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Injured Senior Hit by Car Receives Justice and Rare Insurance Reversal

By Peter Defilippis, Esq.

Our client, an 82-year-old pedestrian, was run over by a car as the driver carelessly backed it up in front of the exit to a gas-station convenience store. The client had just walked out the door of the store when she was struck by the rear of the vehicle, sustaining comminuted fractures in three places – her ankle, heel and mid-foot.

Comminuted fractures are serious injuries, involving a break or splinter of the bone into more than two fragments. Our client needed extensive medical treatment, which would be covered through GEICO, the insurance company for the car’s owner and driver. But even though her entire lower leg and heel had become rigid and she could barely walk, the doctor hired by the insurance company to briefly examine our client determined she needed no further treatment. Then quickly, her no-fault benefits were terminated. The doctor for GEICO had seen our client just once – for about five minutes – before hastily arriving at a “diagnosis” favorable to the bottom line of the insurance company. Sham examinations such as this, misnamed “Independent Medical Exams”, are far more common than they should be, but we showed our client that we were on her side.

The orthopedic surgeon who treated our client recommended a triple arthrodesis procedure, but he understandably would not perform the surgery without the presence of insurance coverage. Medicare claimed it was not obligated to cover the cost of the surgery, and likely would have placed an enormous lien on any arbitration recovery if it had paid for it.

We wrote several letters to GEICO and the New York State Department of Finance, which has some jurisdiction over New York insurance entities. In the letters, we outlined the situation, provided all our client’s medical details, and pleaded with the decision makers to reinstate her benefits. To its credit, GEICO reversed its earlier unfair decision and fully reinstated her no-fault benefits, eliminating the possibility of a lien on any recovery in her case! This was a welcome surprise, but even if GEICO had not done the right thing by reversing its prior decision, we were prepared to pursue other recourse against the insurance company.

In early October, our client went forward with the triple arthrodesis surgery, but it has been a trying experience for her. During arbitration, she used a cane and had a great deal of difficulty either walking or getting comfortable in the witness chair. The arbitrator noted in his written decision that she was a “credible witness.” Arbitrators, judges, and jurors do look closely to see if a plaintiff exhibits physical signs of an injury around the courthouse and on the stand. The plaintiff’s honest, straightforward testimony is always crucial to the jurors and judge in a court of law.

We just received the arbitrator’s decision, awarding our client $250,000 – the full amount of insurance coverage! He found she was not negligent to any degree. He went out of his way to write, “Claimant’s counsel did an outstanding job in preparing and presenting the case” and “She would have been entitled to $500,000, in my view, had there been that much coverage.” He even ordered her underinsurance carrier to reimburse her for the American Arbitration Association filing fee.

Our client is enduring a difficult recovery from the surgery, so she really needed a boost. We hope and pray for her full and speedy recovery and finally some relief from her intractable pain. We truly feel our firm has made a difference for her and that in this case, justice was served.

We are happy that GEICO showed compassion for this client, but also know that doesn’t always happen with insurance companies. If you or someone in your care has been injured in an accident, contact us. Our firm has the experience and expertise needed to ensure that each client is treated fairly and receives the best possible resolution to his or her case.