Articles Posted in Insurance Claims

Gavel, law book, and paper with the text "personal injury"One of the things we try to do here at Slappey & Sadd is remember what it’s like to be in the client’s shoes. It’s a good way to remember that things that may seem routine or unremarkable are actually unknown territory and fairly intimidating for the people we represent. As a result, we thought we’d use today’s post to walk you through the process in the event that you’ve been seriously injured.  

Seek Medical Treatment

If you’ve been injured, the first and most important step is to seek medical treatment. In some cases, you have no choice – you need to go to the emergency room. In other cases, you felt fine right after the accident, but two days later you were in a considerable amount of pain. Or maybe you did receive immediate medical attention, but now you’re presenting with different symptoms.  Whatever the case, you should listen to your body – if something isn’t right, go get checked out as soon as possible.

If you’ve been involved in a car accident, your first priority is your health. Before anything else, you need to get examined by a doctor and seek the necessary treatment. Unfortunately, everything that comes after that – namely, paying your medical bills – can get fairly complicated. In this post, we hope to shed some light on how insurance plays a role in compensating you for your injuries.

For purposes of this post, we’ll assume that your injuries are serious and will require long-term treatment, loss of income, and a significant amount of pain and suffering. Let’s also assume that you wind up having to pursue legal action in order to get fair compensation for your injuries.     

Health Insurance

It’s no secret that ridesharing services like Uber and Lyft have exploded in popularity in recent years. Ridesharing offers a number of attractive options over traditional taxi service such as shorter wait times, a tech-based system, and newer, cleaner cars. However, no one ever thinks about what happens if they are injured in an accident while riding in an Uber or Lyft vehicle. Taxi companies are heavily regulated and have strict insurance requirements in order to protect customers in the event that something goes wrong. Ridesharing, given that it is relatively new, is still developing these standards.  

Insurance

In the event of an accident, the first question that arises is who’s insurance is going to pay the claim. Interestingly, ridesharing companies are actually subject to more onerous insurance requirements than taxi companies. A taxi driver is not required to carry more than the minimum amount of insurance required of private drivers: $25,000 for injury or death of a single victim and $50,000 for all victims in a single accident. The situation for rideshare services changed dramatically in 2015 when Georgia enacted House Bill 225. That law specifically mandated that rideshare services carry the following policy minimums:

If you’ve never been in a car accident, you may be surprised at how quickly the insurance companies spring into action. It’s important to understand, however, that the insurance companies involved have different roles to play and different motivations. Your insurance company is working on your behalf because you pay your premiums and they are under contract.  The other driver’s insurance company, on the other hand, represents the interests of the other driver. Even if the other driver has admitted that the accident was his fault, the insurance company then wants to make sure that it pays no more than it absolutely has to in paying your claim.

As a result, the other insurance company is going to want to settle the claim as quickly as possible. That may sound very appealing, but understand that a settlement is going to require you to waive any other claims, whether you are aware of them or not. For example, if you later discover that you have nerve damage as a result of the accident, you won’t be able to bring a claim against them if you’ve already entered a settlement agreement. For these reasons and others we’ll get into below, it’s very important to understand how to talk to the other driver’s insurance company.

First Things First……..

It is a fact of life that accidents happen every day – at our jobs, on the roadways, and even when we’re on vacation. Thankfully, most of these accidents result in only minor injuries that require minimal medical attention. While we know that some accidents can result in very serious injuries, we don’t like to think about the fact the worst accidents can tragically result in death. If the accident was due to someone else’s negligence, we refer to these as “wrongful death” claims. In addition to being very serious, these cases are more complicated than your typical accident case.  We hope to shed some light on this topic in this post.

Wrongful Death Defined

Under Georgia law, wrongful death cases are when someone’s “negligent, reckless, intentional, or criminal” actions cause an accident that results in the victim’s death. After giving this definition consideration, here are some details of note:

You’ve heard the jingle where a certain insurance company claims to be “on your side.” Even if they don’t say it, every insurance company wants you to believe that they are on your side: they’ll handle your claims quickly, provide top-notch customer service, and will be there whenever you need them, day or night. That may all be true if you’re paying the premiums, but sadly this is not the case if you are injured in an accident and have to make a claim against someone else’s insurance. A recent case out of Columbus, Georgia demonstrates exactly how difficult insurance companies can be when settling claims.  

Jury Finds Geico Acted in Bad Faith

The case discussed in the article involves a man who was injured while riding his bicycle in 2012 when he was struck by a vehicle. The driver was clearly at fault, and the victim did not have health insurance. The victim’s attorney offered to settle the matter for $30,000, which was the limit of the policy. Regardless of the driver’s obvious fault, Geico, who insured the driver, refused to settle the case for more than $12,000, just slightly more than the victim’s hospital bills. When the victim sued, he wound up with a default judgment because neither Geico nor the driver responded to the suit. Geico then tried to get the default judgment set aside, and later objected to the driver’s subsequent bankruptcy proceedings. When the case made it to Federal court, the jury awarded the victim $2.7 million dollars in damages, finding that Geico had acted in bad faith in refusing to settle the claim.  

