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

HANEY v. ACE AMERICAN INSURANCE COMPANY 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: 
2:13-cv-02429 Search Pacer
ACE Group party(s): 
Opposing Party: 
Jane Haney
Court Type: 
Federal
US District Court: 
District of Arizona
Date Filed: 
Nov 26 2013

III. FACTUAL BACKGROUND

10. This suit is necessary to collect a legal debt and damages due and owing
Ms. Haney because of Defendants' wrongful acts in handling of her claim for an on-the-
job injury. The Defendants, individually and/or collectively, have engaged in conduct
 that wrongfully denied and/or unreasonably delayed and underpaid workers'
compensation benefits for workplace injuries sustained by Ms. Haney

11. Ms. Haney, a loyal and hard-working employee of THE BOEING
COMPANY, was injured in the course and scope of her employment on or about March 13,2012
Haney's workers' compensation claim. In processing Haney's claim, Hasty, on behalf of
ACE AMERICAN and SEDGWICK, delayed paying Ms. Haney's owed benefits and
deliberately underpaid Ms. Haney. See Exhibit "A," ICA Award dated July 31, 2013. In
all, rather than properly investigate and adjust Ms. Haney's workers' compensation
claim to ensure Ms. Haney would receive the medical, financial, and other benefits to

12. Upon receiving Ms. Haney's workers' compensation claim, ACE
AMERICAN and SEDGWICK placed Ms. Hasty as the adjuster in charge of processing
which she was entitled as a beneficiary of the workers' compensation promised to the
employees of THE BOEING COMPANY, without a reasonable basis or adequate
investigation, ACE AMERICAN, investigating Ms. Haney's claim and paying workers' compensation benefits) instead
refused to issue the correct payments owed to Ms. Haney. See Exhibit "A," ICA Award
dated July 31, 2013. As a direct result, Ms. Haney was forced to hire and pay a lawyer to
Arizona, Haney was able to secure a binding final determination from the Industrial
Commission of Arizona, ordering payment of the long overdue benefits. See Exhibit "A,
Award Before the Industrial Commission of Arizona, dated July 31, 2013. The Award by
the Industrial Commission of Arizona exhausted all available administrative remedies for
 Haney. In reaching the decision, the Industrial Commission of Arizona noted that the
carrier submitted no evidence to controvert Ms. Haney's owed benefits and "no one
appeared on behalf of the defendant." Yet despite this clear and unambiguous order to
issue payment "immediately," Defendants still refused to pay Ms. Haney's owed benefits

14. The Defendants' wrongful conduct includes the following acts or omissions
a. Failure to conduct a reasonable investigation of the events and facts relating to Ms. Haney's claim;
b. Failure to timely recognize and acknowledge the nature and extent of Ms. Haney's compensable injury sustained on March 13, 2012;
c. Failure to accept the undisputed evidence regarding Ms. Haney's claim;

d. Denial of the existence and/or extent of injury without the input of
competent individuals with appropriate medical training;
e. Creation of pretextual reasons to deny and/or delay payment of Ms. Haney's claim and engagement in an "outcome-driven" approach to her claim;
f. Ignoring and refusing to consider information favorable to Ms Haney's claim for workers' compensation benefits; and

g. Failure to ensure that the industry's best practices were applied
consistently with regard to Ms. Haney's claim.

15. Unfortunately, ACE AMERICAN, SEDGWICK, and Ms. Hasty's delay and
imposition of severe economic distress and underpaid benefits and medical treatment had
reasonably anticipated consequences on Ms. Haney from which she is still fighting to
recover. Given the repeated delays of payment for her necessary medical care and other

benefits, Ms. Haney has been subjected to significant economic impact, humiliation, worry,
distress, and continuing economic and physical damage.

 

16. The Industrial Commission of Arizona retains jurisdiction to determine
medical and disability benefits payable under the Arizona Workers' Compensation Act
 However, jurisdiction for Ms. Haney 's general damages arising from the wrongful
conduct of Defendants is wholly separate from the relief accorded under the Arizona
Workers' Compensation Act and is vested in this Court. Consequently, the significant
effect of Defendants' wrongful and unjustified delay is still uncompensated.
 

