November 16, 2008 by Zale.

It has been suggested to me that I should take just about any injury case that comes up, even if I don’t see merit in the case.  I disagree with this approach.  I only take cases that I believe have merit.  To do otherwise would support frivolous litigation.  It also does a disservice to the client.  If they have a bad case, the attorney should be the first to tell them.

Posted in Litigation, Injury Law, Insurance Law | No Comments »

October 6, 2008 by Zale.

Medicare has announced that it is not paying for medical errors, also known as medical malpractice.  Huh?  What happens if there is a dispute as to whether or not there was actually a medical error?  Sounds to me like the patient is going to be the loser in that battle.

I see a two pronged problem here.  I don’t believe in big government programs, so I don’t really like Medicare in the first place, BUT there are those that have come to rely on it whether or not its a good program.  So, the first problem is this big government program in which governmnet is inept at running.  The second problem here has to do with Medicare’s ability to subrogate.

Subrogation is how insurers get their money back from the liable party.  If Medicare were effective at subrogation, then they would not need to do this.  They have every advantage in the world at collecting their subrogation, and still it appears that they are ineffective.

So what we have here is a government program that is ineffective at part of what it should be able to do, so its going to push those costs off onto the patient.  Unfortunately, this is why people need their own attorney in dealing the medical malpractice.

Here’s the article if you would like to read more.

Posted in Injury Law, Insurance Practices, Insurance Law | No Comments »

September 30, 2008 by Zale.

Be careful if you do.  Here’s a recent Tennessee Court of Appeals case where Farmers asserted an exclusion against one of their policyholders.

Everyday individuals trying to make a living use their personal automobiles to conduct business.  Often, this is encouraged by their employers.  Its good for those individuals to check their insurance policy to make sure their business activities are covered.

It seems to be a fairly rare instance where the insurer for a personal auto policy asserts this type of business use exclusion, since they are usually fairly narrow exclusions.  The point of the exclusion is for the vehicle owner to get a commercial auto policy, which is designed for business use vehicle.

In this instance, the exclusion stated:  “[w]hile used in employment by any person whose primary duties are the delivery of products or services[.]”  Both the trial court and the Court of Appeals agreed with Farmers on this one and the policyholder was out of luck.

Posted in Litigation, Injury Law, Insurance Practices, Insurance Law | No Comments »

September 26, 2008 by Zale.

Farmers Insurance just got hit for a $130M verdict, $80M of which was for bad faith and punitive damages. Wow!

In case you didn’t know Farmers is one of those companies that has created for themselves a reputation of being very hard to deal with when it comes to resolving claims.  I still don’t understand the logic behind a company making such a name for itself in the market place.  Wouldn’t it be better to have a reputation of being fair to the policyholder? Don’t kid yourself.  Someone on that jury knew of Farmers reputation.

Posted in Negotiations, Litigation, Insurance Law | No Comments »

September 24, 2008 by Zale.

I noticed this recent TN bad faith case.  In short, this is one of those cases where the insured’s property burns down and the insurance company insuring the property calls the fire arson, which is not covered.

Let’s set the stage.  If you have a claim like this, one of the first people out there, other than the property adjuster, is the C & O or Cause and Origin expert.  They are there to try to figure out why this piece building, all of a sudden, decided to increase it’s output of carbon and, consequently, lower its roof line to the ground.  The adjuster is going to have the insured fill out proof of loss statements and that sort of thing.  If the insurance company suspects that the policy holder or insured intentionally set the fire, then the  insured can expect to have to sit for an Examination Under Oath, which is often followed by a denial of coverage.

Well, in this case, the jury found that they believed that the insured had made some misrepresentations as to what they had.  This happens all the time, but the stuff that was misrepresented was no where to be found in the debris. So, the court said “no coverge for you!”

What do we learn from this? Just be honest.  At the end of the day, its only money.  Is your integrity really worth trying to inflate a claim?

Posted in Litigation, Insurance Practices, Insurance Law, Business Law | No Comments »

September 8, 2008 by Zale.

Under a liability policy of insurance, whether it be a policy for an automobile, business or anything else, the insurance company has two duties.

• The duty to indemnify the policyholder for the loss and
• The duty to defend the policyholder.

