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The Collaborative Clearinghouse for Lawsuits and Other Claims Against ACE Group Insurance Companies

CHISM v. MASTER-BILT, Inc. et al

ATTENTION: It is possible that this information may no longer be current and therefore may be inaccurate. The index contains both open and closed cases and is not a complete list of cases in which an ACE Insurance Group company is involved. This information is provided to give interested persons an idea of the issues disputed in the indexed cases. For a full understanding of a case, one should read the rest of the court file, including the response. For the most up-to-date and complete information on a case, visit www.pacer.gov or contact the clerk of the relevant court.

Case Number: 
3:12-cv-00080 Search Pacer
Opposing Party: 
Tracy L. Chism
Court Type: 
Federal
US District Court: 
Northern District of Mississippi
Date Filed: 
Sep 11 2012

"COUNTI
BAD FAITH AND BREACH OF FIDUCIARY DUTY BY DEFENDANTS
29. Plaintiff re-alleges those facts and averments contained hereinabove as if set forth fully herein.

30. Defendants IICNA, Master-Bilt and Broadspire, at all times relevant hereto, owed Plaintiff a fiduciary duty to exercise good faith and an obligation to deal fairly. Further, the Defendants owed Plaintiff a duty to deal with him and pay his claims and medical expenses ordered and awarded by the MWCC timely and in good faith.

31. All denials of payment for medical expenses, as noted above, made by Defendants IICNA, Master-Bilt and Broadspire were made without legitimate and arguable reason. Further, said denials were totally made with only the Defendants' best interest in mind and in total disregard of the orders of the Plaintiff s physician and the final orders of the Administrative Law Judges in the Plaintiffs MWCC case. Defendants' payment of previous medical expenses incurred in the MWCC case, after a lawsuit was filed, in January 2012, for non-payment is evidence of the MWCC award and final orders of the MWCC from which the Defendants are now again in violation.

32. Defendants IICNA, Master-Bilt and Broadspire are jointly and severally liable for their failure to properly and timely pay benefits and medical expenses to. Plaintiff as awarded and ordered by the Mississippi Workers' Compensation Act and Administrative Law Judges Hon. Deneise Lott and Hon. Cyn|hia Wilson. Said conduct constitutes an independent text and entitles Plaintiff to punitive damages in an amount which will punish the Defendants for their conduct as well as to deter Defendants and others from similar misconduct in the future. Defendants IICNA, Master-Bilt and Broadspire's actions, inactions, and knowledge are each imputed to the other.

COUNT II FRAUD BY DEFENDANTS

33. Plaintiff re-alleges those facts and averments contained hereinabove as if set forth fully herein.

34. Defendants intentionally, deliberately and fraudulently misrepresented their intentions to provide workers' compensation benefits to Plaintiff. Plaintiff was entitled to reasonably rely upon such representations and, in fact, did reasonably rely upon such representations. The conduct of the Defendants was intentional, deliberate and a product of evil intent, designed to defraud Plaintiff of benefits, with no intention of fulfilling their legal duties.

36. Said conduct constitutes an independent tort and entitles Plaintiff to punitive damages in an amount which will punish the Defendants for their conduct as well as to deter Defendants and others from similar misconduct in. the future. Defendants IICNA, Master-Bilt and Broadspire's actions, inactions, and knowledge are imputed to each other.

COUNT III GROSS NEGLIGENCE OF DEFENDANTS

37. Plaintiff re-alleges those facts and averments contained hereinabove as if set forth fully herein.

38. By way of alternate pleading, the Defendants were under a general duty, at all relevant times herein, to handle Plaintiffs claim with reasonable and prudent care. Defendants owed Plaintiff the duty to pay all medical services and expenses, pursuant to the Mississippi Workers' Compensation Act, which were ordered and awarded by the Administrative Law Judges and/or ordered by the Plaintiffs physician, in a timely fashion.

39. Defendants' failure to pay medical services and expenses, which still remain unpaid,: is and remains to the detriment of the Plaintiff and thereby the Defendants have caused injuries to Plaintiff.

40. . Defendants knew and/or should have known that the failure to pay Plaintiffs medical services and expenses would cause injuries to Plaintiff.

41. By way of alternative pleading, the acts and/or omissions by Defendants, and each of them, exhibit willful, wanton, and/or grossly negligent acts which have resulted in damage to the Plaintiff. Defendants IICNA, Master-Bilt and Broadspire's actions, inactions and knowledge are imputed to each other,

COMPENSATORY DAMAGES AND OTHER DAMAGES

42. As a result of Defendants' bad faith, breach of fiduciary duty, fraud, and/or gross negligence Plaintiff has experienced, suffered and/or sustained damages as follows and is entitled to: (1) Compensatory damages for any unpaid medical expenses related to the functional prosthetic device and summer cosmetic prosthetic device which was awarded and ordered pursuant to the Mississippi Workers' Compensation Act by Administrative Law Judges Hon. Deneise Lott and Hon. Cynthia Wilson; (2) Past, present and future mental anguish related to non-payment of the functional prosthetic device and summer cosmetic prosthetic device; (3) Past, present and future physical pain and suffering related to non-payment of the functional prosthetic device and summer cosmetic prosthetic device; (4) Past, present and future emotional distress related to non-payment of the functional prosthetic device and summer cosmetic prosthetic device; (5) Loss of enjoyment of life related to non-payment of the functional prosthetic device and summer cosmetic prosthetic device; (6) Veasley/Essinger damages and/or extra-contractual damages pursuant to Universal Life Ins. Co. v. Veasley, 610 So.2d 290 (Miss. 1992) and Essinger v. Liberty Mutual Fire Insurance Co., 534 F.3d 450, 451 (5th Cir. 2008); (7) Other damages to be proven at the trial of this matter.

PUNITIVE DAMAGES AND ATTORNEY'S FEES AND EXPENSES

43. Plaintiff re-alleges those facts and averments contained hereinabove as if set forth fully herein. • .

44. The omissions, conduct, breaches, failures, gross negligence and intentional misconduct on the part of the Defendants were willful, wanton, malicious and exhibited a reckless disregard for the rights of the Plaintiff. Likewise, any act of fraud that may have been perpetrated by the Defendants would be intentional and/or grossly negligent and in reckless disregard for the rights of the Plaintiff. There is no arguable or legitimate reason for the Defendants to have denied payment of the medical services and expenses ordered by Administrative Law Judges Hon. Deneise Lott and Hon. Cynthia Wilson or by Plaintiffs physician related to the functional prosthetic device and summer cosmetic prosthetic device. As such, Plaintiff is entitled to an award of punitive and/or exemplary damages from the Defendants, individually and/or jointly, in order to punish Defendants for their unlawful, intentional, grossly negligent, careless and reckless conduct as well as to deter Defendants and others from similar misconduct in the future.

45. In the event of an award of punitive and/or exemplary damages in this action, or a judicial finding that the conduct of the Defendants was punitive in nature and the type.that would authorize an award of punitive damages, Plaintiff is entitled to and hereby demands recovery of his reasonable attorney's fees and expenses."

The provided text is an excerpt from a document filed in this case. For a full understanding of the case, one should read the complete court file, including the response.

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