State Farm Loses Big in Bama

Recently the Alabama Court of Civil Appeals issued an interesting decision on medical payments subrogation. The case is Mitchell v. State Farm. The facts are that the Plaintiff hired an attorney who ultimately secured a settlement for the Plaintiff. State Farm contributed nothing towards effectuating the settlement. It was solely the work of the Plaintiff’s attorney negotiating with the defendant’s insurance company, Cotton States. State Farm paid out $5,000.00 in medical payments coverage to Plaintiff under their contract of insurance with the Plaintiff (for which Plaintiff paid good money in the form of premiums).

Like a good neighbor, State Farm sought full repayment of $5,000.00 from the Plaintiff’s settlement. Never mind that the insured paid premiums for the medical payments coverage to be there when the Plaintiff needed it; never mind that State Farm did absolutely nothing in generating the settlement funds from which they sought full repayment; never mind that this was their own insured from whom they sought to take money meant to compensate the insured for their injuries.

Unfortunately for State Farm, an attorney stood up against this unfairness and won. The Court held that State Farm had to reduce its medical payments claim for reimbursement by the amount of the Plaintiff’s attorney fee. This is a textbook application of what is called the “common-fund doctrine.” The doctrine says that if an attorney creates a pool of money—like in a personal injury settlement—then someone who seeks reimbursement from that fund must share in paying the attorney’s fee. The principle is quite simple, really. If someone’s work benefits you, you have to pay them. It’s just not fair otherwise.

The opinion, however, is not without its flaws. The court seems to suggest that State Farm could simply modify its policy language to disavow the common-fund doctrine. That would mean that an insured would have to pay back what State Farm paid out for medpay benefits that the insured already pays a premium for. However, there is also language in the opinion that the common-fund doctrine might still apply under equitable (“fairness”) principles. We will have to wait and see what the Court does in the future. For now, insurance companies must SHARE in the cost when a Plaintiff’s attorney works and settles a case.

Of course the attorneys at Gary Bruce, P.C. are always happy to discuss your case with you if you have been hurt in a wreck. It is often difficult to determine who has a valid claim for reimbursement on a given settlement. The attorneys at Gary O. Bruce, P.C. know many techniques used to defeat or substantially reduce claims for reimbursement on your settlement. Call us for a free consultation.

HOW DOES HEALTH INSURANCE PLAY INTO MY INJURY CASE IN ALABAMA?

Recently, the Alabama Court of Civil Appeals issued a disappointing decision that permits insurance companies and their defense attorneys to introduce evidence that the Plaintiff’s medical bills were paid by the Plaintiff’s health insurance company.

The case is Crocker v. Grammer. So, if a Plaintiff, injured through no fault of her own, is hit by a DUI driver, the Courts in Alabama say that the DUI driver can minimize the amount he owes the Plaintiff by suggesting that the actual bill incurred by the Plaintiff was much less due to the presence of the Plaintiff’s own health insurance. Since most health insurance companies have contractual adjustments with health care providers for less than the provider’s sticker price, this, in essence, reduces the Defendant’s liability to Plaintiff.

The problem with the Court decision is that it disregards well-settled rules of evidence and long-standing principles of common law. The Alabama Rules of Evidence state that only relevant evidence is admissible. The fact that a Plaintiff has health insurance is really not relevant to anything as to what the Defendant is responsible for due to a wreck. It is about as relevant as the Plaintiff having a rich grandmother. Thus, the Court disregarded this principle of evidence. Furthermore, the decision does away with the collateral source rule. This is a principle of common law that suggests that the tortfeasor does not get credit for outside sources that might pay the Plaintiff’s medical bills. After all, the Defendant is the one who caused the harm to begin with. The common law held that, if anyone should receive a benefit in this situation, it should be the Plaintiff, not the defendant who caused the harm in the first place.

Make no mistake. What the Alabama court has done is shifted some of the cost of the Defendant’s harm to the Plaintiff. Keep in mind that the Plaintiff who has health insurance pays good money in the form of premiums. What the court has done is punished Plaintiffs with health insurance for being reasonable. They are the ones who went out and bought health insurance to begin with. Instead, the Plaintiffs who do not have insurance may claim the full sticker price of the bill. For Plaintiffs who have governmental insurance through Medicare, Medicaid, or Tricare the Court has shifted some of the cost for the Defendant’s negligence to the taxpayer.

You can see the problems this creates when you have two individuals in the same wreck—one with health insurance, the other without. In essence you have two different, unequal measures of damages. This violates the equal protection clauses of the federal and state constitutions.

However, the attorneys at the Law Offices of Gary O. Bruce, know techniques to minimize the effects of this decision for clients who have health insurance and are injured in Alabama. We are always willing to discuss your potential claim/case through a free consultation.

“ I don’t know who hit me or forced me off the road – do I have a case? “

We often represent clients in both West Georgia and East Alabama who are victims of a hit-and-run driver who flees the scene of the wreck, never to be found. Clients who have property damage and bodily injury from such wrecks often want to know if anything can be done in these situations. These cases are known as “John Doe” cases or “phantom vehicle” cases.

Whether or not a client can recover in a John Doe case depends first and foremost on whether there is available uninsured motorist coverage to cover the loss. In fact, in our view, these type of wrecks are one of the primary reasons to go beyond “full coverage” i.e., the state minimum of 25/50 in liability coverage. If there is no uninsured motorist coverage available, you may be stuck without recourse for you property damages and bodily injury.

However, if you have such uninsured motorist coverage, you may have a claim for property damage and bodily injury in John Doe cases.

Unfortunately, insurance companies in some states have designed a system that impedes an injured party’s ability to seek uninsured motorist coverage in John Doe cases. In Georgia, generally speaking, in order to make such a claim on your uninsured motorist coverage, there must be one of the following two critical elements: (1) physical contact between the john doe vehicle and your vehicle; or (2) corroboration from another person that can state that there was indeed an accident involving a John Doe vehicle. The stated rationale for these elements are to prevent fraudulent insurance claims. In other words, the Georgia Courts are going to err on the side of favoring the big insurance company rather than the little guy.

Compare this to the situation in Alabama. Generally speaking, the Alabama Supreme Court has held that neither physical contact nor corroboration are needed to make a “John Doe” claim. Walker v. Guide One, 834 So. 2d 769 (Ala. 2002) (no corroboration needed um claim); State Farm v. Lambert, 285 So.2d 917 (Ala. 1973) (no physical impact needed for um claim). Alabama’s Supreme Court has reasoned that by enforcing physical impact or corroboration, someone with a valid um claim could be left without uninsured motorist coverage. Therefore, in general, Alabama courts do not enforce any insurance policy provisions that include such “physical impact” or “corroboration” clauses.

Of course, each case is different and depends on its own circumstances. If you have a John Doe case, you should seek out an attorney immediately to assist you. The attorneys at the Law Offices of Gary O. Bruce, P.C. are always happy to review potential John Doe cases with you.