Insurance Litigation Monday, July 15, 2019
The High Price of Insurance
You started your trucking business in the early 1990’s. What started as one-man operation has blossomed into a thriving, profitable business. You play by the rules, and your track record proves it. And then it happens. Your trucking company is hit with a massive lawsuit for medical bill reimbursement. Unsolicited advice and opinions are to just pay it, as fighting might be too costly. Depending on the lawsuit, it may be advantageous to hire experienced legal counsel to investigate- and fight- the costs. That is what my trucking client did. Here’s how I re-wrote their story.
Premiums vs. Coverage
The rising cost of automobile insurance premiums in New Jersey is a great concern to all insurance customers. We count on the insurance companies to protect our interests and to keep costs down. But do they actually accomplish this goal? Who is making these decisions? How qualified are the insurance adjusters who are given this responsibility?
It was a simple rear end tap at less than five miles per hour. How does this equate to $185,000 in medical costs? Is your insurance company responsible for preventing these unnecessary costs from occurring in order to protect you, the client? This is the question that my client was left wondering, particularly when asked to pay those bills in conjunction with a lawsuit under the current New Jersey Personal Injury Protection (“PIP”) statute.
Background of the Accident
A tractor trailer driven by my insured driver rear ended an SUV driven by the plaintiff at an intersection in an urban environment in New Jersey. The plaintiff then sued my client’s company and his licensed commercial driver. After the underlying personal injury suit settled, the plaintiff’s insurance company sought recovery of the plaintiff’s medical costs paid for by the plaintiff’s auto insurance carrier under the PIP statute. After a lot of thought, my client reached out to me to weigh his options.
The plaintiff’s carrier, which paid the medicals, was supposed to be “standing in the shoes” of my client during the plaintiff’s medical treatment and thus was able to demand payment from my client for the medical costs incurred after the onset of litigation. However, upon review of the plaintiff’s PIP file and related medicals, I discovered that the medical treatment authorized by the plaintiff’s carrier was excessive. In fact, a large majority of treatment was not causally related to the plaintiff’s alleged injuries, resulting in inflated costs which the client was then expected to pay. Had the client engaged counsel from the start, the company would have been able to monitor the file, thus dramatically reducing the costs my client was legally required to pay back for the plaintiff’s medical treatment.
How did we Handle this Situation?
Once I was formally retained as legal counsel for the matter, then the client was in good legal hands. I was able to finally get a handle on the client’s rapidly increasing responsibility for the plaintiff’s medical bills. From the start, I could not fathom how a simple rear end collision at five miles per hour resulted in medical costs of this inflated nature. The direct settlement of the Plaintiff’s alleged person injuries was for a minimal amount of $45,000.00. The plaintiff claimed a disc herniation, and we began to delve into significant discovery in the underlying action related to the plaintiff’s medical treatment for the accident. On the day of the accident, the plaintiff stated that he had no pain or injuries to the responding police officer. The plaintiff refused medical attention at the scene of the accident; however, the plaintiff then went to the emergency room later that day on his own. At the emergency room, he was treated and released with no definitive diagnosis after x-rays were taken and found to be clear. The plaintiff did not seek any further treatment until almost two months after the date of the accident. The plaintiff then went to a chiropractic facility, which was recommended by his attorney. The treating chiropractor immediately began a costly program laden with unnecessary techniques and billed the Plaintiff’s insurance carrier. The insurance carrier approved all of the treatment methods and paid all of the bills, knowing that it would later collect payment from my client under the PIP statutes.
After the plaintiff completed eighty-three (yes 83!) sessions of chiropractic treatment, the same doctor at the same facility then sent the plaintiff to physical therapy. This physical therapy occurred within the same facility and used the same support staff. The plaintiff continued with physical therapy for forty-three sessions before being discharged. Throughout the plaintiff’s treatment at this facility, the daily care notes indicate that the plaintiff was suffering from neck and back pain due to his employment as an overnight shelf stocker at a local chain hardware retailer. (There was no mention of the pain being casually related to the motor vehicle accident). The Plaintiff complained of lack of sleep due to the overnight hours working and continued neck and back pain due to the constant heavy lifting at work. After the first week of treatment, there was no mention of the auto accident by the plaintiff. All pain reported by the plaintiff was work related and subjective.
The plaintiff’s treating chiropractor then sent the plaintiff to a pain management specialist, who conducted three injections into the plaintiff’s lumbar spine for an alleged spinal disc herniation. Each injection was billed to the plaintiff’s auto insurance carrier at a rate of $16, 500.00. The same pain management specialist recommended an additional “surgery”, which was, in reality, an in-office procedure billed as a surgery, the insertion of a needle into the herniated disk to locate the area of pain. The cost of this procedure? $47,500.00, paid without question by the plaintiff’s insurance carrier and then sent to my client for payment.
At the end of the plaintiff’s treatment, the Plaintiff’s insurance carrier billed my client in excess of $185,000.00, plus the cost of the plaintiff’s potential future medical treatment (which the Plaintiff’s insurance company believed to be estimated at approximately $90,000). After a thorough review and analysis of the plaintiff’s medical records, I determined that my client would NOT be paying an unjustified and fantastical PIP demand.
And so began the discovery battle of battles….
Join us next month as Gwyneth delves deeper into case specific PIP discovery and excessive medical bills. If this scenario sounds all-too-familiar to you, reach out to Gwyneth.
About the Author
Gwyneth K. Murray-Nolan is a Partner at Weiner Law Group LLP who specializes in a multitude of areas of litigation in New Jersey and New York. In particular, Ms. Murray-Nolan advocates for clients in a variety of civil matters, commercial litigation/insurance defense, products liability, premises liability, construction, commercial trucking, auto and consumer fraud litigation. She has extensive trial experience in a wide variety of jurisdictions and has tried cases up to $8 million in value and settled cases up to $25 million in value. Ms. Murray-Nolan also has significant experience with excess insurance claims and catastrophic injury claims, including spinal cord injuries, brain injuries, and RSD/CRPS. Ms. Murray-Nolan will aggressively work with a seasoned panel of experts in accident reconstruction, biomechanics, human factors, and various medical fields to obtain the appropriate value of the case and work towards a resolution that best suits the client. Ms. Murray-Nolan will assertively handle the matter through completion, whether through mediation, settlement, or trial. You can find out more about Gwyneth or follow her on Twitter .