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

HASHEMPOUR 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: 
5:11-cv-00129 Search Pacer
ACE Group party(s): 
Opposing Party: 
Ray Hashempour
Court Type: 
Federal
US District Court: 
Southern District of Texas
Date Filed: 
Oct 6 2011

"Causes of Action: Breach of Contract

20. ACE promised to pay medical and income benefits in accordance with the terms of its Policy in the event Ray Hashempour became disabled because of an occupational accident. Ray Hashempour suffered an occupational injury resulting in his disability as defined in the Policy and fully cooperated with ACE or its agents in their adjustment of his claim Ray Hashempour was and remains disabled as defined in the Policy.

21. ACE's termination of Ray Hashempour's disability benefits constitutes a breach of the insurance policy, for which he now sues. Violations of the Texas Insurance Code

22. Plaintiff re-alleges and incorporates each allegation contained in the proceeding paragraphs of this Petition.

23. Defendants failed to attempt to effectuate a prompt, fair, and equitable settlement of this claim with respect to which its liability had become reasonably clear in violation of Texas Insurance Code § 541.060 (a)(2)(A).

24. Defendants failed to adopt and implement reasonable standards for the prompt investigation of claims arising under its policies.

25. Defendants failed to provide promptly a reasonable explanation, in relation to the facts or applicable law, for the denial of this claim in violation of Texas Insurance Code § 541.060 (a)(3).

26. Defendants refused to pay a claim without conducting a reasonable investigation with respect to this claim in violation of Texas Insurance Code § 541.060 (a)(7).

27. Defendants misrepresented the insurance policy under which it afforded occupational accident insurance coverage to Mr. Hashempour by making an untrue statements of material fact in violation of Texas Insurance Code § 541.060 (1).

28. Defendants misrepresented the insurance policy under which it afforded occupational accident insurance coverage by failing to state a material fact that is necessary to make other statements made not misleading in violation of Texas Insurance Code § 541.060 (2).

29. Defendants misrepresented the insurance policy under which it afforded occupational accident insurance to Mr. Hashempour by making a statement in such a manner as to mislead a reasonably prudent person to a false conclusion of material fact, and in failing to disclose a mater required by law to be disclosed in violation of Texas Insurance Code §§ 541.060 (1)

30. Defendants knowingly committed the foregoing acts, with actual knowledge of their falsity, unfairness, or deception in violation of Texas Insurance Code § 541.060 (1).

31. Defendants' conduct also constituted unfair claims settlement practices in violation of the Texas Insurance Code §§ 542,003, et seq. Breach of the Duty of Good Faith & Fair Dealing

32. Plaintiffre-alleges and incorporates each allegation contained in the proceeding paragraphs of this Petition.

33, ACE, as Mr. Hashempour's occupational accident insurer, had a duty to deal fairly and in good faith with him in the processing of his occupational accident claim. Defendant breached this duty by failing and refusing to timely and properly investigate, adjust, pay, and in its denial of his claim in the absence of a reasonable basis for this denial. Defendant knew or should have known that there was no reasonable basis for its delay in payment or denial of this claim, At all material times, the liability of ACE was reasonably clear. As a result, Defendant breached its common law duty of good faith and fair dealing causing injury and damage to Hashempour, for which he further sues.

34. Plaintiff re-alleges and incorporates each allegation contained in the proceeding paragraphs of this Petition.

35. Defendants acted fraudulently and with malice in denying Mr. Hashempour's claim for occupational accident benefits. Defendants' conduct when viewed objectively from its standpoint, at the time of the occurrence complained of in this action, involved an extreme degree of risk to Mr. Hashempour, considering the probability and magnitude of the potential harm to Mr. Hashempour. In addition, Defendants had actual, subjective awareness of the risk involved, but nevertheless proceeded with a conscious indifference to the rights, safety or welfare of Mr. Hashempour.

36. Defendants acted in an unconscionable manner in their wrongful denial and delay in the payment of Mr. Hashempour's claim for occupational accident benefits, all for which Hashempour further sues. Violation of the Texas Deceptive Trade Practices Act

37. Plaintiff re-alleges and incorporates each allegation contained in the proceeding paragraphs of this Petition.

38, The Texas Deceptive Trade Practices - Consumer Protection Act (DTPA) provides additional protections to consumers who are victims of deceptive, improper or illegal acts and practices. Defendants' violations ofthe Texas Insurance Code create an additional cause of action under the DTPA. Defendants' conduct as recited in this petition and their violations of the Texas Insurance Code, as recite herein, also constitute violations of the DTPA for which Hashempour further sues for his damages, Damages

39. Plaintiff is entitled to the actual damages resulting from the wrongful and illegal conduct of Defendants. These damages include the consequential damages to his economic welfare from the wrongful denial and delay in payment of occupational accident benefits, mental anguish and physical suffering resulting from this wrongful denial of benefits, and all other actual damages permitted by law. He is also entitled to those damages resulting from the delay in providing medical benefits resulting in permanent injury and damage. For these damages and the conduct recited in this complaint, Defendants are jointly and severally liable.

40. Plaintiff is further entitled to statutory multiple damages and other penalties as permitted by law.

Exemplary Damages

41. The actions of the Defendants in handling Plaintiffs claim were done knowingly and intentionally or with a conscious or callous disregard for the rights and welfare of the Plaintiff. As such, their actions reflected gross negligence and were so outrageous as to
warrant the imposition of punitive or exemplary damages, for which Plaintiff further sues for recovery. Accordingly, Plaintiff seeks such punitive or exemplary damages as may be assessed by the jury in its discretion."

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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