Starting this month, healthcare providers must give patients free access to their electronic medical records.…
After a car accident, some insurance claims are more difficult than others, especially when the two claimants are married. In this unique case, on the day of the accident an elderly couple, Tom and Joyce, were on their way back from a doctor’s appointment. It was early evening and they had a long drive home. Tom, age 84, was driving his Honda CRV and our client, Joyce, age 82, was a front seat passenger. As Tom approached an intersection he fell asleep at the wheel and struck a utility pole traveling at a speed of 25 mph. After the impact, Tom was in shock but he was not physically injured. Joyce, however, was not able to get out of car due to severe pain in her hip, shoulder, and wrist.
EMS arrived on the scene and transported Joyce to the local emergency room. In addition to her pain, Joyce had a laceration to her forehead and deep bruises on her forearm and wrist. Multiple diagnostic tests were ordered by the emergency room physician and Joyce was diagnosed with right hip dislocation and fractures to her pelvis, hip, and wrist. Because of Joyce’s age and the severity of her injuries, the emergency room physician admitted Joyce to the intensive care unit. She underwent surgery the next day to repair the hip and pelvis fractures with plates and screws. After six days in the hospital, Joyce was discharged to a skilled nursing facility.
Because Joyce was 82 years old and in frail health at the time of the accident, her injuries were more severe and her recovery took longer than expected. Joyce had multiple complications after her discharge from the hospital including infection and the need for revision surgery. She required extensive physical and occupational therapy to improve endurance, muscle strength, and gait. She was discharged in a wheelchair and provided with a rolling walker. After her second surgery Joyce required eight months of round-the-clock home health care and supervision. Her medical expenses exceeded $300,000.00.
Tom was heartbroken over the pain and suffering he had caused his wife. He was responsible for causing the accident and the investigating officer charged Tom with Failure to Maintain Control of his Vehicle—Reckless Driving, in violation of Virginia State Law. Because Joyce was a passenger in the single car accident caused by Tom, she had to file a claim against her husband in order to receive compensation for her injuries.
Tom had a policy with State Farm with limits in the amount of $250,000 per person/$500,000 per accident. The liability coverage was insufficient to pay his wife’s damages because her medical bills exceeded the amount of coverage. Therefore, the attorneys at Burnett & Williams, P.C., looked for additional sources of compensation. Upon further investigation it was discovered that Tom also purchased an umbrella policy with State Farm in the amount of $1,000,000. He bought the excess coverage as additional protection to go beyond his liability policy. However, Joyce was a named insured on both State Farm policies. The umbrella policy contained language which excluded coverage for any “named insured” listed on the policy and for that reason, State Farm denied payment under the umbrella insurance.
To complicate matters, Joyce’s medical bills were paid by Medicare and Tricare. Both Medicare and TriCare were entitled to repayment for medical treatment under federal law. Medicare asserted a lien in the amount of $87,000 and the TriCare lien was $11,000.
The only available coverage was Tom’s State Farm liability policy. State Farm tendered their limits in the amount of $250,000. Medicare voluntarily reduced its lien and accepted $54,997.56 as final payment and the TriCare lien was paid in full.
In the end, Joyce’s medical and legal bills were paid and Joyce was able to receive some compensation for her pain and suffering.
Although Tom was traveling at a low rate of speed (25 mph) at the time of the accident, the impact caused severe injury to his wife from which she never fully recovered. This case study illustrates the importance of buying automobile insurance with limits high enough to cover claims arising from an accident resulting in serious injuries. If Tom had bought a $500,000 single limit liability policy or $1,000,000 single limit coverage, rather than the $250,000 per person/$500,000 per accident coverage that he had, his wife could have been better compensated for her injuries. Often, this additional coverage can be added with just a small additional expense to the consumer.
If you have questions about insurance coverage limits, or if you need help with a complex insurance claim, please feel free to contact Burnett & Williams.