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


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 or contact the clerk of the relevant court.

Case Number: 
1:11-cv-00995 Search Pacer
Opposing Party: 
Douglas Mahoney
Court Type: 
US District Court: 
District of Colorado
Date Filed: 
Apr 14 2011

"32. Plaintiff repeats and incorporates by reference each and every allegations of paragraphs 1 through 29, as «f fully set forth herein.

33. Defendants have a contractual and implied obligation of good faith and fair dealing to Plaintiff in the handling of Plaintiffs Workers' Compensation claim.

34. The obligation to Plaintiff includes, but is not limited to, handling his claim in an appropriate fashion, to provide benefits as awarded, and to act in a manner consistent with the purposes of the Colorado Workers' Compensation Act to provide prompt payment and medical care'to injured workers who are injured on the job in the State of Colorado, in order to relieve the affects of their industrial injuries.

35. Defendants breached the covenant of good faith and fair deal ing through their conduct as described above and by engaging in the following;

a.    Attempting to control and dictate Plaintiffs medical treatment;

b.    Failing to consider Plaintiffs interests as equal with their own interests;

c.    Refusing or failing to promptly pay claims without conducting a reasonable investigation
based upon ail available information and/or failing to adopt and implement reasonable
standards for the prompt investigation of claims arising under the Workers' Compensation
insurance policy.

d.    Maintaining denial of medical and wage-loss benefits, despite receipt of reasonable medical
opinions from treating physicians and/or Division 1MB physicians, despite receipt of
information justifying authorization of wage-loss benefits and medical care;

e.    Failing to promptly provide a reasonable explanation of the basis under the Colorado
Workers' Compensation Act in relation to the facts or applicable law for denial of the
benefits in question;

f.    Compelling Plaintiff to institute litigation to recover amounts clearly due under the policy
by refusing to timely provide medical and/or wage-Soss benefits;

g. Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of wage-loss benefits and refusal to authorize reasonable medicaj care; and

h. Using their financial power and resources to delay and deny reasonable and necessary medical care In order to coerce Plaintiff into paying for his own medical care and incurring substantial financial hardship.

36. Defendants breached the duty of good faith and fair dealing owed to Plaintiff by the unreasonable manner in which they have processed his Workers' Compensation claim and to reach their decisions to deny and delay the payment of benefits on his claim.

37. Defendants breached the duty of good faith and fair dealing owed to Plaintiff by the unreasonable delay and/or dental of wage-loss and medical benefits.

3 S. The expense and delay involved in these disputes has been unnecessary and caused Plaintiff to incur costs associated with medical care; which included insurance premiums, co-pays and deductibles, as well as other expenses.

19. Defendants1 conduct violates industry standards as established by C.R.S. §10-3-1104, regarding "Unfair methods of competition and unfair or deceptive acts or practices".

40.Defendants knew or should have known their cond uct was unreasonable or disregarded the fact that their conduct was unreasonable.

41. As a result of Defendants' conduct, Plaintiff was forced to endure unnecessary pain and suffering, anxiety and physical impairment.

42. Plaintiff has suffered injuries, damages and losses as a result of the claim's handling practices implemented by Defendants.

43. Defendants' patterns and practices, as demonstrated in this case, have improperly shifted the economic burden to a disabled injured worker which is thereby defeating the purpose and intent of the Colorado Workers1 Compensation Act, as well as their contractual obligations.

44. As a direct result of Defendants' breaches of their duties, Plaintiff has been damaged, including but not limited to:

a. Plaintiff has endured unnecessary pain and suffering* anxiety, an ulcer, hiatal hernia, depression, and upon information and belief, Plaintiff may have also incurred a heart attack as a result of Defendants' conduct. In addition, Plaintiffs may have suffered damage to his back and according to Plaintiffs chiropractor Ptaintiffhas a curve inhis spine from side to side.

b. Plaintiff has suffered unnecessary financial hardship and severe emotional distress; and

c. Plaintiff has suffered a past loss of income, due to an inability to return to work and will suffer financial losses in the future, over the remander of his working life, due to diminished work capacity and the expense of continuing rnedicai care and palliative care."

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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