IV. FIRST CLAIM FOR RELIEFBREACH OF THE DUTY OF GOOD FAITH AND FAIR DEALING AS TO DEFENDANT ACE AMERICAN

17. Plaintiff re-alleges and incorporates by reference the allegations of of Par. 1-16, of this complaint as if fully set forth herein.

18. Defendants have 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
to Ms. Haney.

19. ACE AMERICAN, as Ms. Haney's workers' compensation insurer, had a
duty to deal fairly and in good faith with Ms. Haney in the processing of her workers'

compensation claim. ACE AMERICAN breached this duty by refusing to properly
investigate and effectively denying payment for 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.

20. Defendants' acts and omissions include, but are not limited to, the following
a. Intentionally denying workers' compensation benefits without a reasonable basis for such denial;
b. Knowingly terminating workers' compensation benefits without a reasonable basis for such action;

c. Failing to perform an adequate and reasonable investigation or evaluation
to determine whether any termination of benefits was supported by a reasonable
basis;

d. Unreasonably interpreting Defendants' obligations under the Arizona
Workers' Compensation Act to arbitrarily and capriciously delay, decrease, and
deny benefits owed to Ms. Haney;

e. Abusing the litigation process and procedures of the Industrial
Commission of Arizona as a tool to delay, decrease, and deny benefits owed to Ms. Haney;

d. Needlessly compelling Ms. Haney through administrative litigation to
receive benefits under her workers' compensation insurance policy;

e. Delaying, decreasing, and denying benefits to Ms. Haney with the intent to
cause her to accept a compromised amount of the benefits that should have been
due and owing under her workers' compensation insurance policy;

f. Failing to adopt and implement reasonable standards for investigating and
evaluating benefits due to Ms. Haney under her workers' compensation
insurance policy;
g. Placing the financial interests of Defendants above the interests Ms. Haney,
ACE AMERICAN'S insured.

21. ACE AMERICAN'S acts and omissions, including those described in
paragraphs 7-16, supra, violate the common law duties of good faith and fair dealing owed
to Ms. Haney, its insured.

22. As a direct and proximate result of the conduct of Defendants described
herein, Plaintiff was caused to suffer the injuries and damages aforementioned

 

V. SECOND CLAIM FOR RELIEF - AIDING AND ABETTING ACE
AMERICAN'S BREACH OF DUTY OF GOOD FAITH & FAIR DEALING
AS TO DEFENDANT SEDGWICK

23. Plaintiff re-alleges and incorporates by reference the allegations of Par. 1-22,
of this Petition as if fully set forth herein.

24. The acts and omissions of SEDGWICK were performed by it in its

individual capacity and as an agent for ACE AMERICAN. Such acts and omissions
were within the scope of its actual authority, express authority, implied authority, or
was not fairly debatable, that ACE AMERICAN and SEDGWICK denied or delayed
Plaintiff's claim without a reasonable basis, and that ACE AMERICAN and SEDGWICK

26. SEDGWICK substantially assisted or encouraged ACE AMERICAN in
delaying or denying the claim without a reasonable basis
knew or recklessly disregarded the lack of a reasonable basis for denying Plaintiff's
claim.

VI. THIRD CTAIM FOR RETIEF-AIDING AND ABETTING ACE
AMERICAN'S BREACH OF DUTY OF GOOD FAITH & FAIR DEALING
AS TO DEFENDANT LORI HASTY

27. Plaintiff re-alleges and incorporates by reference the allegations of If If 1-26, of
this Complaint as if fully set forth herein

28. The acts and omissions of Ms. Hasty were performed by her in her
individual capacity and as an agent for ACE AMERICAN. Such acts and omissions were
within the scope of her actual authority, express authority, implied authority, or apparent
authority

29. As an adjuster for workers' compensation claims in the State of Arizona, Ms
responsibilities and obligations, both independent of and in conjunction with

ACE AMERICAN. Ms. Hasty's licensure as an adjuster imputes upon her personal

responsibilities and obligations, both independent of and in conjunction with her

employment with ACE AMERICAN.

