Any lawyer will tell you that real-life trials are nothing like the dramatic portrayals you see on TV. Witnesses never “confess” from the stand, lawyers aren’t always on the attack (and don’t yell), and you’ll rarely see a dramatic event occur in court. In fact, judges and attorneys sometimes do their level best to make trials as uneventful as possible.
However, there are some cases where the drama is unavoidable.
In a recent victory, a Jordan, Herington & Rowley Denver Car Accident attorney was able to work alongside Attorney Robert Manning in holding Geico accountable for their refusal to approve a claim for Manning’s client. Below, we outline the story and discuss why it was a just outcome for a deserving client.
The Background: How the Accident Happened
Our client, a 40-year-old mother of 4, was on her way to pick up her daughter with her 3 other kids in the car. While she was stopped, she was struck by a young woman in a Volvo S60 at 15 miles per hour. At the time, the accident was covered by Bodily Injury Insurance for $100,000 and Uninsured Motorist Insurance for $250,000. The accident occurred in 2013, but our client didn’t make a formal demand yet.
This would normally be the end of the story—accident occurs, insurance covers it—but there was a small wrinkle in the process: our client had a fracture she was unaware of. Specifically, she had a “pars defect,” which is a lumbar spine fracture that is stabilized by scar tissue. It usually occurs in adolescence and most people never know they have it.
However, if the scar tissue is disturbed or destroyed, the fracture can become a problem that causes instability and spondylolisthesis. This is what happened to our client. Five months after the accident, she went under the knife to address the pressure on her nerves and the resulting instability. After the surgery, our client made her formal insurance demand.
State Farm paid the full $100,000 on the Bodily Injury policy almost immediately. However, Geico denied their claim—in fact, they assessed the claim and valued it at $16,000. They asserted that State Farm offered a windfall of $84,000, and thus they weren’t obligated to offer anything to our client. After our client’s surgeon testified on behalf of the victim, Geico hired their own doctor, who testified that our client’s surgery was not related to the car accident. They denied the claim a second time.
The Deposition: Complete Lack of Good Faith Investigation
It’s important to understand that insurance companies are (or should be) required to fully investigate any claim to determine if it’s valid. A half-hearted investigation or an investigation that provides no warrant for denial is both unethical and a breach of insurance law. Every denied claim needs clear and provable reason for why the claim was denied.
At deposition, it was revealed that Geico had a policy where if there was two medical experts who testified on opposite sides of a case, they could just believe their hired gun, and not do anything further, regarding checking the veracity of either experts opinion, and Geico wouldn’t be obligated to pay on the claim. This is significant because they hired a medical expertafter the victim’s surgeon sent over his findings and they denied the claim—basically, they hired a doctor just to trigger their “opposing medical experts” policy rather than finding a doctor who would reveal the truth.
In addition, both the claims adjuster and manager could not identify what a pars defect was—which indicates that they didn’t do a thorough investigation of our client’s injuries.
Once at trial, our team made a simple case: our client had scarring that was knocked loose by the car accident, necessitating the surgery. We also claimed that the insurance company wrongfully denied the claim, having not conducted a thorough or fair investigation.
Rather than investigate, the claims adjuster:
- Kicked the case upstairs to a lawyer (per their policy)
- Denied the claim twice
- Hired a doctor to justify denying the claim after the fact
- Hired biomechanical experts, after they denied the claim so that they could “defend” their position that they were actually unable to even articulate since they did not even understand the medicine.
We see that as thedefinition of insurance bad faith.
The expert witness for the defense regarding bad faith said from the stand that “at some point, enough is enough” and Geico can just deny the claim. In this case, the “enough” he’s referring to is a grand total of 3 letters: one from the client’s surgeon and two from their hired medical witness. This, to the defense witness, was enough to constitute a thorough investigation: three letters and yet, zero understanding of the medical condition by the adjuster and her manager.
Even the evidence thedefense provided regarding the biomechanical issues at stake—whether our client’s injuries were caused by the car accident—supported the plaintiff’s claim. The defense submitted a report that used formulas to prove how unlikely the car accident would have been to cause the pars defect-related injury.
Unbeknownst to the biomechanical experts the defense hired was asked to read a passage from the author of the study they used to come to their conclusions, that warned about using their formulas in real-world situations, as real situations have “high variance”—a passage even they weren’t aware of.
The Final Nail in the Defense’s Coffin
All in all, the defense was putting up a weak case—but there was one more dramatic moment to come. The final witness was the medical expert who originally caused our client’s claim to be denied. He affirmed his original position, repeating over and over that our client would have required surgery anyway—and that it was “highly unlikely” that our client required surgery due to the car accident. This “expert actually said that most people with this condition require surgery in the 4th decade of life and that this was a natural progression of a spinal deformity”.
However, lodged within the 6 medical studies he cited (which were submitted as evidence and thoroughly read over by our office six months ago), which included this powerful conclusion: “Patients that develop pain at 40 or older, is highly unlikely related to the pars defect, but rather a traumatic event that disrupted the fibrous union.” In other words,the defense’s own cited studies helped prove our case and showed the defense expert’s testimony to be totally not credible.
In the final question to the witness, and the trial in general, Mr. Jordan had him read this passage—and rested our case.
The jury returned a verdict in favor of our deserving client, that should result in a final judgement of $1.2 million.