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Insurance Companies Don’t Make Rational Choices

28 Jun 2016

Very few personal injury cases get tried these days, but yesterday, I tried a personal injury case to a jury and received a fair verdict for my client. After a rear-end collision causing back pain and neck pain that never fully resolved, my client, incurred $22,792.22 in medical expenses. But that isn’t the point of this story. The point of the story is that the insurance company only offered $9,985.00 as their last and final offer before trial.

Now, because I’m human, my first thought was that I had done something wrong in the case that made them think that a jury wouldn’t see it my client’s way. But after working my tail off to get this case ready for trial, I came to realize that insurance companies don’t make rational choices. This mantra manifested itself in several ways in this case:


1. Insurance Companies Rely On Bought Opinions

In this case, an orthopedic surgeon bought and paid for by the insurance company, gave his opinion that none of the treatment that occurred 4 months after the car wreck, in this case, was caused by this wreck. He said that my client’s degenerative changes in her spine were causing her pain even though it had never caused any pain before. Everyone agreed, including this doctor, that my client had never had any back or neck pain prior to this wreck. And everyone agreed that we all have degenerative changes in our spine that may or may not cause pain. Just because we have degenerative changes in our spine does not mean that those changes will cause pain.

These opinions were irrational. If the degenerative changes existed prior to the wreck and never caused any pain before the wreck, why would they cause pain now? If my client was only 80% better when she was released from active physical therapy, why say that the last date of physical therapy is the last date for any reasonable treatment especially if my client reported continued pain to her primary care doctor one month later?

The only answer is that this doctor’s opinion was paid for by the insurance company.


2. Insurance Companies Manufacture Gaps in Treatment When They Don’t Really Exist.

In this case, after my client finished physical therapy she was only 80 percent better. She was told to do her home exercise program. She followed that a month later with a visit to her primary care doctor who told her the same thing. So for the four months after that, she tried her home exercise program but it didn’t provide the relief she needed. So she tried a chiropractor. The defense argued that this was a “gap in treatment” when in reality, my client was following her doctors instructions the entire time.

The defense argued a similar “gap in treatment” after an orthopedic doctor gave my client a nerve medication called gabapentin and told her to take it to treat her nerve-related pain. They argued that she didn’t seek treatment for 4 months, 6 months, and then 11 months while she was on this drug called gabapentin. They argued that she didn’t receive any treatment.

The truth is that she was following her doctor’s orders and receiving treatment every day in the form of medication. Gabapentin requires a prescription from a doctor. That is treatment and it is disingenuous to say that she was not receiving medical treatment during that time.


3. They Suggest Mediation To Scare You Away From Trial

This one is a mixed bag. Some insurance companies will go to mediation with the intention of settling your claim, otherwise, I would never agree to it or even suggest it. Other insurance companies will go to mediation without any intention of resolving the suit. Those in the second group are going to mediation simply to scare you away from trial. They want to plant the seed of doubt in your mind that maybe this case isn’t worth what I think it is.

What do they know that I don’t?

Truth is that they don’t have any information beyond what we have. They think that they can bully you into a lower settlement by showing you how lowly they value your case. And I guess some people will just settle based on that doubt.

4. They Admit Liability At The Very Last Minute

The week before trial I heard from the insurance companies lawyer that the defendants were going to admit liability. That means that they conceded that the driver was negligent in causing the wreck and in causing the injuries to the Plaintiff. They do this to make it look like they are accepting responsibility for their actions, but if handled appropriately, it can add to the damages in the case.

For four years my client had to deal with the fact that she was hit from behind and the defendants have refused to accept responsibility until now. Now that a jury will hear how ridiculous it is that they have refused to accept responsibility for their actions, they want “get in front” of that negative sentiment. Unfortunately, it is a little too late to relieve my client’s worries from the last four years. It only helps the defendants. And the jury is smart enough to understand that and deal with it appropriately.

Well, as you know, we didn’t settle for $9,985 like the insurance company wanted us to. We kept going and my client trusted me to present her case to the jury in a way that would obtain a fair result for her. You can read more about the result here.

What do you think? Have you had an experience with an insurance company that seems simply irrational? Leave a comment below! I’d love to hear from you.

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