Archive for new-filings
Doyle Raizner LLP has filed a workers comp bad faith lawsuit against Zurich American Insurance Company and Sedgwick CMS. The plaintiff was an employee of Starwood Hotels & Resorts at the time of his injury.
The plaintiff was a cook for Starwood and was injured while in the kitchen. He suffered a fall against a freezer and injured his shoulder. Upon examination by an orthopedic surgeon, it was found the plaintiff had suffered a torn rotator cuff. The surgeon recommended surgery to repair the tear and ensure long-term recovery.
There was conflicting information on how the plaintiff fell, however, the Industrial Commission of Arizona during proceedings cited Arizona law confirming that the mechanism of injury is irrelevant; and that there was no legitimate dispute that the plaintiff did in fact get injured while in the scope and course of his employment.
Upon submitting a claim to Zurich American Insurance Company, the claim was handed to Sedgwick CMS, a third party claims administrator. Sedgwick assigned an adjuster who denied the claim. The adjuster did not properly investigate the claim and improperly denied the claim despite the fact the plaintiff was promised workers compensation as an employee of Starwood Hotels & Resorts. The plaintiff initiated proceedings with the Industrial Commission of Arizona who ordered the benefits paid.
These benefits do not fully compensate for the failure of Zurich and Sedgwick to timely recognize and acknowledge the nature and extent of the plaintiff’s injury, and to follow the law. The two companies also failed to accept the undisputed evidence regarding the claim. The companies’ representatives worked in an “outcome-driven” approach claim and created reasons to deny and delay his claim.
Doyle Raizner supports this plaintiff in his pursuit of justice against an insurance company and third party administrator who chose to breach their duty of good faith and fair dealing to an injured worker in need of compensation for an injury sustained while
Doyle Raizner has filed a RICO (Racketeer Influenced and Corrupt Organizations Act) lawsuit in the Federal District Court for the District of Arizona against York Risk Services Group on behalf of firefighters employed by the City of Phoenix whose workers’ comp claims were wrongfully denied. York is a third-party administrator of workers compensation and other types of insurance claims management. The United States Court of Appeals for the Sixth Circuit ruled in Brown et al. v. Cassens Transport Company that a company may be held accountable under the federal RICO statute for scheming to withhold and/or wrongfully deny workers compensation benefits.
The suit was brought by eight City of Phoenix firefighters injured on the job. The proper paperwork and procedures were followed by the firefighters after each of their on the job injuries. York denied each firefighter’s claim by letter sent through United States Mail, and in each circumstance York refused these first responders medical treatment for on the job injuries sustained helping the residents of Phoenix. Each firefighter appealed York’s denial to the Industrial Commission of Arizona (ICA), the agency that administers state laws relating to workers’ compensation. In each individual appeal, the ICA determined that York wrongfully denied care to the firefighter.
The extent of the injuries each firefighter sustained varies; however, each was harmed financially, medically and emotionally. York’s fraudulent denial and lack of timely payments for the medical care of one firefighter resulted in her untimely death from work related cancer due to chemical exposure. Prior to her death, the financial loss due to York’s lack of payment resulted in her family losing their home. Another firefighter also lost her home due to financial hardship due to York’s denial of supportive care for the on the job injury. York ignored the Industrial Commission of Arizona’s ruling that rejected their denial for coverage, and continued to refuse payment in defiance of the law and administrative orders.
Doyle Raizner has filed a lawsuit against the maker of Mirena; an intrauterine device (IUD) that provides continuous birth control, on behalf of a woman whose IUD migrated outside the uterus resulting in the surgical removal of her right ovary and fallopian tube.
The plaintiff’s physician implanted the device without difficulty. During the six week follow up appointment, the device was in proper placement. A short time later the plaintiff was admitted to the hospital due to severe abdominal pain, nausea and vomiting. It was found at the hospital the plaintiff had a ligament abscess and infected Fallopian tube. She then underwent surgery to remove the right Fallopian tube, right ovary, the Mirena IUD and appendectomy. Since the plaintiff underwent this surgical removal of the device after uterine perforation, she has had difficulty conceiving a child.
