Articles Posted in Insurance Disputes

Published on:

By

An insurance company must protect its insured from a potential judgment greater than the insurance coverage, otherwise an insurance bad faith claim may arise, explains a California injury lawyer.

Insurance companies naturally want to avoid having to pay for claims. A company may even be willing to gamble at trial, knowing that the exposure is limited to the amount of insurance it must pay out. However, an insurer must not jeopardize the insured, or risk ruin of the insured, to avoid paying a claim. An insurer must consider the insured’s interest as it would its own.

Consider why an insurer must protect the insured. An insurance company typically chooses the defense attorney to defend a lawsuit. The insurance company controls the litigation. It is authorized to decide when to accept or not accept an offer of settlement. However, if the insurer wants to gamble and go to trial, it must be very careful to weigh the possible outcomes to the insured first. This is especially true if the insured stands to lose greatly if found responsible for an accident or injury. Here is a recent case in point:

By
Published on:
Updated:
Published on:

By

You purchase insurance (or it is provided to you by your employer as part of your compensation package). You, either directly or indirectly, pay the premiums. You are injured, and the insurance policy pays for medical treatment related to your injuries. Most people at this point would typically assume that the insurer has done what they were hired to do and that will be the end of it. On the contrary, oftentimes it isn’t. In California, insurance policies typically have buried within their boilerplate provisions what is known as a “right to reimbursement.” It gives the insurance company a right to seek reimbursement for the expenses they have paid on your behalf from any third party who has caused you injury. “Right to reimbursement” clauses are outlawed in many states, but is permissible in California so long as the insurance contract is clear and precise in its language.

It sounds innocuous enough: why should an insurance company have to bear an expense caused by a negligent third party? In operation, however, it is one of the most nefarious aspects of the California insurance industry. In catastrophic injury cases, it threatens to derail the entire notion of what people expect from insurance companies. It isn’t really the Defendant who is reimbursing the medical provider, it is the insured.

The “right to reimbursement” and the right to proper treatment comes directly from what the injured person would have received the negligent third party that injured them. In essence, the insurance company is reimbursed in whole or in part, and the insured is left with a significantly reduced recovery, or occasionally no recovery at all. For example, in cases involving insurance provided by your employer, the Supreme Court of the United States has ruled that the medical plan is entitled to 100% reimbursement before the insured receives a single dime.

By
Published on:
Updated:
Published on:

By

An initiative measure has qualified for the ballot this next voting period that will alter how premiums are calculated for drivers who have maintained their automobile insurance coverage in effect without a 90 day period of lapse. The initiative allows automobile insurance companies to offer a discount to a person even if they switch to a new carrier. The initiative is sponsored only by Mercury Insurance.

The Legislative Analyst, in preparing the ballot analysis asked for input from the state insurance department on whether there would be an increase in premiums to some drivers. They answered a resounding yes. Here is why.

Insurance companies must develop a rate plan that is complex and provides different tiers of coverage and rate options. One of the tiers is the discount offered to an existing insured that has maintained coverage.

By
Published on:
Updated:
Published on:

By

I have recently written on the number of examples where tort reform has not worked. Workers compensation is a failure, as workers have no right to sue their employers for negligence. Health insurance companies, operating under ERISA laws deny coverage wrongfully, and often, and have no legal recourse. In none of these examples has there been a fair treatment of those injured due to the negligence of another. Instead there has been a compromise of their rights, allegedly for the sake of society.

One frequent argument proposed for tort reform is that a less expensive and more effective method of controlling negligence is through government supervision and regulation. Nothing could be further than the truth as evidenced by the recent Los Angeles Times article on October 21, 2009 investigating Cal OSHA penalties for employer negligence. I invite your review of this article personally becasue I believe it deserves a Pulitzer for fair and in depth investigative reporting by Jessica Garrison.

An employer, Bimbo bakeries in California, had six amputations and a fractured hand at the workplace between 2003 and 2006. Cal OSHA investigated each of these violations, determined them to be caused by a serious failure to abide by safety regulations, maintain guards on equipment and operate the factory safely. Investigators levied fines anywhere from $2000-$21,000. However, the article pointed out that the Cal OSHA appeals boards waived almost all of the fines assessed and levied against this particular employer, not because they found the investigations without merit, but according to Candice Traeger, chairman of the appeals board, a backlog of cases drew a federal complaint causing the board to settle thousands of cases for pennies on the dollar.

Published on:

By

Most people will tell you they are fed up with high insurance rates, fraud and waste in medical auto and homeowners insurance. The standard answer by insurance companies is tort reform.

