i. Claims Splitting
Sean Kelly won an important decision in the Court of Appeals in Michigan Head & Spine Institute v Hastings. No-Fault insurers have argued that using assignments violates the prohibition against “claims splitting.” The Court in Sean’s case held that claims splitting is an ancient doctrine that has been replaced by more modern procedural rules. This is an important victory for service providers as we try to maintain our ability to bring actions in the aftermath of Covenant.
ii. Consent Judgment
Andrew Horne collected over $918,000 on a consent judgment entered on behalf of The Detroit Medical Center after the Court of Appeals affirmed a Trial Court Order denying Geico’s Motion for Summary Disposition. The injured patient had exited and was subsequently struck by his own uninsured, disabled vehicle after it was rear-ended at high speed by an inattentive driver. Had the uninsured vehicle been deemed to have been unreasonably parked in a travel lane of Telegraph Road during rush hour, DMC would have been disqualified from receipt of No-Fault benefits. Although the patient never regained consciousness following the collision to offer his version of events, we successfully established a question of fact through impeachment of the negligent driver’s account of the accident and his opportunity to have avoided it.
iii. Home Modification Claims
Claims for Barrier Free Home Accommodations. These cases are difficult because they are typically the largest single expense that No-Fault insurers face for catastrophic losses after the acute hospitalization. Moreover, injured claimants can seldom pay for these accommodations without and in advance of insurance participation. Therefore, it is rare to start the penalty clock running. Insurers often delay until trial or otherwise beat down claimants to accept far less than what they need. We have handled many such cases. In one recent case, the No-Fault insurer hired an out of state contractor to opine that our client only needed $95,000 in modifications, which could be done within the current footprint of the house. Our client’s team was of the opinion that suitable accommodations would require $275,000 with an addition to the home. We submitted the case to arbitration and presented our proofs to the panel. We had the Occupational Therapist, Architect and Contractor all testify. The panel was convinced and ordered an additional $165,000 to be paid (on top of the $95,000 that the insurer paid based on their own consultant).
MEDICAL PROVIDER vs MACP INSURER: PAYS BILLS PLUS NO-FAULT PENALTIES OWED – FALL 2021 Maureen Kinsella settled a home modification case this summer for her client who is a double amputee as a result of a motorcycle verses motor vehicle accident. Prior to retaining M&T, her client spent years trying to get modifications paid by the insurance company. The insurance company did little to respond and no modifications were completed. After hiring M&T and with Maureen’s direction, a thorough home modification plan was created based on an Occupational Therapy home assessment; and the cost to modify the home was incurred with the contractor. Faced with trial and exposure to No-Fault penalties, the insurance company agreed to pay $435,000 for modifications to the home.
iv. Aggressive use of penalties in no-fault litigation
NF insurers often violate the law in many ways and are unreasonable in claims handling. Although not easy to get, NF penalties (interest and attorney fees) exist to punish these poor claims handling practices. We are always looking to exact these penalties so as to minimize the cost of litigation to our clients and to (hopefully) promote better claims handling practices. In one recent case, M&T obtained a settlement of $407,000 for hospital charges that were delayed without reason. $62,000 of this award was for NF penalties. In another recent case, M&T obtained a settlement for $413,000, $43,000 of which was for NF penalties.
Case settled with Insurance Company paying 100% of hospital charges PLUS $135,000 in PENALTY Attorney Fee and Interest! Our Hospital client had over $750,000 in services provided a catastrophically injured patient. The Insurance Company repaid the Medicaid lien alone and informed the Hospital client that it would not pay the balance of the bills. We successfully compelled the Insurance Company to pay the $750,000 PLUS $135,000 in No-Fault penalty interest and attorney fees.”