Mirena has been scrutinized for the potential health risks associated with the device and the lack of warning of serious and dangerous side effects. Their overzealous and deceptive marketing tactics have also been subject to warnings from the Department of Health and Human Services’ Division of Drug Marketing, Advertising, and Communications (DDMAC) concerning their failure to communicate risk information. DDMAC also stated Bayer inadequately communicated Mirena’s indications and overstated the efficacy. DDMAC contacted Bayer in 2009 regarding a consumer-directed program that represented Mirena users would increase the level of intimacy, romance and emotional satisfaction between sexual partners. DDMAC determined these claims to be unsubstantiated and pointed out the package insert states at least 5% of clinical trial patients reported a decreased libido after use.
Bayer intended for their dangerous device to be promoted as safe and effective and as a result physicians began commonly prescribing Mirena even though it was not reasonably suited to the use intended. Bayer failed to exercise due care when advertising and promoting Mirena. Further, Bayer placed its profits above its customers’ safety by downplaying the serious and dangerous side
Doyle Raizner Files Negligence Suit on Behalf of Worker Injured on Grounded Vessel off Coast of Chile
Doyle Raizner has filed a negligence lawsuit against T&T Marine Salvage and Titan Maritime on behalf of a worker who was thrown 30 feet in the air and dropped on the beach landing on his back.
The plaintiff was an employee of T&T Salvage in Texas and the company sent him to Chile to work on the salvage of a grounded vessel offshore Puerto San Antonio. While on the shore operating a winch to unload cargo from the ship, the line on the winch broke. A cable from the vessel en-wrapped the plaintiff’s leg and body and launched him into the air.
After landing on the beach, he was rushed to the hospital where a pain shot was administered and the plaintiff was released. He was taken to a motel for three days without pain medication while waiting for a flight back to Texas. The plaintiff was taken directly from the airport to an urgent care clinic chosen by T&T Salvage where a pulled muscle was diagnosed, light duty and painkillers were prescribed. The plaintiff sought an independent physician who diagnosed two protruding discs in his back after review of a MRI.
T&T Salvage negligently failed to provide safe, properly maintained equipment and work facilities for the plaintiff’s use to carry out his job duties. The company also failed to provide proper training and supervision. Managers of T&T Salvage and Titan Maritime had obligations to safety they failed to uphold by proceeding with conscious indifference to the rights, safety and welfare of the plaintiff despite having awareness of the risk involved.
Doyle Raizner stands behind this client in their fight for justice and accountability for his injury and inability to work.
Doyle Raizner has filed a workers’ comp bad faith case against Gallagher Bassett and Ace American Insurance on behalf of an injured worker whose claim for benefits was wrongfully denied and unreasonably delayed. Ace American Insurance issued the workers’ comp insurance coverage under the Arizona Workers’ Compensation Act. Gallagher Bassett adjusts insurance claims on behalf of Ace American under the same act.
The plaintiff was injured in the scope and course of his employment in 2011, when another vehicle hit at a high rate of speed the truck he was driving. The collision resulted in traumatic brain injury, post-traumatic headaches, post-concussion syndrome, chest injuries, cervical spine injuries, among other injuries.
The plaintiff’s claim for benefits was initially accepted by Ace American and Gallagher Bassett. However, Ace American and Gallagher Bassett began to ignore their obligation to timely and appropriately approve reasonable and necessary medical treatment recommended by the plaintiff’s treating physician. Due to the denial of timely benefit payments to which the plaintiff was entitled, an attorney was hired to help secure the workers’ compensation benefits. A final and binding order was issued by the Industrial Commission of Arizona and required Ace American and Gallagher Bassett to provide the treatments. The commission noted the carrier had no evidence to controvert the plaintiff’s right to treatment and had not even bothered to appear to attempt to justify its wrongful conduct.
Ace American, as the plaintiff’s workers’ compensation insurer, breached their duty of good faith and fair dealing by refusing to properly investigate and effectively denying necessary medical care and other benefits, without any reasonable basis to do so. Gallagher Bassett acts and omissions were performed by it in its individual capacity and as an agent for Ace American. Gallagher Bassett knew the claim was not fairly debatable and substantially assisted or encouraged Ace American in delaying or denying the claim without a reasonable basis.