They claim that if you simply stop lawyers from suing them, they would save so much for you in premiums. Of course they proclaim this as a way of getting much more. If they can preclude lawsuits, then they are also free to act without care or regard to others in their charge. They can avoid setting up procedures to ensure their insureds are treaeted fairly. These actions cause death as in this article about tort reform failures.

Health insurance companies protected by ERISA have a free ride, and cannot be sued for monetary damages when they wrongfully deny coverage to a woman that needed a liver. . A young woman died because of this callous attitude that insurance companies have when they face no consequences for their actions.

By
Published on:
Updated:
Published on:

By

According to new federal safety data, traffic fatalities in Orange County have decreased 15% in 2008 from the previous year but O.C. motorcycle accident deaths have increased 44%. There are several reasons for the increase; less skilled riders, a bad economy and more powerful riding equipment.

It started with the high cost of fuel and now with lower incomes, more than ever people are turning the cars in for motorcycles. However, driving a motorcycle is not like driving a car. Newer motorbikes are heavier, faster and more difficult to control. In California over one-third of all motorcycle accident victims did not have the proper Department of Motor Vehicle endorsement on their licenses.

It is not unusual for me to see an accident outside one of the motorcycle performance shops in Orange County. You know the guy, just bought the bike, can’t wait to ride, has little training on this bike, pulls from the parking lot and gives too much throttle, inevitably dumping the bike.

Published on:

By

Summer is quickly approaching and so far this year, the Orange County Fire Authority has responded to in the Orange County area. This is quite alarming especially since the summer swimming season has not yet begun. Of the 14 calls, four have been fatal.

In the last two weeks, a one year old boy from Aliso Viejo and a 47 year old man from San Juan Capistrano have died from drowning. The one thing these two calls as well as the other 12 have in common is that no one was watching. At a party or a public pool, don’t always think that someone else is watching your child. Lifeguards often times are distracted and can’t always see everyone in the pool! Additionally, just because someone is an adult doesn’t mean that they can swim.

Officials from the OCFA will soon begin a new water safety campaign to provide safety tips for parents. The most important tip is to assign someone to watch your pool during large gatherings, and it goes without saying that children should be monitored at all times.

By
Published on:
Updated:
Published on:

By

Should sports athletes really be pursued so aggressively for illegal drug use? I say let’s treat them with the same standards that we apply to personal injury victims, The victim and the athlete have an opportunity to be compensated by the public (you and I pay insurance premiums for accident victims), because society places a value on your circumstance. While one is an entertainer, and one suffers peril, we never-the-less pay to both of them. However, each must be honest to get paid and each must not try to cheat the system. Otherwise, we lose trust of that system and remove the rewards. Let’s see if I am on the

right path.

In an LA Times article, STRIKING OUT IN STEROID DEBATE, by Michael Hiltzik, March 2, 2009, he makes several good points about the unfair prosecution of steroid users in professional sports. The overall point however is a little misguided. He states, “Unless we define with clarity what’s acceptable and what’s not, and unless we demand from our police the same pristine integrity we demand of our targets, sports will never be free of doping issues.”

Published on:

By

All 50 states are looking forward to funding highway and local municipality projects thanks to the recently passed federal stimulus bill. Most states will receive money to upgrade roads, bridges and various other municipal projects to hopefully make our lives a little safer.

A recent study on the most deadly highways in America ranked 4 of the top ten deadliest roads right here in Southern California. One surprising fact is that these are all interstate highways. Normal expectations are that deadly road accidents involve rural, windy country roads, and while they are dangerous also, these highways are dangerous for a variety of reasons.

I-15 in San Bernardino County was ranked #1 in fatalities during the last five years, and our experience in representing victims of this stretch of road is the same. Ironically, it is dangerous because it is so straight and wide that it is implicated in so many accidents since many drivers fall asleep driving on it. Additionally, alcohol is a factor since this is the major thoroughfare between Southern California and Las Vegas. If you need to consult with a California accident attorney, chose to do so sooner rather than later, so that evidence can be preserved.

Published on:

By

In today’s economic environment, insurance companies are affected the same as regular companies. When the market for securities drops, and people are losing their homes, insurance companies are facing non-renewal of premiums and losses in their safe investment of capital. Additionally, many companies have had to pay out huge claims for natural fire and floods, more often than I can recall in recent years.

As a result, many insurance companies are now lowering their payout of claims for personal injury cases. What can we do as aCalifornia personal injury attorneys during this period. Here are a few ideas.

first, I suspect that the reduction in offers and amounts is only temporary while the financial and housing markets settle. Once the largest of the issues is addressed, I expect it will be business as usual.

By
Published on:
Updated: