On June 6, 2012, Doyle Raizer filed a workers’ compensation insurance bad faith lawsuit against AIG/Chartis (Chartis) and its adjuster. The suit was filed on behalf of an employee who was injured while working on the job in April 2011. Despite medical and factual evidence that conclusively showed the injury suffered on the job by the employee, Chartis denied the claim in its entirety. As a result, the injured employee was left without medical care and income benefits, as were owed to him under the law. The injured employee had to proceed to hearings before the Texas Department of Insurance, Division of Workers’ Compensation, which delayed his medical care and caused additional physical and financial injuries.
Doyle Raizner is proud to represent this injured employee against Chartis and its adjuster for their blatant violations of the law.
On Sunday, February 19, 2012, Mike Doyle appeared on Wyatt Wright’s Justice for All radio show on KTSA
550AM in San Antonio. Mike discussed the Texas Supreme Court’s recent decision in Port Elevator v. Casados. Mike focused in particular on the legal hurdles faced by temporary employees who are injured due to the actions of negligent employers.
The website for The Wyatt Wright Show is available at www.wyattwrightshow.com.
A podcast of the show is available here.
The Texas Department of Insurance on June 13, 2011, released final disciplinary decisions for violations of Division of Workers’ Compensation rules. Among these fines were the following insurer violations:
- Zurich [$9,000]: Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to accurately submit medical bill and payment data; Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to timely reimburse injured employee for travel expenses.
- Hanover Insurance Company of Worcester, MA [$15,000]: Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to accurately submit medical bill and payment data.
- The Hartford [$5,500]: Failed to timely pay income benefits to injured employee; Failed to timely pay attorney fees.
- Indemnity Insurance Company of North America (AIG/Chartis) [$15,500]: Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to timely pay income benefits to injured employee.
- New Hampshire Insurance Company (AIG/Chartis) [$5,000]: Failed to timely pay income benefits to injured employee.
- XL Insurance America Inc. of Exto.n, PA [$7,000]: Failed to accurately submit medical bill and payment data
- Zurich [$10,000]: Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to sufficiently explain reasons for the reduction or denial of payment for health care services; Failed to pay for preauthorized medical services.
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 of fines is available here.
Doyle Raizner filed a workers’ compensation bad faith lawsuit on April 29, 2011, against Indemnity Insurance Company of North America (“ACE”)–an ACE Group insurer–Sedgwick Claims Managment (the third party claims administator), and their adjuster, on behalf of an employee who was injured on the job in April 2010. Despite documentation of his injury from his employer, ACE denied the employee’s claim for the medical and income benefits he was entitled to under Texas law. ACE only initiated benefits after being ordered to do so by the Texas Department of Insurance, Division of Workers’ Compensation.
Doyle Raizner is proud to assist this injured employee in seeking justice for the actions of ACE, Sedgwick, and their adjuster.
The Texas Trial Lawyers Association (TTLA) has filed an amicus brief with the Texas Supreme Court on behalf of Timothy Ruttiger.
Doyle Raizner LLP represents Mr. Ruttiger in a bad faith workers’ compensation claim against Texas Mutual Insurance Company. Mr. Ruttiger was injured in July 2004 while he was working as an electrician’s helper. Texas Mutual wrongfully continued to deny medical care and income benefits, leading to financial hardship and continuing medical problems.
Doyle Raizner originally filed suit against Texas Mutual in 2005 in Texas’s 122nd Judicial District in Galveston County, obtaining a favorable jury verdict in the case. Since then, Texas Mutual has continued to delay benefits and care to Mr. Ruttiger by seeking appeal.
TTLA was compelled to file the brief because of their numerous concerns with the fairness of the Texas workers’ compensation system and a lack of accountability that allows workers’ compensation insurers to take advantage of injured employees. The Texas Supreme Court heard oral arguments in the case in April 2010. The parties are currently awaiting the court’s decision.
Today, the Honorable Judge Michael Gomez in the 129th District Court of Harris County granted summary judgment for Doyle Raizner client Ronald Jerrols in a suit against him by Texas Mutual Insurance Company, his employer’s workers’ compensation insurance carrier.
Texas Mutual had sued Mr. Jerrols seeking reimbursement for medical and income benefits it was ordered to pay Mr. Jerrols by the Texas Department of Insurance, Division of Workers’ Compensation. Mr. Jerrols and several of his co-workers were severely injured on the job when their company van collided with an 18-wheeler nearly two years ago. Since that time, Mr. Jerrols and the other accident victims have been fighting for the benefits they were rightfully owed under their employer’s insurance policy – benefits that even the employer’s representative wants paid.
Texas Mutual, however, maintains that the men were not in the course and scope of their employment at the time of the accident and therefore were not entitled to their employer’s workers’ compensation coverage.
The favorable ruling for Mr. Jerrols in today’s summary judgment hearings disposes of Texas Mutual’s argument and shows that Texas Mutual did not even have enough facts to support its denial of Mr. Jerrols’s claim to warrant taking the matter before a jury.