Most people just think about the duty to indemnify.  This means that if the policyholder gets sued, and the plaintiff wins $500, then the policy pays $500.

Contrast this to the duty to defend.  The duty to defend has to do with whether or not the insurance company is going to hire one of their attorneys to defend the policyholder at all.  This phase is well before finding out whether or not the claim is worth the above $500.

The duty to defend the policyholder is broader than the duty to indemnify the policyholder.  So, if the insurance company says that part of the lawsuit is excluded under a policy provision, this means that they still pay an attorney to defend you.   If the insurance company does not defend or indemnify the policyholder, then they are just completely leaving the policyholder out in the cold.

So, if you find yourself in a position where the insurance company is denying you a defense, that’s a big deal.  Have an attorney look at that denial for you.  Being an attorney who has actually dealt with coverage denials, feel free to give my office a call.

Posted in Insurance Practices, Insurance Law | No Comments »

August 24, 2008 by Zale.

So you believe that the person that hit you did it intentionally.  You think that that fact will help you win over a jury.  Well, maybe so, but that does not mean their insurance company will pay up.  That’s right.  Insurance policies are designed to pay for the NEGLIGENT actions of the policyholder, not the INTENTIONAL acts of the policyholder.

So, when you are talking to the adjuster and you think that telling the adjuster that their policyholder INTENTIONALLY injured you, don’t be surprised when you promptly receive a denial letter from them.

If you have any more questions about this topic, or a similar personal injury or insurance related topic, contact the Dowlen Law Firm, PLLC, serving all of Middle Tennessee.

Posted in Injury Law, Insurance Practices, Insurance Law | No Comments »

August 24, 2008 by Zale.

Generally speaking, Med Pay is medical payments coverage that is found on your Automobile policy.  If you are injured in an accident, it can come in quite handy.  So, here’s some commonly asked questions regarding it.

Why should I use it instead of using the coverage of the person who hit me?  Well, the coverage of the person who hit you is NOT going to pay as you go to the doctor.  Your Med Pay will, up to its limit, and then it will get reimbursed when you settle with the other person’s coverage.  You probably don’t know how long you will be treating, so go ahead and get the bills paid.

Why does my health insurance coverage want to know if I have any Medical Pay coverage?  Well, normally Med Pay is the first coverage that is to be used when there is an automobile accident.  Chances are that your health insurance policy says that it is secondary to Med Pay coverage, and if you refuse to tell your health insurer about the coverage, they may be able to deny your claims until you comply.

Will using this coverage increase my insurance rates?  Generally speaking, it’s not supposed to.

Do I need an attorney to help me with my Med Pay claim?  Generally no.  Most insurers don’t mess around too much with this coverage.  But if you have filed a Med Pay claim that has been denied, then talking to an attorney is not a bad idea.

Do I have to fill out all these papers my Med Pay adjuster sent me?  Well, only if you want the claim paid.  They can require you to comply with the policy to get the claim paid.

If you have any other questions regarding Med Pay coverage or an injury claim, feel free to contact the Dowlen Law Firm, PLLC.  We are a law firm that covers all of Middle Tennessee.

Posted in Injury Law, Insurance Practices, Insurance Law | No Comments »

August 15, 2008 by Zale.

Yes.  According to a recently released case, if you walk up on your seriously injured child after a car accident and witness them lying lifelessly on the ground bleeding profusely, you can.  This was actually an Underinsured Motorist case, so the claim was against the aggrieved mother’s own insurance policy.

I suspect that this case will now be settled, instead of going back to a jury.

Posted in Litigation, Injury Law, Insurance Practices, Insurance Law | No Comments »

July 25, 2008 by Zale.

I’ve handled fatality cases before, when I was an adjuster.  They are never easy.  The Tennessee Supreme Court just decided a case where the plaintiffs were awarded $18.4M in the fatality of an infant.

There are those that would say that we need tort reform and that $18.4M is excessive for this.  I say the founding fathers got it right.  The monetary value for the death of a child coupled with an auto manufacturer’s negligence should be determined on a case by case basis by a jury, not legislation.

You can read more on the case here.

Posted in Negotiations, Litigation, Injury Law, Insurance Law | No Comments »