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

JONES v. ACE AMERICAN INSURANCE COMPANY (ACE)

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: 
4:13-cv-00554 Search Pacer
ACE Group party(s): 
Opposing Party: 
Scottie Jones
Court Type: 
Federal
US District Court: 
Southern District of Texas
Date Filed: 
Mar 1 2013

"FIRST CAUSE OF ACTION- Violation of the Texas Insurance Code.
4.1 Plaintiff Scottie Jones re-alleges and incorporate each allegation contain in paragraph 1-28 Of this petition as if fully set forth herein.

4.2 Defendants failed to effectuate a prompt, fair and equitable settlement of a claim with respect to which liability has become reasonably clear, in violation of the Texas Insurance Code Section 541.060 (a)(2)(A)(formerly Art. 21.21§ 4 (10)(ii).

4.3 Defendants failed to adopt and implement reasonable standards for prompt investigation standards for prompt investigation of the claims arising under the policiesjv'

4.4 Defendants insurers failed to provide promptly a reasonable explanation^ in relationship to the facts, or applicable law, for the denial of a claim, in violation if the TexasjSsurance Code Section 541.060(a)(3) (formerly Art. 21.21 §4(10)(iv). <rW

4.5 Defendants refused to pay a claim without conducting •ajpteonable investigation with respect to the claim in violation of the Texas Insurance Code SectiojnA.060(a)(7)(formerly Art 21.21§4(10)(vii).

4.6Defendants misrepresented the insurance policsjlgder which Defendants affords workers compensation coverage to Plaintiff SCOTTIEtf^JES by making an untrue statement of material fact, in violation of the Texas Insurance Code Sec0i 541.060 (l)(formerly Art. 21.21 §4(ll)(a).

4.7 Defendants misrepresented the in&Klace policy under which Defendants affords workers compensation coverage to PldntifeSCOTTIE JONES, by failing to state a material fact that is necessary to make others statements mjaae^iot misleading, in violation of the Texas Insurance Code Section 541.060 (2)(formerlyA%2f.21 §(ll)(b).

4.8 ©Defendants njkf|presented the insurance policy under which Defendants affords workers compensation cojltage to Plaintiff SCOTTIE JONES, by making a statement in such a manner as to mislead a reasonably prudent person to a false conclusion of material fact, and failing to disclose a matter required by law to be disclosed, in violation of the Texas Insurance Code Section 541.002 (l)(fonnerly Art. 21.21 §4(ll)(e).

4.9Defendants misrepresented the insurance policy under which Defendants affords workers compensation coverage to Plaintiff SCOTTIE JONES by making an untrue statement of material fact, in violation of the Texas Insurance Code Section 541.060 (l)(formerly Art. 21.21 §(1 l)(a).

410 Defendants allowed the employer, company officers and directors, to dictate the methods by which and the terms on which a claim is handled and settled, in violation of the Texafjhsurance Code Section  415.022.

SECOND CAUSE OF ACTION-BREACH OF DUTY OFGOOD FAITH &FAIR DEALING

5.1Plaintiff SCOTTIE JONES re-alleges and incorporate ea^fallegation contained in Paragraph 1-28 of the petition as if set forth herein.

5.2Defendants, as set forth herein, workers compea^ion insurers and reinsurers had a duty to deal fairly and in good faith with Plaintiff JONES | n p e processing of his workers compensation claim. Defendants breached this duty by refusing ©properly investigate and effectively denying necessary medical care and settlement benefits$$e$endants knew or should have known that there was no reasonable basis for denying or delaying the required benefits. Defendants knew or also knew of a mass tort settlement and agreement^ween Defendants Chevron Phillips Chemical Company LLC, Phillips Petroleum Company and^pSHA. As result of defendant's breach of these legal duties, Plaintiff JONES suffered legal damag^)

THIRD CAUSE OF ACTION-PUNITIVE DAMAGES OF GOOD FAITH AND FAIR DEALING

6.1 Plaintiff JONES re-alleges and incorporates each allegation n Paragraph 1-5.1 of this Petition as if folly set forth herein:

6.2 Defendant acted fraudulently and with malice (as that term is defined in denying Plaintiff JONES claim for workers compensation benefit. Defendants conduct when viewed from objectively from its standpoint at time of its occurrence involved an extreme degree of risk to Plaintiff JONES, considering the probability and magnitude of the potential harm to Plaintiff JONES. Further, Defendants had actual subjective awareness of the risk involved, but never the less proceeded with cmscious indifference to rights, safety, or welfare of Plaintiff JONES. \J

FOURTH CAUSE OF ACTION-VlOLATK#OF TEXAS DTPA

7.1 Plaintiff JONES re-alleges and incorporates each allegatijli n Paragraph 1-6.1 of this Petition as if fully set forth herein: s^W

7.2 Deceptive Trade Practices -Consumer Protecti^Act (DTPA) provides addition protection to consumers who are victim of deceptive .imprqfiejfror illegal practices. Defendants' violation creates cause of action under the DTPA. Defendant violation of the Texas Insurance Code, as set forth herein specifically violates the DTPA as weftj^

8.1 Plaintiff SCOTT^pONES is entitled to the actual damages resulting both jointly and severally from Defendants violalfHis of the law. These damages the consequential damages to the economic welfare from the wrongful denial and delay of benefits, the mental anguish and physical suffering resulting from the wrongful actions and denial of benefits, and continued impact on the medical evaluation, treatment and final diagnosis of all the other actual damages permitted by law. In addition, Plaintiff SCOTTJE JONES is entitled to exemplary damages.

8.2 As a result of Defendants' acts and or omissions, Plaintiff has sustained damages in excess of the minimum jurisdictional limits of this court.

8.3 Plaintiff is entitled under law to the recovery of prejudgment interest at the maximum legal rate. PRAYER

WHEREFORE PREMISES CONSIDERED, Plaintiff respectfully r||Sest that Plaintiff have judgment against Defendants for actual damages jointly and severally in<6«pss of minimum jurisdictional limits of this Court, pre-and post judgment interest as allowed by<j|p, cost of suit and all other relief, at or inequity, to which SCOTTEE JONES may be entitled/-^ Plaintiff JONES hereby demand a Constitution of the United States many."

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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