The Texas Tribune has published an article highlighting a window’s struggle against Ace American Insurance Company (“ACE”) for worker’s compensation benefits following her husband’s death. Crystal Davis’ fight for her family’s future began amidst tragedy. While heading to the grocery store she received the message every mother or wife dreads, “Can you come home, something has happened.” Her husband, Wayne Davis, had died after a distracted driver crossed into his lane and crashed into hitting him, head on.
Wayne, a corporate employee of Burger King, was traveling for the company at the time, causing the state to correctly consider his death a workplace fatality. Wayne regularly traveled to help franchisees raise their level of performance and align with company standards. Crystal remained at home, taking care of their children, aged 1 and 5. The couple discussed insurance coverage and retirement savings often, and assumed they were covered for situations such as this.
The article reveals that ACE’s actions added insult to the already heartbreaking injuries this family endured. Crystal, facing a $9,000 dollar funeral bill and her children’s first Christmas without their father, was relieved when she first discovered that all workers’ compensation policies must include burial expenses and partial replacement income. But after filing a worker’s comp claim, she waited, and waited..
Horrible news arrived as Burgers King’s insurer, ACE, sent a letter denying her claim.
The pretextual excuse provided was that her husband wasn’t in the “course and scope of employment” at the time of the collision. Though Wayne’s job included a company car, home office, and said in its description that he would travel about 90 percent of the time, ACE still tried to avoid coverage.
Crystal couldn’t believe that an insurance provider was doing everything possible to avoid keeping its promises. Sadly, this situation has become commonplace ever since the Texas Supreme Court granted immunity to workers’ compensation insurers facing bad faith claims in the Ruttiger case. Timothy Ruttiger, represented by attorney Mike Doyle of Doyle LLP, fell while carrying a bundle of electrical conduit at work. After filing a workers comp claim with Texas Mutual and scheduling to undergo surgery, the provider cancelled the procedure a day before it was to take place. Texas Mutual then claimed Ruttiger’s injury occurred away from work and during an activity the plaintiff never actually engaged in. The improper delay and denial of benefits, along with and creation of pretextual excuses, were only some of the violations that resulted in a jury finding of bad faith.
Crystal and many others are trapped within the Texas Supreme Court’s decision in Rittiger, which eliminates any legal incentive for workers compensation insurers to act in the insured’s best interest and in accordance with the rules set in place by the state’s insurance code.
At the time of death, her husband was driving ‘for business reasons’ under the states Labor Code and was presumed to be at work. Through a benefit review conference agreed and ordered ACE to pay a lump sum and regular payments to the children, they did nothing.
Instead, ACE appealed the state agency’s ruling and argued Wayne wasn’t “at work” because he hadn’t reached Burger King’s restaurant before he died. The article notes that the appeal review board didn’t buy the insurer’s reasoning and sided with Crystal again. ACE made a final effort to cut payments before a workers’ compensation appeals panel. On June 3, 2013, almost a year after the accident, the panel upheld the previous decisions.
However, rather than acting in accordance with these rulings, ACE stalled payment by suing Crystal in district court, which causes Crystal to start over in her plea for relief.
Mike Doyle said that suit against Crystal and her two children illustrates the extent to which insurers can now improperly dispute claims, without fearing repercussions. “This is a good example of the floodgates for bad behavior being more fully opened by the Supreme Court’s rollback of protections,” Doyle said. “If you make it harder to penalize, you’re going to get more misbehavior.”
Crystal has not received any portion of replacement income, or payment to her children that is supposed to continue through college, if they attend. Ace has only sent a check for funeral expenses thus far. Her attorney said he had to threaten legal action to compel this small payment. In the meantime, the state of Texas is powerless to stop ACE’s frivolous lawsuit or to remove the uncertainty that hangs like a dark cloud over the Davis family’s financial future.
The article closes with Crystal saying she had no idea how hard it was for workers and their families to obtain the benefits that are supposedly guaranteed under state law.
The full story can be found at: http://apps.texastribune.org/hurting-for-work/a-twisted-system/