to escape liability and performed unreasonable investigations, underestimated damages, and still continue to deny proper payment of benefits.
To this date, only 4% of the total damages have been covered by Mid-Century; this injustice is causing immense economic impact and other harms to our client. Two years after the hailstorms, the condition of the unrepaired roofs and other damage to the property continue to worsen and impair the properties physical condition and value.
The commercial property insurance lawyers of Doyle Raizner LLP are meticulous in identifying each and every violation in the cases we handle. Mid-Century and its adjusters violated the Texas Insurance Code by failing to handle the claim appropriately, and they also disregarded the time frames set forth in the Texas Prompt Payment Act. Those time frames require an insurer to promptly acknowledge a claim, complete an investigation and pay within a set period of time, typically 60 days. Many insurers ignore these legal requirements, as Mid-Century did in this case.
In situations like this, the assistance of professionals who know how to deal with insurance companies is invaluable. The commercial property insurance lawyers of Doyle Raizner LLP have achieved substantial success in fighting against the most prominent insurance companies, and have recovered sums that compensated our clients for the impacts of insurance misconduct. If an insurance company and/or adjuster has handled your commercial property insurance claim in a way you feel is improper, contact Doyle Raizner LLP as soon as possible.
A lawsuit has been filed by Doyle Raizner LLP against The Travelers Lloyds Insurance, (“Travelers”), for multiple breaches and violations, including; breach of contract, breach of the duty of good faith, and violation of the Texas Insurance Code and Deceptive Trade Practices Act (DTPA).
Our client’s property, a large commercial building in Dallas, sustained a devastating amount of damage wind and hail from the devastating Spring 2011 storms pounded the facility. After a claim was filed, Travelers handled the claim in a manner inconsistent with its obligations to its policyholder. Travelers assigned an adjuster that conducted an inadequate investigation, denying the obvious impacts of the storm. Beyond the sheer denials, the adjuster undervalued the areas where coverage was admitted, which gave false representations to Travelers. The insurance company then wrongfully denied, delayed, and underestimated the extent of damages.
This situation happens to countless storm victims, but sadly, most are unaware of the legal framework set in place to protect them. Travelers, and the assigned adjuster, violated the Texas Insurance Code which requires an honest attempt to effectuate a prompt, fair, and equitable resolution. Also, there must be a reasonable investigation and explanation of all findings. Misrepresenting facts is yet another violation. Though the agency ultimately made a partial payment, Texas prompt payment requirements require insurance payments to be made in a timely manner, which Travelers refused to do.
Travelers conduct also amounts to a breach of contract and a breach of the insurance company’s duty to deal fairly and in good faith during the processing of the claim. The insurance company acted with an actual awareness of the risks involved, and preceded with a conscious indifference to the rights, safety, or welfare of our client; this violates the DTPA.
The commercial property lawyers of Doyle Raizner LLP are consistently recognized by the legal community for our ability to strategically fight against insurance companies, as we are well-accustomed to their methodology
Doyle Raizner LLP has filed a wrongful termination suit against Gerdau Ameristeel US, Inc., (“Gerdau”), after he was fired in retaliation for filing a workers compensation claim.
Our client, a loyal and diligent employee of Gerdau, was engaging in unloading a shipment of iron beams from a mechanical forklift when he felt a pull and pop in his hamstring. Rather than respond to the injury as required by law, his employer harassed and then fired our client, fabricating excuses for his termination to prevent having to provide lawful benefits.
State and federal law are designed to protect employees in these circumstances, examples of wrongful termination include;
Being fired on the basis of sexual orientation, religion, race, or disability
Being dismissed for reporting illegal or unethical actions taking place in the company
Retaliation for acting under afforded rights, like filing a company complaint, filing for medically necessary time off, or applying for worker’s compensation benefits
Gerdau violated the State of Texas’ workers’ compensation laws, set in place to prevent discriminatory misconduct against a worker injured on the job. The violation involved the company being aware of our client’s compensable job injury and then engaging in actions designed to result in his termination. This mistreatment entitles our client to his actual, punitive, and exemplary damages, along with other penalties the law sets forth.
The employment law attorneys of Doyle Raizner LLP will continue to provide sophisticated legal counsel to this client. This level of well-considered guidance is provided to each general worker, manager, or executive level employee we represent after they have been treated unjustly in the workplace. There are options available if you feel you have been a victim of wrongful termination. Contact Doyle Raizner LLP today for a personalized assessment of your situation.
Doyle Raizner LLP has filed a worker’s compensation bad faith action against Safety National Casualty Corporation (“Safety National”), after an injured plaintiff was denied medical and financial entitlements as required by law.
Our client, a hardworking salesperson for Dillard’s, was involved in an incident where her supervisor began shaking her chair to prove she was not seated properly. The jerking movements knocked our client off the chair causing her to fall violently. She sustained an immediate onset of severe lower back pain, followed by a physician diagnosis of mild spinal disk collapse, stenosis, and scoliosis.
Though the plaintiff had previous back injuries, worker’s compensation law requires an insurer to cover the acceleration and aggravation (or “further damage”) of pre-existing injuries. After epidural steroid injections proved insufficient, a physician recommended spinal decompression, direct lateral fusion, and other medically necessary procedures.
These medical interventions never took place; instead our client endured repeated denials, delays of payment, humiliation, distress, and continuing economic and physical harm. Unfortunately, some insurance companies have mastered manipulating the worker’s compensation system and rules in order to minimize or deny valid claims, such as this one.
Here are some signs that a workers compensation insurer may have committed bad faith:
Failure to conduct a reasonable investigation of the events relating to an injury
Creating pretextual reasons (“excuses”) to deny and/or delay payment
Failure to recognize and acknowledge the extent of claims in reasonable time
Ignoring or refusing to consider information favorable to a claim
Failure to accept undisputed evidence supporting the claim, (and more)
Each of the above illegal actions is present in our client’s case.
Though it may be difficult for you to identify each prohibited act in your own situation, if you feel you have been wronged by the worker’s compensation process, allow our firm to pinpoint each violation. The worker’s compensation bad faith lawyers of Doyle Raizner LLP have a consistent record of striving for