Workers Compensation Bad Faith
Doyle LLP Trial Lawyers has filed a bad faith suit in Dallas County District Court, in Dallas, Texas, against an insurer who wrongfully denied an injured worker’s compensation claim. The suit was filed against Ace American Insurance Company and Underwriters Safety and Claims Inc. and their adjuster, Dawnmonique Lee. The claims made against these Defendants include breach of the duty of good faith and fair dealing under Arizona law.
At the time of his injury, Doyle LLP’s Client was a bakery employee. Rather than properly investigate and adjust his claim to ensure that he received necessary workers’ compensation benefits, without a reasonable basis or adequate investigation, Underwriters and Ms. Lee, on behalf of Ace American, chose to continue to deny timely approval and payment of the medical care and insurance benefits to which Doyle LLP’s Client was entitled. Specifically, his shoulder surgery was recommended by his treating orthopedist in August 2015 and was not performed until January 2016, in spite of medical evidence confirming the tears in his rotator cuff and bicep. His neurological and psychiatric care were additionally systematically delayed and denied. Doyle LLP’s Client has been subjected to numerous IME’s and delayed approvals of prescriptions and refills recommended by his treating physicians. Indeed, he has been forced to pay out-of-pocket for many of his prescriptions and prepare for the potential refusal to reimburse.
As a result, Doyle LLP’s Client had to file protective orders with the Industrial Commission of Arizona (“ICA”) in response to the numerous additional requests for IME’s from Defendants. When his workers’ compensation attorney attempted to contact Underwriters and Ms. Lee, they would refuse to answer the phone or emails, only answering if the caller ID was concealed. Moreover, he would have to schedule hearings with the ICA and take formal administrative action in order to achieve in any response regarding his treatment approval.
The suit alleges that the Defendants committed violations of the Arizona Workers’ Compensation Act and their other duties under the laws of the State of Arizona arising from their obligations under the Arizona Workers’ Compensation Act and the contract of insurance for which Defendants provided workers’ compensation insurance coverage.
Under Arizona law, Ace American, as workers’ compensation insurer, has a non-delegable duty to deal fairly and in good faith in the processing of his workers’ compensation claim. Ace American breached this duty by relying on Underwriters’ unreasonable investigation and improper delays of payments for necessary medical care or other benefits, without any reasonable basis to do so. In the alternative, Ace American improperly delegated its authority to Underwriters and Lee who failed to conduct a reasonable investigation and delayed and denied necessary medical care and other benefits, without any reasonable basis to do so. Ace American knew or should have known that there was no reasonable basis for denying or delaying the required benefits.
Ace American’s liability is based on its own actions, including relying on an unreasonable evaluation and investigation, permitting Underwriters to improperly delay payment on Doyle LLP’s Client’s claim with no reasonable basis. See e.g. A.R.S. § 23-963-01 (B) (“Any compensable claim for benefits shall be paid by the carrier.”).
Doyle LLP Trial Lawyers frequently is retained by injured workers who suffer a wrongful denial of their workers’ compensation insurance claim. In the years of handling such claims, Doyle LLP Trial Lawyers has represented many clients all the way through trial to ensure that justice is served. If you or someone you know has suffered from the denial or delay of workers’ compensation benefits, you may be entitled to damages caused by the insurance company’s wrongful conduct.