Ace American and Gallagher Bassett placed unnecessary
Doyle Raizner has filed suit against DynCorp International on behalf of an injured military contractor serving in Afghanistan. The plaintiff was injured when an employee of DynCorp made an unsafe and improper U-turn along a main route of Camp Davis and rammed into a portable laundry container in which she was stationed.
DynCorp International identifies itself as a “global government services provider in support of U.S. national security and foreign policy objectives.” The company also claims to “provide expertly conceived and professionally executed services.” As confirmed by the subsequent investigation, the collision was caused by the inattentive driving of DynCorp’s employee and was listed as drug/alcohol related. The collision resulted in serious injuries to the plaintiff which required medical treatment in the past and will require future medical care.
DynCorp’s acts constitute negligence in that the company, acting through its employee, failed to act in a reasonably prudent manner and violated laws and statutes of the United States. The company also acted in a way that constitutes gross negligence. DynCorp had knowledge of the risk involved at the time of the occurrences and proceeded with conscious indifference to the rights, safety and welfare of others resulting in the injury of the plaintiff.
Doyle Raizner stands behind their client in the fight against a military service provider more interested in profits than honoring an obligation to safety.
Doyle Raizner has filed suit against Central United Life Insurance on behalf of a policyholder whose cancer treatment was denied. The policyholder had purchased a cancer insurance policy long before her diagnosis of breast cancer and continued to pay the premiums during her treatment and recovery.
Upon receiving the policyholder’s claim for benefits, Central United failed to assign her claim to an adjuster and failed to even research or request any information reasonably required to adequately investigate her claim further. The company did not conduct a reasonable and objective investigation of the facts of the claim. Further, Central United ignored medical evidence, including records from the treating doctors, and failed to collect or analyze other evidence related to the claim for insurance benefits.
In 2011, the company completely denied the claim for insurance benefits under a policy which expressly provided comprehensive coverage in the event of a cancer diagnosis. The plaintiff had maintained the policy in full force and effect by timely payment of insurance premiums for more than a decade.
Central United violated the Texas Insurance Code by refusing to pay the claim without conducting a reasonable investigation with respect to the claim. This conduct also breached the duty to deal fairly and in good faith with the policyholder. Central United acted fraudulently in denying the coverage benefits.
Doyle Raizner stands behind this policyholder in their fight against an insurance company’s bad behavior and failure to honor their financial obligation.
In November 2011, we posted about a new filing against Pan American Life Insurance Company. The suit was filed on behalf of a policyholder who had been denied medical treatment for skin cancer. The medical evidence and the opinions of her doctors supported the claims, yet her insurer wrongfully denied care and treatment.
There have been updates to this case. Tragically, our client passed away in January from cancer. The wrongful denials by Pan American Life Insurance, and resulting lack of medical treatment, ultimately led to her death.
The case has recently been re-filed in Houston after a dismissal in New Orleans due to a venue argument. The policy was purchased by a couple living in Honduras but the parent company is based in New Orleans. All medical treatment and procedures were to be performed in Harris County causing jurisdiction to fall under Texas law.
In the original filing, the plaintiffs were attempting to reverse the wrongful denial in order to pursue medical treatment. In the subsequent filing in Harris County, the damages have shifted as the plaintiff has died as a result of the insurance company’s misconduct.
To add to the issues, and compounding the effect of the insurance company’s misconduct, health care providers whose services were sought by the plaintiff under the pretext Pan American Life Insurance would pay the cost, enlisted the services of Specialized Collections to begin harassing the plaintiffs for the debts owed. A grieving family is now faced with financial ruin, in addition to the tragic loss of a loved one. All of this could have been avoided had Pan American Life simply honored its responsibilities.
Pan American Life Insurance’s actions had dire consequences. Our client sought medical treatment in Houston, one of the best medical cities in the world, with the expectation of being cured. Instead, her insurance company created roadblocks and bars to her treatment, and abandoned her and her family. Doyle