Engaged by policyholder’s defense counsel to analyze whether carrier actions constituted Insurance Bad Faith relative to assigning improper Workers Compensation and Commercial General Liability class codes and processing inaccurate premium audits. Case required analysis of carrier’s failure to determine and apply correct NCCI class codes for 4 years of audits and renewals. These deficiencies resulted in significant lost business opportunities due to wildly inaccurate NCCI Experience Modifiers 50-220% higher than actual, erratic premiums accounting, and disputes over revised audits premiums. Attorneys Lindsay Wright Brett, Brendan Cook and Lola Ojeniyi, Baker & McKenzie (713) 427-5000. Zurich v. TxEx Energy, Case No. 4:20-cv-3622 In United States District Court for the Southern District of Texas Houston Division.
Workers Compensation Expert Witness Cases
Engaged by carrier counsel pursuing an Insurance Agent Errors & Omissions action for Bad Faith to recover claim payments made under a Workers Compensation policy underwritten based on agent’s material misrepresentations on the application. After a tree trimming worker was seriously injured it was discovered the agent had withheld critical underwriting information relative to eligible NCCI classifications and guidelines for the Workers Compensation program. Case required analysis of NCCI class codes and disparate answers provided on multiple Workers Compensation applications. Attorneys Brad Burns and Amanda Newman, Dickinson Wright, PLLC (602) 285-5000. FirstComp v. Ensign, Case No. CV2020-007001 In the Superior Court Of The State of Arizona In And For The County Of Maricopa.
Retained by carrier’s defense counsel to review allegations of Insurance Bad Faith Claims Handling for a Workers Compensation claim denial. Case required opinions regarding whether claim denial was reasonable, based on inconsistencies in employee’s version of how and where the injury occurred, and ceasing communications shortly after the alleged injury. Attorneys Paul Gerding and Andrew McNichol, Kutak Rock LLP (480) 429-5000; Ndwiga v. Plaza Insurance Company, Case No. 2:18-cv- 02324-SPL In United States District Court For The District of Arizona.
March 1, 2019Don Hirsch
Retained by contractor’s defense counsel to review Commercial General Liability policy structure relative to insurance requirements listed in a Subcontract. Dispute involved Workers Compensation and a third party over action. Case required opinions regarding whether the Subcontractor’s policies complied with the Subcontract’s “Additional Insured” language. Moss v. J4 Development, Cause No. 2016DCV4519, In The 327th Judicial District Court of El Paso County, Texas. Attorney Jim Mounts, Ray McChristian & Jeans, PC (915) 832-7253
August 30, 2018Don Hirsch
Retained by counsel for carrier seeking to rescind a Commercial General Liability policy based on agent’s failure to disclose material underwriting information on the application. Case required analysis of issues relative to Agents Errors & Omissions, Insurance Bad Faith Claims Handling and Workers Compensation issues involving an injured worker. Atlantic Casualty v. N&A Properties; Case 4:17-CV-368-A in United States District Court for the Northern District of Texas, Fort Worth Division. Attorneys Camille Johnson and Steve Santayana, Savrick, Schumann, Johnson, McGarr, Kaminski & Shirley, LLP, (214) 368-1515.
October 20, 2017Don Hirsch
Engaged by defense counsel to analyze Agent Errors & Omissions issues relative to whether the agent was provided a copy of an oil field services Master Services Agreement. Plaintiff had failed to provide the agent with accurate information to obtain Jones Act / USL&H Maritime Workers Compensation and/or Other States coverage. The dispute resulted from the Commercial General Liability carrier denial of a contractual liability indemnity claim (under the customer’s MSA) for an employee injury which occurred over water. Zadok v. Bell Insurance, Cause No. 2016-44757 In 80th Judicial District Court, Harris County, Texas. Attorneys Ryan Brown and Nathan Shackelford, Hermes Law, PC (214) 749-6800.
July 21, 2017Don Hirsch
Engaged by defense counsel to opine regarding Agent Errors & Omissions relative to whether the insurance agent was ever provided a copy of an oil field Master Services Agreement. The dispute resulted from an employee injury, plaintiff’s previous failure to complete required actions to obtain Workers Compensation and carrier denial of a Commercial General Liability claim. Allegations against the agent included failure to procure Commercial Auto and Commercial General Liability to comply with MSA contractual liability insurance requirements. Emperor v. Millennium Insurance Services; Cause No. 2016CI14546 In The District Court of Bexar County, Texas 150th Judicial District. Attorney Frank McNiff, Welder Leshin Lorenz McNiff Buchanan Hawn, LLP, (361) 561-8008.
June 16, 2017Don Hirsch
Engaged by defense counsel for managing general agent as their Workers Compensation and Insurance Bad Faith expert. Case involved allegations by a long haul trucker of Insurance Bad Faith and Agent Errors & Omissions resulting from a Workers Compensation carrier insolvency. Case required analysis of interplay between Commercial Auto and Workers Compensation insurance markets for truckers. Attorneys George Carr, Janik LLP (440) 740-3016 and Joe Nicholas, Mazanec, Raskin & Ryder (440) 287-8320. AIM v. Safe Fleet, et al; Case No. 4:14-cv-02161 United States District Court Northeastern District of Ohio, Eastern Division
March 12, 2016Don Hirsch
Engaged by plaintiff counsel as their Commercial Auto, Insurance Bad Faith and Workers Compensation expert. Case involved a truck driver fatality and required analysis of Commercial Auto and Workers Compensation coverage and claim denial issues. Dispute resulted from differing positions as to whether trucker was an employee or independent contract driver. Attorney Chris Pinedo, Hilliard Munoz Gonzales, LLP (361) 882-1612. Arca Trucking vs. Hallmark County Mutual Insurance Co.; Cause No. 2014-DCV2416 In The District Court of El Paso County, Texas, County Court at Law 6.
