Recently in Insurance Claims Category

June 4, 2011

Supreme Court of Appeals of West Virginia Holds Failure to Present Accurate Insurance Policy Language Not a Basis to Relitigate Claims Under WVRCP 60(b)

774605_car_accident_2.jpgCar wrecks are one of the most common events that give rise to personal injury claims, and when a vehicle accident occurs, insurance companies are invariably involved. In such cases, understanding the insurance policy at issue is of the utmost importance, and the language of that policy can have a huge impact on the recovery amount available to the injured persons. We here at the Wolfe Law Firm have handled cases for many victims who have been wounded in automobile, motorcycle, and tractor trailer accidents, so our West Virginia traffic accident attorneys are constantly monitoring changes in the field as new decisions are issued by the courts in this state. We recently discovered a decision rendered by the Supreme Court of Appeals of West Virginia that shows just how important it is to be mindful of the wording and definitions contained within any insurance policy factoring into a case.

Adkins v. Erie Insurance Company is a case that arose from an automobile accident in 2005 that severely injured a young girl under the age of 18. The case began as a declaratory judgment action filed by the victim's parents, who sought the court's ruling as to whether they were entitled to damages that they incurred as a result of their daughter's injuries and the medical costs of helping her recover. Plaintiffs alleged that the woman who caused the accident was insured by defendant Erie Insurance, and the policy she had purchased from defendant provided a $300,000 per accident limit and a $100,000 per-person limit. The victim's case settled for the per-person limit of $100,000, and as a part of that settlement, plaintiffs reserved the right to file a declaratory judgment action against defendant in order to determine whether the defendant would have to pay an additional sum to plaintiffs under a separate per-person policy limit.

At the circuit court, defendants proffered evidence that their policy provided coverage for damages from "bodily injury, meaning physical harm, sickness or disease, including care, loss of services, or resultant death." As a result of this definition, the court found that the plaintiff parents' claims were separate and distinct from their daughter, and that their claims for expenses and medical treatment for their child. That meant that the claims were not subject to the limitation of liability provision restricting payment to the single, per-person limit. Defendant then moved under rule 60(b) of the West Virginia Rules of Civil Procedure for the court to vacate the order, contending that they had given the court an incorrect and inapplicable definition of bodily injury. Evidently, Defendant had amended the policy at issue so that damages involved "bodily injury, meaning physical harm, sickness or disease, or resultant death of a person" -- meaning they had removed the language regarding care and loss of services. As a result of this motion, the circuit court reversed its earlier decision, and held that the per-person limit applied, and that her settlement prevented any further recovery under the insurance policy.

Plaintiffs appealed the circuit court's reversal, claiming that the circuit court had abused its discretion by basing its ruling on what amounted to newly discovered evidence. The Appellate Court found that a failure to file documents in an original motion did not convert the evidence in those documents into newly discovered evidence under West Virginia law. However, the Court held in favor of the plaintiffs, because defendants had failed to present the correct version of its own policy, and that could not serve as a basis to relitigate all of the claims in a Rule 60(b) motion. In so holding, the Court reversed the circuit court's decision.

January 6, 2011

Road Work on West Virginia Bridge is Completed, but Citizens Concerned that Dangers Persist

1025128_bridge_and_water.jpgWVNS has recently reported a story that may be the first of its kind, as many residents of Willow Wood, West Virginia are upset that roadwork on a community bridge recently stopped after several years of construction. The complaints are not about the bridge itself, but the new traffic pattern at the intersection adjacent to the bridge. People unhappy with the bridge fear that the newly constructed interchange that requires a sharp turn to head towards nearby Forrest Hills, West Virginia will eventually cause a major accident. The Division of Highways has stated that the bridge interchange was designed to prevent traffic from backing up and sitting on the span, which could cause undue stress to the structure and significantly reduce the length of the bridge's life.

No wrecks have occurred since the construction stopped, and we here at the Wolfe Law Firm hope that there are no accidents near the bridge in the future. However, this news story does provide the opportunity to speak about issues that may not arise in the average automobile accident. Situations like the one in Willow Wood illustrate the potential for accidents caused by road and bridge design, as opposed to driver negligence, which is a much more common cause of accidents. When crashes happen under these conditions, it is extremely important to contact a West Virginia car crash attorney as soon as possible afterward. A lawyer can evaluate the circumstances that led to your injuries and help you pursue all the parties at fault. With an attorney's help, you have a better chance of protecting your interests and obtaining maximum compensation for your injuries.

March 31, 2010

Bad Faith Insurance Claims: Tackling Denial of Health Benefits

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Recent government discussions about health care reform have brought a number of issues to the surface regarding insurance practices in West Virginia and throughout the country. One of the biggest problems consumers have with insurance companies, regardless of political affiliation, is denial or gross underpayment of health insurance claims.

A lawyer can build a case against an insurance company for "bad faith" practices by proving that nothing in your policy stated that your claim could be denied for the reason given and that the company acted with recklessness disregard and/or malicious intention in your case. By definition, bad faith is the intentional or malicious denial to perform a contractually obligated duty and/or the fraudulent deception of another. Under the law, insurance companies (health care or otherwise) are required to pay claims properly and swiftly (good faith) and are prohibited from discounting, denying or unfairly denying payment of claims (bad faith).

You have the right to appeal any insurance claim you believe is in bad faith. A West Virginia attorney can help you prove your case so that you can recover all that is owed to you. Sometimes, if the case goes to trial, the judge may even order punitive damages above and beyond your policy limits in order to punish the company for their actions. In the future, policy limits may be eliminated through new health care legislation, but for now, many people are dealing with this issue and have valid grounds to pursue legal action against less-than-reputable insurance companies.

January 11, 2010

Don't Accept Underpayment of Insurance Claims

dollarsigns.jpgInsurance claims in West Virginia can be filed for numerous events, including car accidents, homeowner catastrophes and medical costs. You pay for insurance so that you're covered in times of need, but what can you do when the insurance company underpays or denies your claim? If you're not receiving all the money you're entitled to from an insurance claim, you need to hire a lawyer to file a "bad faith" claim against your insurer.

Especially in the medical billing industry, the pricing for services, supplies and medications is completely non-regulated, which leads to gross underpayment of medical claims for many people. Particularly for what insurers deem as "Out of Network" services, claims can be grossly underpaid or even denied. According to a report published in June 2009 by a U.S. Senate Committee on Commerce, Science and Transportation, insurance companies base their payments for out-of-network claims on what they call the "usual, customary and reasonable" (UCR) charge for a service, rather than on a healthcare provider's actual charge. As a result, patients end up footing a major portion of the bill, since UCR charges can be quite divergent from actual charges.

In the auto insurance industry, underpayment often occurs when drivers are forced to get an estimate for repairs by an inferior auto body shop that is often in the insurance company's back pocket. In these cases, if the driver wants to get the work done at another body shop, he or she has to pay the difference in cost, even though the repair could not be adequately completed at the "recommended" body shop.

Trust your instincts. If you feel like an insurance company is cheating you, there is a chance that you are. Sadly, insurance companies often only have their bottom line in mind, not your best interests. Contact a West Virginia lawyer to discuss your case before you pay for costs your insurance company should be covering.