Insurance provider sued for denying on-the-job injury claim

David Yates Dec. 10, 2007, 10:00am

Michael Doyle

Otis Rogers is suing his employer's insurance provider, claiming he was wrongfully denied worker's compensation benefits for an on-the-job injury.

Rogers' suit against Ace American Insurance Company, ESIS Inc. and Brenda Preuss was filed with the Jefferson County District Court on Dec. 6.

According to the plaintiff's petition, Rogers, "a loyal and hard-working employee of Protherm Services Group," was injured while working on the job on Dec. 5, 2005 when a rubber hose fell and struck him.

The suit says rather than properly investigate Rogers's injuries, ACE, ESIS, and Preuss chose to deny his insurance benefits.

According to the suit, on Jan. 10, 2006, ACE, ESIS, and Ms. Preuss filed a denial which is included in the lawsuit.

"ESIS disputes an injury in course and scope of employment," the denial document stated. "ESIS disputes medical and indemnity benefits. Employee is alleging that two pieces of flex hose fell from a tower above and hit him in his right shoulder and head. According to witness statement the hose hit the ground and the employee did not seem to be in any distress.

"Another worker in the area did not witness any injury to the employee. The employee's alleged incident is a result of an uncorroborated incident. There is no medical to support lost time beyond seven days. ESIS reserves the right to amend this dispute."

By denying his benefits, the suit alleges the defendants committed violations of the Texas Insurance Code and Texas Deceptive Trade Practice Act and also acted with malice and bad faith.

"Unfortunately, ACE, ESIS, and Ms. Preuss's delay and imposition of severe economic distress and delayed medical treatment had reasonably anticipated consequences on Mr. Rogers from which he is still fighting to recover," the suit said.

"Given the repeated delays of payment for his necessary medical care and other benefits, Mr. Rogers has been subjected to significant economic impact, worry, distress, and continuing economic and physical damage. In addition, Mr. Rogers has suffered financial harm and damage to his credit as a result of defendants' denials and repeated delays."

Rogers is demanding a trial by jury and is represented by Michael Doyle of the Doyle Raizner law firm.

Judge Milton Shuffield, 136th Judicial District, has been assigned to the case.

Case No. D180-867

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