May 2, 2014Don Hirsch
Engaged by carrier’s defense counsel as their Workers Compensation expert. Carrier and third party administrator were enjoined in litigation between policyholder and agent following a fatality injury to an out of state employee. Case involved allegations of Agent Errors & Omissions and Insurance Bad Faith relative to “Other States Insurance”, Construction agreements and Certificates of Insurance. Factory Sales and Engineering v. Ellsworth Corporation, et al; Docket No. 2007-15870 Division “D”, 22nd Judicial District Court for the State of Louisiana, Parish of St. Tammany. Attorneys for carrier Heather Blackburn & Janice Unland, Rabalais, Unland, & Lorio, (985) 893-9900.
June 1, 2011burld
Retained as consultant to evaluate ongoing projects coverage continuity issues relative to termination of a rolling OCIP (Owner Controlled Insurance Program). Consultation included forensic review of premium audit procedures for Commercial General Liability, Completed Operations, Commercial Umbrella, Inland Marine Builders Risk and Workers Compensation. Policyholder Tarrant County College District; Attorney Burch Waldron, Law, Snakard & Gambill, P.C. (817) 878-6319.
November 1, 2010burld
Retained by counsel for physician seeking claim payment under his Professional Liability policy. Case required expertise in Claims Made medical malpractice Liability Insurance, Workers Compensation and Insurance Bad Faith. Lowe vs. TMLT, Cause No. 348-223452-07; 348th Judicial District Court of Tarrant County, Texas. Attorney Bill Kirkman – Bourland & Kirkman, LLP (817) 336-2800.
October 1, 2009burld
Insurance expert witness designation pertaining to Business Auto claim denial for Uninsured/Underinsured Motorist coverage. Case required analysis of interplay between Commercial Auto, Agent Errors & Omissions, Insurance Bad Faith and Workers Compensation. Elizondo v. American International Group, et al; Cause No. 07-62262-1, County Court at Law No. 1, Nueces County, Texas. Plaintiff counsel Doug Allison (361) 215-7802.
April 1, 2009burld
Retained by hospital’s in house general counsel to provide analysis of CCIP for a large hospital addition. Engagement included assessment of how and what coverage would be extended to the owner under a CCIP (Contractor Controlled Insurance Program) in contrast to an OCIP (Owner Controlled Insurance Program). Client requested evaluation of issues involving Commercial General Liability, Completed Operations, Commercial Umbrella, Inland Marine Builders Risk (including “soft costs”) and Workers Compensation. Attorney John McNey, General Counsel, Cook Children’s Medical Center , (682)-885-1330.
March 1, 2009burld
Defense counsel engagement regarding alleged Insurance Bad Faith placement of a loss sensitive insurance program and carrier’s claim reserve methodology. Case required expertise in Commercial General Liability, Workers Compensation, Agent Errors & Omissions. Attorneys Leland de la Garza and David Tabor – Shackelford, Melton & McKinley, LLP (214) 780-1400 Lauren Engineers and Contractors, Inc. v. Hilb Rogal, and St. Paul Insurance , 104th District Court, Taylor County, TX, Cause # 23376-B.
February 1, 2007burld
Engaged to assist defense attorneys answering alleged Agent Errors & Omissions. A fireworks explosion and fire resulted in multiple fatalities and widespread property losses. Allegations involved coverage placement disputes for numerous lines of insurance: Commercial Auto, Workers Compensation, General Liability Insurance, Commercial Umbrella, and Property Insurance. Attorneys Brent Cooper and Joyce Ondich – Cooper & Scully, PC, (214) 712-9500. Joseph M. Lamb, Jr. d/b/a Pyrotechnics by Lamb v. Britton-Gallagher, et al; Civil Action No. 2-04CV-400, US District Court, Eastern District of Texas, Marshall Division.
September 1, 2005burld
Defense counsel engagement regarding insurance placement “Standard of Care”, market conditions and allegations of fraud. Case issues included Insurance Agent Errors & Omissions during placement of a PEO Workers Compensation program. Attorney Troy Glander – Davis, Cedillo & Mendoza, Inc. (210) 822-6666. Texas Citrus Exchange, et al v. Brown & Brown, Inc., et al; Cause No.C-1420-02-E; in the 275th Judicial District, Hidalgo County, Texas.
March 1, 2005burld
Retained by plaintiff to provide forensic insurance analysis of coverage and premiums. Case involved issues of agent negligence over multiple policy years in placing Workers Compensation, Products Liability Insurance, Commercial Umbrella, and Property Insurance. Attorney – Craig Albert of Godwin Gruber Attorneys (214) 207-6901. Aurora Equipment v. Arthur J. Gallagher & Co.; Cause No. 04-07955-E; 101st Judicial District Court of Dallas County, TX.
March 1, 2005burld
Litigation involved Commercial General Liability Insurance third party over action and establishing “Non-employee” status of plaintiff under Texas Workers Compensation Insurance Nonsubscriber statutes. Engaged by plaintiff’s attorney Mike Henry – Jose, Henry, Brantley, MacLean & Alvarado, L.L.P., (817) 877- 3303. Lewis v. The Williams Companies, Inc., et al; Cause No. 2003-29049; 334th District Court, Harris County, Texas.
August 1, 2004burld