On a cold night in December a few years ago, my client was asleep in bed when a drunk driver lost control and struck the client’s home just below his bedroom. My client found himself on the floor, having fallen off his bed, into a desk. The desk was broken and he felt a little sore. Police arrived, the driver was arrested, and my client and his sister started having to go through the process of making insurance claims for the damage to their home and some of their personal property.
This particular client lives in a fairly remote area. It’s a good 45 minute to hour drive each way for him to visit his doctors or go to a hospital. For this client, getting medical treatment is a major inconvenience. He figured that since he wasn’t bleeding, didn’t have any broken bones, that he didn’t need to go to the hospital, that these injuries were not terribly serious, and they would heal on their own in time. After a few months of eating Advil on a daily basis, his sister encouraged him to finally seek out medical treatment for the pain he was having. The client didn’t really begin receiving medical treatment for these injuries for nearly three months. He came to me a couple of months later because Medicare was sending him questionnaires asking if the bills Medicare was receiving were because of an accident.
In Pennsylvania, if you incur medical bills that stem from a motor vehicle accident, your own car insurance company is responsible for those bills. It doesn’t matter who was at fault for the accident. It doesn’t matter whose car you were occupying. It wouldn’t even matter if you were a pedestrian or if you happen to be asleep in your own bed. If the injury and medical treatment was brought on by a car accident, your own car insurance is responsible for those bills. So once Medicare found out that these bills stemmed from an auto accident, it would not pay for any of the bills to treat these injuries.
We discussed that because these bills resulted from a motor vehicle crash that we would need to set up a claim with his own insurance company to pay the bills. We set up a claim, filled out every form his insurance company wanted, we agreed to provide them a diagram of the house and his bedroom, we agreed to a recorded statement and the insurance carrier agreed to provide us a copy of the recorded statement.
From the beginning though, this client’s own insurance company did not take a fair look at this claim. During our first conversation, the adjuster argued that the medical bills could not be related to the accident given that he didn’t start getting medical treatment until almost three months after the accident.I told the adjuster that some people are tough. Some people just live with pain as long as they can and don’t run to a doctor’s office right away if they think things will get better, or if they live 45 minutes away from any doctor like this client. All we asked is that the insurance company take a fair look at the claim.
After giving a recorded statement, which his own insurance company assured they would provide to us in a week or two, the insurance company played games, lied to us, and strung us along. After making multiple requests for a copy of the transcript of the recorded statement, it was sent to my office after business hours, about 8 months after the recorded statement was given, and less than 48 hours before his own insurance company filed a lawsuit against our client in Federal Court claiming he was a fraud. His own insurance company had not paid one bill nor provided us with their position until we received their lawsuit.
We were blindsided. We expected that the insurance company was either going to pay the bills or send us a letter explaining why it believed it shouldn’t pay the bills. Instead, my client gets slapped with a lawsuit and the insurance company was claiming he was a fraud. The insurance company even went so far as to hire an expert to write a report saying that it was not possible for him to be “thrown” out of bed as a result of the impact. Notably, the client never said he was thrown out of bed. All he said was that when he awoke, was on the floor beside his bed, and that his desk was broken. The “expert” hired by the insurance didn’t mention it in the report that was submitted when they filed their lawsuit, but later in discovery we learned the “expert” did tell the insurance company that it was possible he fell out of bed after being startled.
Hindsight is 20/20 but this client knows he made a mistake. His mistake was being a tough guy, just living with the pain, failing to immediately seek medical treatment, and then later being honest about it. It would have been easier for him to just lie about the whole thing, say that these bills had nothing to do with the accident, and Medicare would have paid the bills. But the client is an honest guy and I believed him.
Once his own insurance company filed suit, I then filed motions to dismiss their lawsuit. While the Federal Court did maintain jurisdiction in the case, we were successful in getting the fraud count against our client dismissed. I filed a counter claim against the insurance company alleging that they acted in bad faith and never took a fair look at this claim. We also then filed suit in state court against the driver which caused the crash.
We had two lawsuits going on in two different court systems at the same time for this one accident. The fact is, this was not a big value case. There were no broken bones, there were no surgeries, our client did respond to medical treatment and was better after getting medical treatment for a few months. But the bottom line was that I believed this guy so I was not going to let these insurance companies walk all over him. I believed he was being railroaded by his own insurance company, and he wasn’t being treated fairly by the drunk driver’s insurance company so I took up his fight. Recently, after more than a year of litigation, after depositions, after motions being filed, the client’s own insurance company finally agreed to accept responsibility for the accident related bills. They are issuing payment. The drunk driver’s insurance company also finally agreed to offer a reasonable settlement to resolve his claims.
This was not the type of case where the numbers were ever going to be big. Sometimes though, in this line of work, these small victories can be as gratifying as any large settlement. The result didn’t come without a lot of hard work, research and argument. But I believed my client and I was intent on seeing this through until both the insurance companies paid what was rightfully due my client.
If you have been injured in a motor vehicle accident, don’t trust auto insurance companies.
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