MEDICAL PROVIDER vs MACP INSURER: PAYS BILLS PLUS NO-FAULT PENALTIES OWED. Maureen Kinsella recently settled a case for a medical service provider client against an MACP insurer where the entirety of the one year old medical bills plus considerable No-Fault penalties were paid: $974,000.
v. Unlawful taking defenses by insurers
M&T recently settled a case for $853,000 on behalf of a minor who was catastrophically injured. The vehicle was taken by the owner’s 15 year old son in the middle of the night. He went on to pick up two other minors, including our client. Our client was a backseat passenger who was ejected from the vehicle when the driver struck a utility pole at a high rate of speed. The vehicle was uninsured and entitlement to benefits through assigned claims was hotly contested. As a result of thorough and aggressive discovery, M&T overcame this defense and established our client’s entitlement to lifetime benefits. This highlights an important distinction under the stolen vehicle disqualification where an innocent passenger will not be disqualified from No-Fault benefits.
vi. TBI - Rehabilitation Facility
Milea represented a brain injury rehabilitation facility that had been treating a man who was injured in a car accident in November 1978. The man suffered a traumatic brain injury with resulting cognitive deficits, hemiparesis, hemiplegia and behavioral deficits. Milea’s client treated this man for years and his auto insurer refused to pay for some of the services that were provided claiming: 1. They were not needed because of his car accident, 2. The charges were unreasonable, 3. The provider fraudulently billed for services that were not performed, and 4. The provider did not submit proper documentation to support payment under the No-Fault Act. After four years of contentious litigation, Milea obtained an Arbitration award for her client of $165,000, that consisted of $135,000 in outstanding benefits owed, $20,000 in No-Fault interest, and $10,000 in penalty attorney fees.
$1.9 MILLION settlement for no-fault benefits on a residency issue. Milea Vislosky recently settled a claim on behalf of the injured person’s guardian, hospital and rehabilitation facility for $1.9 million. The injured person was a passenger in an uninsured, unregistered vehicle that was involved in a serious crash, leaving him catastrophically injured. The main issue in the case revolved around whether or not the injured person was a California resident or a Michigan resident. The case was complicated by the fact that the original application for benefits, as well as the police report, stated the injured person was a California resident. There was evidence that he was traveling to Michigan to stay with his sons when the crash occurred. He never made it to his sons’ home. Milea went into great depth to show how the patient was a Michigan resident and was successful in getting Michigan No-Fault benefits for the injured person and his medical providers.
$768,000 settlement for a pedestrian’s no-fault benefits. Andrew Horne recently settled a case in an action in which the underlying patient had sustained catastrophic injuries arising out of a motor vehicle v. pedestrian accident. The driver of the striking vehicle fled the scene, and no insurance applicable to the loss could be identified. As a result of litigation filed against the insurer, Andrew successfully recovered over $768,000.
ix. Medical Causation
Martin Hogg and Milea Vislosky recently obtained a jury verdict on behalf of a neurosurgical group. The case involved significant pre-existing injuries, with the patient having undergone back surgery by our client eight months before the accident for similar complaints. The patient was still recovering from the prior surgery when he was struck by a car while trying to cross the street. He did not go to the emergency room until the following day. Our client performed a lumbar fusion surgery several months after the accident. Along with his long and well-documented history of low back issues, the patient had a low level of education and suffered from bi-polar disorder. As a result, he had a very difficult time articulating the difference between his post-accident symptoms and the back pain he had experienced before the accident. The insurer denied it was responsible for payment of any of the medical bills following the accident, claiming the pain complaints were the same and there was no change in the MRI before and after. The successful trial strategy involved an intense focus on the medicine through the testimony of the neurosurgeon, who was in the unique position of being the only witness who had physically seen the patient’s spine both before and after the motor vehicle accident. The insurer offered nothing to settle the case. After eight days of trial, the jury returned a verdict in favor of our client for $66,176.75 (100% of the unpaid medical bills and No-Fault interest). Case evaluation sanctions are pending. Another great result on a difficult medical causation case!
Wayne Miller settled a horrific intersection collision case for $505,000. The Defendant ran a red light at a high rate of speed, causing terrible injuries to our client. We required the Defendant to pay his full policy limits plus an extra amount out of his own pocket due to the aggravated nature of his negligence.
