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Winning the Case That Appears Unwinnable: Part 3

Winning the Case That Appears Unwinnable: Part 3

 Posted by:    Jun 10, 2011  


This case started with a garden-variety two vehicle car crash. The at-fault driver was uninsured. At first, it seemed that the injured woman would only need conservative medical care, but the injuries and subsequent treatment soon spiraled out of control. Because of persistent pain, a doctor ordered an MRI and located a cyst dangerously near the spinal cord.

The doctor explained that the reason for her persistent pain and associated neurologic symptoms was the precarious location of that cyst. Spinal surgery was thereafter attempted. The surgery was unsuccessful at first, requiring surgeons to go back in two more times over the next year. While the procedures were ultimately declared successful by the surgeons, the crash victim was rendered permanently injured, not to mention that she also incurred medical bills in excess of $200,000.

Her first attorney bundled a full set of the medical records together along with her medical bills and adequately detailed the extent of his client's injuries, damages and losses. He then sent it to the Plaintiff's UIM [Uninsured Motorist] auto insurance carrier and requested the full value of her coverage, $250,000.

Three weeks later, the attorney received a denial letter from the insurance company. The letter was a total of 4 sentences and essentially said that the insurance company was not convinced that the injuries or associated care were related to the car crash.

The next week, the attorney quit the case, claiming to be too busy to continue the battle against this insurance company. The crash victim then took her bundle of medical records, bills, and the insurance company denial letter to three of our competitor law firms over the course of the next two months. They all rejected her case, citing everything from the "complicated nature of her case" to their "trial schedule being too exhaustive." However, the crash victim was not stupid. Regardless of the fancy words being used, she knew the truth--she was being given the brush-off by law firms that saw her case as a loser.

She then came to see us. We didn't think the case was a loser. What it was, unfortunately, was a case that had not been properly focused.

The advantage that her case had, that no one else apparently considered, was that she was a quality, hard- working, honest person who was simply seeking coverage from her own insurance company. Her insurance company had certain obligations to treat her interests equally (what is known as "due regard") to their own business interests. It appeared to us, however, that the insurance company wasn't planning on treating this victim like they had promised, even though she had paid them premiums for years.

But without ferreting out the insurance company's intentions, the value of the case was uncertain. So we thought someone needed to help her focus her case, not so much with respect to the relatedness of injuries to the crash, but focusing on requiring the insurance company to show us the basis for their generic denial. She had surgeons relating her injuries to the crash. Did the insurance company have similar experts denying the relatedness, or were they just hoping to blow her off and gamble that no law firm would have the guts to challenge them? We thought the chances were good that the insurance company hadn't reasonably investigated the cause of her injury, so we took the case.

For the next several months, we began a letter-writing campaign. We asked the insurance company to assist our client/their insured in understanding the basis of their claim denial. Was it based on a doctor's opinion? Did they not believe the opinions of her treating surgeons who related her injuries to the crash? Was there some medical record or medical opinion that they overlooked?

In response to each letter we sent the insurance company, we received a nearly immediate response. But they never really answered any of our questions. They continued to recite the same verbiage. "We do not believe that all the care is related to the accident." In kind, we followed up asking, "well, if it's not all related to the crash,' how MUCH of it IS related? We asked why they weren't offering any money if their only concern is that the medical care is not ALL related.

After numerous letters to the insurance company, giving them multiple opportunities to express the basis of their denial of benefits, to no avail, we brought a lawsuit against the insurance company based on their unreasonable denial of benefits. We brought this under a fairly new statute that mandates stiff penalties if an insurance company acts unreasonably.

Thereafter, we had the opportunity to take the depositions of the insurance company adjuster and claim supervisor who were behind those short and non-responsive letters. It became plainly obvious, both to us and even the insurance company attorneys, that the insurance company never did their homework on this claim. It never secured the opinion of a single medical doctor to support its "from the hip" claim denial.

Treating this case not like an automobile injury case, but as an insurance company breach of contract claim, resulted in the insurance company ultimately coming to the table and offering substantial settlement money to our client. In fact, they eventually offered so much money that our client just couldn't say no.

CONCLUSION:
I hope that these last three blog posts have illustrated the absolute necessity of having your case evaluated by a law firm that is willing to see past the initial stumbling blocks of your case and think outside the box. In each case, our client had been turned away by multiple prior firms. In each case, we were able to find the light at the end of the tunnel for our clients.

This is not to say that every case is winnable, but certainly a good portion of the "unwinnable" deserve to have a closer look. Please call us today at Anderson Hemmat, so we can take a closer look at your case.









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