An Orange County man claims his life insurance company refuses to pay medical bills he incurred after he injured his back when a child jumped on it.
Ross Carroll filed a lawsuit Feb. 10 in Jefferson County District Court against American Heritage Life Insurance Co.
Carroll claims he purchased a plan from American Heritage that supposedly covered accidental death or dismemberment, dislocation or fractures, hospital confinement, ambulance services, medical expenses and disability.
Carroll went to the emergency room on Dec. 31, 2008, complaining of right flank pain. Prior to the onset of the pain, a small child had jumped on Carroll's back, according to the complaint.
An MRI revealed Carroll suffered from a disc herniation, probably caused from the jumping child, the suit states.
Because of the herniation, Carroll had to undergo surgery and became hospital confined for more than two months, the complaint says. He also required six weeks of follow-up care.
In February 2009, Carroll filed a claim with American Heritage for his injuries and requested they pay his medical bills. However, American Heritage denied his claim, saying no accident had occurred.
"Defendant failed to perform their contractual duty to adequately compensate Plaintiff under the terms of the Policy," the suit states. "Specifically, Defendant failed and refused to pay the full proceeds of the Policy, although due demand was made for proceeds to be paid in accordance with the Policy and all conditions precedent to recovery upon the Policy had been carried out and accomplished by Plaintiff."
In his complaint, Carroll alleges American Heritage violated the Texas Insurance Code, failed to make prompt payment of claims, breached the contract, breached the duty of good faith and fair dealing and violated the Texas Deceptive Trade Practices Act.
Carroll seeks actual, treble, punitive and exemplary damages, plus attorneys' fees, costs, pre-judgment interest and other relief the court deems just.
Eric W. Newell and Ryan Douglas White of Brent Coon and Associates in Beaumont will be representing him.
The case has been assigned to Judge Gary Sanderson, 60th District Court.
Jefferson County District Court case number: B185-895.