 

30. Ms. Hasty knew that, after an adequate investigation, Ms. Haney's
claim was not fairly debatable, that ACE AMERICAN delayed and denied Ms. Haney's

claim without any reasonable basis, and that ACE AMERICAN knew or recklessly
disregarded this lack of a reasonable basis to delay and deny Plaintiffs claim.

31. Ms. Hasty thus substantially assisted or encouraged ACE AMERICAN in
delaying or denying Ms. Haney's on-the-job injury claim, without any reasonable basis

32. Ms. Hasty's conduct to aid and abet ACE AMERICAN resulted in the delay
and denial of insurance benefits to Ms. Haney and, ultimately, in the damages sustained by Ms. Haney.

33. Because of Ms. Hasty's acts and omissions to aid and abet ACE AMERICAN,
she is individually, as well as jointly and severally, liable for Plaintiff's damages. Wells
Fargo Bank v. Arizona Laborers, Teamsters and Cement Masons Local No. 395 Pension Trust
Fund, 38 P.3d 12 (Ariz. 2002).

 34. As a direct and proximate result of the conduct of Ms. Hasty described
herein, Plaintiff was caused to suffer the injuries and damages aforementioned.

VII. FOURTH CLAIM FOR RELIEF- INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS
AS TO DEFENDANTS ACE AMERICAN, LORI HASTY, AND SEDGWICK

35. Plaintiff re-alleges and incorporates by reference the allegations of If If 1-34 of
this Complaint as if fully set forth herein

36. Defendants intentionally and/or recklessly caused Haney severe emotional
distress through its conduct,

37. Defendants knew that Haney was owed benefits yet Defendants repeatedly
underpaid and delayed Haney's owed benefits. Defendants refused to correct the
underpayment, even though they knew the amount was incorrect (and agreed to pay the

correct amount in the future). Instead Defendants forced Haney to file a hearing before the
Industrial Commission. Yet Defendants failed to attend the hearing. Defendants even

refused to pay the owed benefits months after the Industrial Commission of Arizona's
ordered the Defendants to pay "immediately." See Exhibit "A.

38. Defendants knew or recklessly disregarded that its conduct was substantially
certain to cause Haney to suffer extreme and emotional distress. Defendants were
repeatedly told by Haney, her attorneys, and the Industrial Commission that they must
pay the owed benefits. In addition, because of her on-the-job traumatic head injury,
Defendant knew that Haney was emotionally vulnerable and in pain. Thus Defendants
knew that denying her owed benefits would have significant detrimental impact to
Haney's health.

39. Defendants conduct caused Haney to suffer severe emotional distress.

40. Defendants conduct was so outrageous and so extreme in danger, that the
conduct went beyond the possible bounds of decency, and was atrocious and utterly
intolerable in a civilized community.

VIII. FIFTH CLAIM FOR RELIEF—PUNITIVE DAMAGES

41. Plaintiff re-alleges and incorporates by reference the allegations of If If 1-40, of
this Petition as if fully set forth herein.

42. Defendants acted intentionally, fraudulently, and with malice (as that term is

legally defined) in denying Ms. Haney's claim for workers' compensation benefits.

43. Defendants' conduct constituted aggravated, malicious, and outrageous
conduct in conscious disregard to Ms. Haney's rights, physical health, and financial condition.

44. Defendants' conduct when viewed objectively from its standpoint at the time

of its occurrence involved an extreme degree of risk to Ms. Haney, considering the
probability and magnitude of the potential harm to Ms. Haney. Further, Defendants had
actual, subjective awareness of the risk involved, but nevertheless proceeded with
conscious indifference to the rights, safety, or welfare of Ms. Haney.

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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