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The Case About the Insurance Company That Didn’t Know Its Own Policy

On December 20, 2001, an uninsured driver crossed the center line and hit a car being driven by a 56-year-old woman. The collision resulted in injuries to the woman’s knees, including a meniscus tear that led to arthroscopic knee surgery. When that procedure and physical therapy failed to improve her condition, she had her right knee replaced. She incurred medical bills which exceeded her own medical insurance coverage. The medical liens (the amount she would have to repay from any settlement) totaled $41,269.19.

Her auto insurance company initially told her that she had only $50,000 in Uninsured Motorist Coverage (the coverage that is meant to protect you if you’re hurt by an uninsured driver). About two years after her accident (and after her first knee replacement), her insurance company tried to get her to settle her claim for $7,798.00.

Our client’s first lawyer decided to withdraw from the case. He told her that there just wasn’t enough coverage available to her under her policy to compensate her and repay the medical liens.

On her own and without a lawyer, our client requested a report from the orthopaedic surgeon who had replaced her knee. In the report, the doctor said that the car accident had not only led to the first knee replacement, but that the injury to her other knee would mean that the other knee would need to be replaced, too.

Our client gave this report to her insurance company, along with a letter in which she told the insurance company the following:

I do not want to hire a lawyer or file suit against the insurance company; however, the value of my bodily injury and work loss claims exceeds the limits available under my policy. Please be fair with me. I have not been able to work and need another knee replacement. I implore you to pay the uninsured motorist limits of $50,000…so that I can pay all of these medical bills, have another knee replacement, and begin to make a living again.”

In response, her insurance company merely reiterated their previous offer of $7,798. It was then that the client came to us.

We determined that rather than $50,000 in coverage, our client actually had $100,000 in coverage. It took six months and a lot of prodding from us, but eventually the insurance company confirmed that she had $100,000 in coverage all along. Still, the insurance company tried to get away with a low-ball offer. They offered $20,000 to settle the case, which our client refused. One month later, the insurance company relented and paid the full policy limits of $100,000.

Awarded: $100,000

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