No one wants to sue another person, especially when your injuries were caused by an accident – it’s not as if the at-fault person intended to harm you. However, you should understand that who you are really suing is the other person’s insurance company. In exchange for their premiums, the insurance company agrees to compensate accident victims and pay for any property damage that insured person may cause. In addition, the insurance company agrees to provide a legal defense if they are sued.  

It is important to understand this relationship between the at-fault party and the insurer because the insurance company’s primary focus is to reduce the amount of the claims it has to pay. As a result, you should assume that they do not have your best interests at heart.  Instead, they are likely to employ one of the tactics we describe below.

Quick Settlement

People most are familiar with car accidents, they are fairly common. Accidents involving buses, planes, cabs, trains, Uber or other ride-sharing services are less common and are referred to as “common carrier” accidents. These cases present some unique challenges when compared to accidents involving only personal vehicles.  

If you’ve been injured in an accident with a common carrier vehicle, it is important to understand these differences. You should first seek medical treatment, but you should also seek experienced legal counsel to help you understand your rights and the potential implications of how to proceed.  

The Role of Insurance

We’ve written before about the effects that social media posts can have on your personal injury claim. If you have been injured in an accident and filed an insurance claim or personal injury lawsuit, you can be assured that the defendant’s insurance company or attorney will perform an online search to find out more information about you. They will most likely looking for information that they can use to deny your claim or downplay the seriousness of your injuries. In the age of social media, the best places to find this kind of information are Facebook, Twitter, Instagram, and other social media platforms. One of the biggest social media mistakes that a personal injury plaintiff can make is posting photos that make it seem like they are not as injured as they claim. This is exactly what happened to a North Carolina woman, who is being sued by her insurance company for fraud.

Cynthia McCullough claimed that she suffered from a debilitating condition known as reflex sympathetic dystrophy that made it difficult for her to get dressed and bathe herself and that she required in-home care. Since 2010, McCullough has received about $389,500 from her comprehensive long-term care policy from New York Life. However, her insurance company is now suing her for fraud after it discovered Facebook photos of her going down a slide and playing Skee-Ball at an arcade.

The lawsuit also accused McCullough of transporting heavy objects into her vehicle and moving freely during an investigation between December 2016 and January 2017. She was also spotted driving 50 miles from her home to a church. During a 15-day surveillance last year, McCullough was seen driving to several locations including a bank, two restaurants, a doctor’s office, and a gas station where she pumped the gas herself. New York Life informed McCullough in July that it was discontinuing her payments. She challenged the decision, stating that her condition was “severe and debilitating,” according to the lawsuit.

At least four lawsuits have been filed against a nursing home in Florida that was the site of eleven deaths in the wake of Hurricane Irma. The facility, known as the Rehabilitation Center of Hollywood Hills in Hollywood, Florida, lost power during Hurricane Irma, which subsequently knocked out the facility’s air conditioning. All victims of the tragedy are believed to have died from heat-related conditions or from existing conditions that were exacerbated by excessive heat.

The first lawsuit, filed by the family of 94-year-old Rosa Cabrera, is based in negligence and seeks unspecified damages. Cabrera, a diabetic with weight problems, had her left leg amputated last year and her right leg amputated in March of this year, just one month before she was placed in the nursing home. In their lawsuit, the Cabrera family said that, as a double amputee, she suffered injury, pain, and distress inflicted by the center’s staff, who should have known that she could not care for herself or escape the “horrific conditions” at the nursing home. Stuart Grossman, the Cabreras’s attorney, said that Cabrera was assured by the rehab center’s staff that she would be safe from the storm as Hurricane Irma approached Florida. Instead, the home placed her in unnecessary danger that could have cost her her life. He said that the center’s conduct far surpasses a failure to meet a standard of care because Cabrera was forced to endure unbearable heat when the staff did not immediately respond to the escalating medical emergency.

The nursing home, which has had its operating license suspended since the incident and is under criminal investigation by state and federal regulators, has defended its procedures before, during, and after the storm. In a timeline, the center said that two Florida Power and Light (FPL) transformers—one that powers the building’s life safety systems and the second the air-conditioning chiller—flickered and came back on on the afternoon of September 10th during the storm, but then the power to the AC chiller went down and did not come back online. Nursing home operators said they contacted FPL, state regulators, and even Governor Rick Scott’s cell phone, but received no assistance. They said the staff set up 10 spot coolers and fans on the first and second floors, and eventually obtained additional spot coolers from Memorial Regional Hospital, across the street.But the rehab center’s administrator also admitted in the timeline that they did not call 911 to deal with the medical emergency and failing patients until 1:30 a.m. on September 13th, three days after the air conditioner went down. Five patients had already suffered cardiac arrest or respiratory distress by 4:45 a.m. on that day.

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