In Wayne’s second case, a 74 year old woman was lawfully operating her car in an intersection on a green light. Another driver ran the red light and collided with our client. This very nice lady suffered a severely fractured collarbone, resulting in 2 surgeries. The case settled for $400,000.
ii. Hit and Run
Maureen Kinsella settled a hospital’s claim for services provided to a catastrophically injured child after a pedestrian hit and run accident where the insurance company, assigned by the MACP, failed to pay without reason for over a year. The settlement included 100% of the $800,000 in charges owed plus an additional $90,000 in penalties.
iii. Child Dart-Out
A common but terrible injury scenario occurs where inattentive drivers fail to anticipate impulsive actions of children. Defense attorneys denigrate these cases by blaming the victim and calling these “dart out” cases. The cases are difficult because drivers and witnesses alike often say that “nothing could have been done.” The law, however, promotes safety by requiring an elevated level of vigilance. The law requires that drivers anticipate these impulsive actions of children, particularly in areas like school zones where many safety signs are in place. We have successfully handled a number of these over the last couple of years. In one such case involving a 14 year old who ran across a big highway at night time, we were able to obtain a $75,000 settlement. In another, a 13 year old girl entered a street in front of her school as the school was letting out. She was hit by a driver who admitted that he “didn’t expect that she would run in front of him.” That’s exactly what the law requires our drivers to do. That case settled for $300,000. M&T recently handled another case involving a 12 year old girl crossing a busy street in a residential neighborhood who suffered a traumatic brain injury after being struck by a car. Liability was hotly contested and the police refused to issue a citation to the striking driver. Despite this, M&T obtained a substantial confidential settlement for the client.
iv. White out sudden emergency crash
Milea Vislosky settled an auto negligence case that involved a “white-out” snow storm resulting in a 100 car pile-up in February 2013. Milea’s client was struck by another car that was unable to stop. He suffered neck and shoulder injuries that required surgery. Liability was highly disputed, with the at-fault driver claiming it was a “sudden emergency.” Milea was able to settle this matter for $150,000.00 before trial.
v. Trucking Negligence
“Trucking Negligence Wrongful Death. A trucker suffered a fatal heart attack while driving his double bottom truck and trailer. As a result, he crossed the center line into on-coming traffic, and killed our client. We sued, learned that the trucker had a lengthy history of high blood pressure and diabetes. His doctor prescribed 2 medications for each condition. Unfortunately, the trucker became noncompliant with his medication regimen. This resulted directly in the fatal heart attack. We were able to obtain a settlement of $775,000 for our client’s estate.”
$575,000 Settlement for trucking Injury case. Wayne Miller recently settled a case for No-Fault insurance benefits involving serious burn injuries to a trucker. The case hinged on whether the trucker was an employee of the insured trucking company or an independent contractor. After careful review of the trucking company personnel file and depositions of the various personnel, we were successful in establishing that the trucker was an employee of the trucking company. Therefore, the trucker was covered by the company’s No-Fault insurance and benefits were secured.
vi. Rear-End Crash
ADMITTED LIABILITY REAR-END CRASH – FALL 2021. Milea Vislosky obtained a $500,000 settlement for pain and suffering on behalf of our client who suffered severe orthopedic injuries and a mild traumatic brain injury. The defense highly disputed the nature and extent of the injuries, as well as damages. Our client was retired and had significant medical history and pre-existing conditions. Aggressive handling of the case, doctor depositions and extensive knowledge of the medical were the keys to obtaining this great result for our client!
vii. Center Line Crossing
CENTER LINE CROSSING WRONGFUL DEATH CASE – SUMMER 2021. Wayne Miller settled a wrongful death case for all the insurance that was available, $200,000. The challenge to the case was the sheriff’s accident reconstructionist found that our client had crossed the center line. There were no eye witnesses. The solution was to conduct our own accident reconstruction. Our expert opinion exposed the shoddy methodology of the sheriff and convinced the insurers to pay their full limits.
viii. Moped Collision With City Bus
MOPED COLLISION WITH CITY BUS – SUMMER 2021. Wayne Miller settled another case also for $200,000 for a moped operator who suffered a severe ankle fracture when a city bus ran a stop sign. Once again, accident reconstruction testimony coupled with eye witness testimony was the key to overcoming another poor accident reconstruction opinion retained by the Defendant.