Injured worker angry over year without benefits

Kelly Holleran Jan. 3, 2011, 5:52am

After surviving for more than one year without workers' compensation benefits, a Jefferson County man finally received more than $25,000 in back pay. However, he remains miffed about the year he had to go without pay.

Michael Trahan filed a lawsuit Dec. 16 in Jefferson County District Court against Seabright Insurance Co. and adjuster Nikki Heredia.

Trahan claims Seabright and Heredia repeatedly denied his claim for workers' compensation benefits. Not even doctors' notices could convince the insurance company and its adjuster that Trahan was entitled to the benefits, according to the complaint.

Trahan filed for the benefits following an injury he sustained while working for Bo-Mac Contractors on June 29, 2009, the suit states.

When he first received notice that he had been denied his workers' compensation benefits, Trahan sought help from the Texas Department of Insurance-Division of Workers' Compensation. In turn, the department assigned Dr. David Schwartz to determine if Trahan's injury stemmed from his work, the complaint says.

After an examination, Schwartz diagnosed Trahan with Lumbar Intervertebral Disc Syndrome and Lumbar Radioculopathy, Trahan claims. In addition, Schwartz confirmed that Trahan's conditions did originate from his June 29 work-related injury, according to the complaint.

Trahan forwarded Schwartz's findings to the defendants, but still they refused to compensate him, the suit states. A benefit review conference also did not sway the defendants' decision to withhold money from Trahan, the complaint says.

Finally, at a contested case hearing in Beaumont, the Texas Department of Insurance-Division of Workers' Compensation ordered the defendants to pay Trahan his workers' compensation benefits from July 2, 2009, through May 10, Trahan claims.

Eventually, Trahan received $25,198.80 in past due benefits and $4,275 for attorney's fees he incurred, according to the complaint. Still, he remains outraged by the months he was forced to go without pay, the suit states.

"It was only after Mr. Trahan had been forced by Defendants to go through a contested Benefit Review Conference and a Contested Case Hearing, that Mr. Trahan was paid benefits," the complaint says. "This was months after Mr. Trahan was injured, and months after Mr. Trahan should have received benefits. Mr. Trahan and his family went for months without benefits."

Because of the months he went without benefits, Trahan experienced financial hardship and suffered severe emotional distress, according to the complaint.

He claims the defendants violated the Texas Insurance Code by failing to attempt to effectuate a prompt settlement of his claim and by refusing to pay a claim without a reasonable investigation.

In his complaint, Trahan seeks an unspecified judgment, plus pre- and post-judgment interest and other relief the court deems just.

Curtis W. Leister and John Werner of Reaud, Morgan and Quinn in Beaumont will be representing him.

Judge Donald Floyd, 172nd District Court, has been assigned to the case.

Case No. E188-977

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