Doyle Raizner is pursuing a separate action against Texas Mutual on Mr. Jerrols’s behalf for insurance bad faith for this wrongful denial and delay of his workers’ compensation coverage.Rich Text Area
Yesterday morning the Texas Supreme Court heard oral argument in Texas Mutual Insurance Co. v. Timothy Ruttiger. In this workers compensation bad faith case, Texas Mutual requests to be immune from liability for violations of the Texas Insurance Code and seeks to avoid any accountability before a court or jury for bad faith conduct on the part of its managers, supervisors and adjusters. In doing so, the state’s largest workers’ compensation insurance company asked the Texas Supreme Court to overturn many years of precedent recognizing the important legal obligation to handle claims in good faith and to abrogate the Texas Insurance Code.
At oral argument, four Justices seemed to express skepticism on various grounds about Texas Mutual’s immunity bid, while two suggested otherwise in their comments and questions. The argument was attended by Texas Mutual’s executives as well as a number of their lawyers, and representatives of other insurers that write workers compensation insurance in Texas were also present. One insurance carrier, Liberty Mutual, even hired former Chief Justice Tom Phillips to write an amicus brief in support of Texas Mutual’s arguments. Ruttiger represents the third attempt in recent decades (following the Aranda and Fodge decisions) where the insurance industry has made this same immunity pitch to the Texas Supreme Court. Those prior attempts were rejected by the Court.
The case arises out of Texas Mutual’s denial of a workers’ compensation claim, and the case was tried to a verdict in Galveston County in 2006. The jury found that Texas Mutual violated the Texas Insurance Code and committed bad faith by failing to conduct a reasonable investigation into the claim and denying our client Tim Ruttiger’s insurance benefits without a reasonable basis. The First Court of Appeals affirmed the judgment in favor of Mr. Ruttiger. Texas Mutual made a number of complaints to the Texas Supreme Court, but at oral argument put front and center their request for outright
On the front page of today’s Texas Lawyer, reporter Mary Alice Robbins profiled our Texas Mutual Insurance Co. v. Narvaez case, which was recently reversed by the 5th Court in Dallas. The trial court had sanctioned Texas Mutual for altering a medical record, then using the doctored record at trial in the Narvaez matter. The trial court’s awarded $30,000 in sanctions to our client, Juan Narvaez, and further ordered Texas Mutual to post a copy of the sanctions order on its web site. In addition to reversing the sanction order, the 5th Court reversed summary judgment in favor of Mr. Narvaez. We intend to file a motion for rehearing, and potentially seek review in the Texas Supreme Court. If the 5th Court’s decision stands, the end result will be that the case will be remanded to be tried in the trial court. We are hopeful that Texas Mutual will chose not to use the “annotated” as they phrase it medical record the next time.
Interestingly, the stated basis for the 5th Court’s decision was that Narvaez did not establish that the alterations to the medical record were fraudulent or false, not that Texas Mutual somehow didn’t alter the document. As Mike said in his quote, “It doesn’t say that they didn’t do it. It just says they shouldn’t be punished for it.” Our appellate counsel on the case was Rick Thompson of Hankinson Levinger, and he did a great job presenting the issues. We are hopeful the 5th Court will reconsider its decision on rehearing.
You can read the article in the print version or log on to Texas Lawyer and let us know what you think.
In a disappointing decision, the Fifth Court of Appeals in Dallas let Texas Mutual off the hook for altering a medical record. The decision is Texas Mutual Insurance Company v. Juan Narvaez.
After a reported work injury, an emergency room doctor at Parkland hospital recorded on a progress note that Mr. Narvaez described lower back pain. A Texas Mutual adjuster took that hospital record and wrote in “x 3 mos” meaning “times three months.” Then, Texas Mutual used the document at depositions. Then, Texas Mutual used the document at trial purporting it to be evidence in front of a Dallas jury. Texas Mutual’s lawyer even submitted the document to the Court under a business record affidavit, claiming it to be a true and correct record from the hospital. And, the Fifth Court of Appeals, in an opinion written by Chief Justice Carolyn Wright, said this was ok.
When it became clear during the trial that the document had been altered, the trial court judge, Martin Hoffman, declared a mistrial and sanctioned Texas Mutual for litigation fraud. He conducted a hearing to determine what occurred, then issued an order finding that the state’s largest workers compensation insurer knowingly and fraudulently altered the medical record. As a sanction, the judge ordered Texas Mutual to post his ruling on its website under the section labeled “fighting fraud.” He also granted summary judgment favor of Mr. Narvaez.
Not surprisingly, Texas Mutual issued a press release boasting their “delight” with the ruling, as if to say “look at us, we faked a document and got away with it.” Texas Mutual’s litigation conduct, and the appeals court’s apparent approval of it, demonstrate the need for real and substantial legislative insurance reform in the Texas workers’ compensation system.