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

WAINWRIGHT 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: 
2:15-cv-01944 Search Pacer
ACE Group party(s): 
Opposing Party: 
Robert E Wainwright
Court Type: 
Federal
US District Court: 
District of Arizona
Date Filed: 
Sep 29 2015

PARTIES, VENUE AND JURISDICTION

  1. Plaintiff Wainwright is, and at all times relevant hereto, was a citizen and resident
    of the State of Arizona, wherein he engaged in a business transaction with
    Defendant.
  2. On information and belief. Defendant ACE is and, at all times relevant hereto, was
    a Pennsylvania corporation, authorized to do business in the State of Arizona.
  3. This Court has original subject matter jurisdiction of the federal claims pursuant to
    supplemental jurisdiction of the state claims pursuant to 28 U.S.C. § 1332.

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Case 2:15-cv-01944-ROS Document 1 Filed 09/29/15 Page 2 of 6

  1. Venue is proper in this District under 28 U.S.C. § 1391.

GENERAL ALLEGATIONS

  1. Plaintiff was an independent contractor of Swift Transportation Co., Inc. on
    September 12, 2009.
  2. As such, Plaintiff was covered under a Occupational Accident Insurance
    Agreement, specifically Occupational Accident Plan A, Policy Number
    TOCNO1303533 (hereinafter “Policy”).
  3. On September 12, 2009, Plaintiff was involved in a motor vehicle accident, while
    working as an independent contractor for Swift Transportation Co., Inc.
  4. Among other things, under the Policy, Plaintiff was to receive (1) payment of
    medical expenses incurred in connection with an accident, (2) payment of
    temporary total disability benefits under the Policy, and (3) payment of permanent
    total disability benefits under the Policy.

FIRST CAUSE OF ACTION

BREACH OF CONTRACT

  1. Paragraphs 1-8 are hereby incorporated by this reference in support of this cause
    of action as though fully set forth herein.
  2. Plaintiff Wainwright and Defendant ACE entered into a contract, namely the
    Policy.
  3. Defendant ACE agreed that it would timely provide to Plaintiff the benefits
    identified in the Policy.
  4. Despite Demand, Defendant ACE did not pay all the reasonable medical expenses
    covered by the Policy that were incurred by Plaintiff as a direct and proximate
    result of the accident.
  5. Defendant ACE did pay Plaintiff for temporary total disability benefits owed to
    Plaintiff under the Policy.
  1. Despite Demand, Defendant ACE has not paid any of the permanent total
    disability benefits owed to Plaintiff under the Policy.
  2. The Social Security Administration (hereinafter “SSA”) made a formal
    determination that Plaintiff is totally disabled. Pursuant to the request of ACE, the
    entire SSA file of Plaintiff was delivered to ACE at the insistence of Plaintiff,
    establishing for ACE the basis for the SSA finding of total disability.
  3. Plaintiff has forwarded to Defendant ACE all medical bills incurred by him.
  4. Defendant ACE has failed and refused to fulfill its obligation under the Policy
    despite Plaintiffs having substantially fulfilled all his duties under the Policy and
    having met all Policy conditions to such payments.
  5. Defendant ACE has breached its contract with Plaintiff, and as a direct and
    proximate result. Plaintiff has incurred multi-faceted damages.
  6. Plaintiff did not get the benefits of the bargain for which he paid.
  7. Plaintiff has incurred significant pain and suffering as a result of the failure of
    ACE to authorize covered medical expenses.
  8. Plaintiff has suffered damage to his credit and severe emotional distress as a direct
    and proximate result of being deprived of benefits to which he is entitled under the
    Policy.

