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 Raizer filed a workers’ compensation insurance bad faith lawsuit on June 13, 2011, against AIG/Chartis Insurer New Hampshire Insurance Company/American Home Assurance Company (AIG) and its adjuster. The suit was filed on behalf of an employee who was injured while working on the job in November 2010. Despite knowing of their obligation under the law to take care of the injured employee, AIG completely denied the claim. As a result, the injured employee was left without the medical care and income benefits AIG owed her under the law until winning her case at a hearing in front of the Texas Department of Insurance, Division of Workers’ Compensation.
Doyle Raizner stands with the injured employee in her continuing fight against AIG and its adjuster for their knowing violations of the law.
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
Judgment entered by Court enters Final Judgment for $1.78 million against Gallagher Bassett and AIG insurer
The 61st Judicial District Court of Harris County, Texas, Judge Al Bennett presiding, on December 17, 2010, entered Final Judgment on the jury’s verdict for injured Continental international flight attendant Sue Ann Stinson for $1,785,729.60, plus additional attorneys’ fees and interest if appealed by Defendants Gallagher Bassett Services, Inc. and AIG insurer The Insurance Company of the State of Pennsylvania. The Final Judgment was entered as a measurement of the consequences of the wrongful delay of on-the-job insurance benefits to Ms. Stinson by the insurer and Gallagher Bassett, its third party administrator (TPA). The jury also included $1,000,000 in additional damages in their verdict for Gallagher Bassett’s “knowingly” violation of the Texas Insurance Code in their delay and denials.
Not surprisingly, attorneys for Gallagher Bassett and the insurer promised to file still more motions to attempt to persuade the Court to disregard the unanimous verdict rendered November 22, 2010, by twelve Harris County citizens. While likely not the end of the long path of obstacles to justice thrown in Ms. Stinson’s path by the Defendants, it represents an important milestone.