In January of 2011, 10 ACE Group Companies agreed to pay $70 million in settlement fees to the New York Workers’ Compensation Board after an investigation into whether certain insurance companies had been overcharging policyholders.
ACE Group Unit Sues Amputee to Overturn Workers’ Comp Case
According to a lawsuit filed in U.S. District Court in Houston, Alfonso Cristino was determined by the Texas Department of Insurance, Division of Workers’ Compensation, to have been injured on November 12th, 2008. Records in the case indicate that he had stepped on a nail, which punctured the big toe on his left foot, while working for FW Services Inc.
Cristino had what was called “poorly controlled” diabetes, and by the time he checked into a hospital on November 21st, 2008, his big toe had developed gangrene and cellulitis. Cristino initially had his left leg amputated above the ankle, but then was subjected to an above-the-knee amputation.
ACE contested the award of workers’ compensation benefits. The result of the contested hearing was that Cristino, of Houston, had a compensable injury extending to and including the amputation, that he had a 32 percent impairment rating and that he was not able to earn his pre-injury wage from November 17th, 2008, to November 23rd, 2010.
ACE appealed the hearing officer’s decision. On November 16th, 2012, the Appeals Panel of the Division of Workers’ Compensation declined to issue an opinion on the appeal. By failing to do so, the contested hearing decision became final and appealable.
In the suit it filed against Cristino, ACE said it will show the court that Workers’ Compensation officials improperly interpreted state law, that Cristino’s injury was not a cause of his amputation and that he had a zero percent impairment rating as a result of the compensable injury.
ACE asked to overturn the state decision, and that it be “discharged with recovery of its costs.” It said the value of the dispute exceeds $100,000.
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