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A federal judge recently denied Ace Insurance Company (“ACE”) motion to dismiss after the defendant was sued for bad faith practices following the handling of our client’s worker’s compensation claim.

Nearly 10 years ago, while our client was a hard-working scaffolding technician for Archer Western Construction, he fell at a scaffold site, injuring his right wrist, arm, and shoulder. Our client received surgery on his wrist, but the pain never subsided. In 2012, our client suffered two accidents involving this same hand while playing football and also while catching a falling aquarium filled with tools.

A private hand surgeon found that our client’s original injury had still caused a current need of surgery. Specifically, the physician found tendon or skeletal muscle ruptures which occurred from slow but continuous muscle tears throughout the decade.

Based upon this finding, our client sought assistance through the worker’s compensation process by filing a petition to reopen his prior claim with the Industrial Commission of Arizona (ICA), April 9, 2012. This request was forwarded to a third party administrator whose adjuster then engaged in conduct  that clearly aided ACE’s  bad faith practices.

Insurance is a contract  between you and your provider, enforced by rules and laws.  In exchange for  you paying monthly premiums, your insurance company is obligated by law to pay claims properly and promptly in good faith. This makes it “bad faith” and illegal for an insurance company to;

* Undervalue your damages

* Delay the timely payment of claims

* Not consider evidence beneficial to your situation

* Fail to acknowledge and time reply to claims

* Deny payment of legitimate claims without a reasonable basis

* Use harassing, intrusive or demeaning methods or procedures

The assigned adjusted didn’t bother to look at our client’s claim for 11 days and testified that she only spent a couple of hours reviewing it before submitting a denial of behalf of the insurance provider. She also ignored the private physician’s findings while delaying and denying claim benefits without a reasonable basis. Adding insult to injury, even after the defendant’s own Independent Medical Examiner (IME) later confirmed the need of surgery, the defendant chose not to respond for over a month. ACE finally responded by challenging the findings of their own doctor.

It was only when the our client requested the ICA  find ACE acted in bad faith that the company finally gave the green light for surgery. The ICA still found ACE unreasonably delayed payment and acted in bad faith.

Postponing surgery has caused our client severe damages that were not addressed in the workers’ compensation proceeding. In fact, the delay of the medical benefits even damaged  our clients ability to recover after surgery. Not only did the improper actions cause agonizing physical and emotional pain, but the hindering condition prevented our client from working the same position and has caused continued financial turmoil.

This client’s decade of suffering will continue to be heard and respected. The worker’s compensation litigation team of Doyle LLP understand the unlawful practices our clients are subjected to and are accustomed to successfully holding each insurance agency accountable.