DAMAGES IN GENERAL

  1. As a direct and proximate result of Defendant ACE’s having breached its contract
    with Plaintiff, as reflected in the Policy, Plaintiff Wainwright has incurred multi-
    faceted, substantial, and ongoing damages and losses, including, but not limited to,
    unpaid medical expenses, unpaid temporary total disability benefits, unpaid
    permanent total disability payments, severe physical pain as a result of the failure
    to pay for medical benefits and Plaintiffs inability to receive the medical care he
    needed, severe emotional distress, embarrassment, humiliation and damage to

credit. Plaintiffs are, thus, entitled to significant compensatory damages.

PRAYER FOR RELIEF

Wherefore, for the First Cause of Action, Plaintiff requests a trial by Jury and
prays that a judgment be entered in his favor as follows:

  1. For compensatory damages against Defendant ACE in an amount to
    be determined at a jury trial, but not less than $200,000.00;
  2. Attorney’s fees and costs;
  3. Interest at the highest legal rate from the date first recoverable until
    paid in full; and
  4. Such other and further relief as the Court deems fair and just.

SECOND CAUSE OF ACTION

BAD FAITH: BREACH OF IMPLIED CONVENANT OF GOOD FAITH AND
FAIR DEALING BY DEFENDANT ACE

  1. Paragraphs 1-21 are hereby incorporated by this reference in support of this cause
    of action as though fully set forth herein.
  2. Defendant ACE and Plaintiff entered into a contract for insurance benefits.
  3. Defendant ACE had a duty to deal at all times with Plaintiff fairly and in good
    faith.
  4. Defendant ACE breached this duty (1) through its failure to properly pay for
    reasonable and necessary medical expenses; (2) through its failure to pay for the
    temporary total disability benefits to which Plaintiff was entitled, (3) through its
    failure to pay for the permanent total disability benefits to which Plaintiff was
    entitled, (4) through its delayed investigation and analysis of Plaintiff s claims, (5)
    through its denial of benefits for medical care costs; (6) through its unreasonable
    and bullying type tactics designed specifically to humiliate Plaintiff and (7)
    through its refusal to promptly provide to Plaintiff all of the benefits under the
    Policy to which he was entitled.

-4

  1. Defendant’s acts and omissions violated the duty of good faith and fair dealing
    owed to Plaintiff under the Policy.
  2. Defendant intentionally deprived Plaintiff of his benefits under the Policy at a time
    when he needed the benefits the most.
  3. Defendant acted with an evil mind, placing its desire for profits above the rights of
    one of its insureds.
  4. Defendant’s acts and omissions violated the duty of good faith and fair dealing
    owed to Plaintiff under the Policy.
  5. As a direct and proximate result of Defendant ACE’s having breached its duty.
    Plaintiff has incurred multi-faceted damages.
  6. Defendant is liable to Plaintiff for punitive damages.

DAMAGES IN GENERAL

  1. As a direct and proximate result of Defendant ACE’s having breached its duty
    owed to Plaintiff, Plaintiff has incurred multi-faceted, substantial, and ongoing
    damages and losses, including, but not limited to physical pain and suffering,
    severe emotional distress, embarrassment and humiliation. Plaintiffs are, thus,
    entitled to significant compensatory damages in an amount to be proved at trial,
    but not less than $200,000.00.
  2. In addition to the entitlement of significant compensatory damages, Plaintiff are
    each entitled to significant punitive damages from Defendant ACE: Defendant
    ACE engaged in conduct that was intentional, and performed with an evil mind
    and attitude toward Plaintiff.

PRAYER FOR RELIEF
Wherefore, for the Second Cause of Action, Plaintiff requests a trial by Jury and

prays that a judgment be entered in his favor as follows:

  1. For compensatory damages against Defendant ACE in an amount to be

determined at a jury trial, but not less than $200,000.00;

  1. For punitive or exemplary damages against Defendant ACE in an amount to
    be determined at a jury trial;
  2. Attorney’s fees and costs;
  3. Interest at the highest legal rate from the date first recoverable until paid in
    full; and
  4. Such other and further relief as the Court deems fair and just.

RESPECTFULLY submitted this 29th day of September 2015.

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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