Georgia Insurance Companies and Injury Claims: The Good the Bad and Ugly


Its been a mixed bag the last two weeks for dealing with accident insurance companies in Georgia. Friends and potential clients alike often wonder what their options are with injury claims. The best way to answer that is through a number of examples that illustrate what we do week to week.

Example I: Bilateral Torn Rotator Cuffs USAA Underinsured Motorist Policy.

I finsihed mediating a case with USAA today involving a Colonel in the US Army with two torn rotator cuffs. Fantastic client and I am glad to report that two years after filing suit, USAA finally stepped up to the plate and agreed to pay a fair amount on the case. The crash happened in December of 2010 when a guy slammed into the back of the good Colonel’s BMW. There was not a lot of damage to the eye but there were $8,000 in repairs to our vehicle and his shoulders had been operated on 6 years before, so they were in less than pristine shape. He underwent 3 arthroscopic surgeries and had over $80,000 in gross medical bills. The at fault driver had only $30,000 in coverage and that was paid almost immediately. We sent a demand to USAA to recover the balance of the value of the case and the response was a $5,000 offer. This is a good illustration of the point that you cannot assume that your insurance is going to do the right thing after a car accident except in slam dunk situations. USAA did the right thing today at mediation and my hat is off to the litigation adjuster, I am just frustrated that it took a year and a half to come to the conclusion that 1) their insured is a great guy 2) the defendant is a scum bag 3) because of 1 and 2, the argument that the injury was pre-existing is not going to fly with a jury.

Example II:
I mediated a case for lawyer with a claim against a Progressive insured. The Plaintiff had about $8,000 in damage so it was not a low impact case. Very reasonable care with $2,000 in Emergency room bills and about $3,500 in orthopedic and physical therapy visits. Also had a $1,500 lost wages claim. Thats not a bad little case and the Plaintiffs lawyer was right to value it with a jury at about $15,000. So what do insurance companies do with a case like that? They sent an offer of judgment at $8,000. Why? Part of it is just policy but during the course of mediation, I convinced the defense lawyer to share the true and valid reason why the offer was low… the plaintiff had 3 visits over two years complaining of significant back pain. When contrasted with her testimony at deposition that she had never treated for back pain, it had the effect of lowering the floor. By that I mean that the jury would normally never award less than the medicals and lost wages. Once the spectre of dishonesty or the fact that a complained of medical condition had been problematic before is raised in this setting, it can result in a jury that only awards the emergency room bills. In the end the case settled for $10,000. The plaintiffs lawyer was unhappy, but as a mediator I can say the right thing happened and an ambush disaster at trial was avoided.
Take away?

1. Never ever say I never. I preach to all lawyers to pull every single medical prior on their clients before charging headlong into a lawsuit. Right now we are puling 10 years worth of records from before the crash on one of our clients because we need to know before we file suit how strong our position is going in.

2. Always mediate your case when you can. If this Plaintiff had gone into court to try her car accident case against Progressive and had been ambushed with these records, she could have owed costs of litigation to the insurance company. Always learn as much as you can about your case before taking a hard stance.

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