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|Court||Circuit Court of Jackson County|
|Date||2012, May 15|
The plaintiff was injured on State Line Road in Kansas City when the defendant turned in front of him. The plaintiff was unable to avoid the accident, pushed into the Chick-fil-A drive thru line and hit another car.
Plaintiff had an open compound fracture of his wrist, an injury to his liver and an extended hospitalization. Plaintiff continues to receive physical therapy and is unable to work. The amount billed for medical was in excess of $800,000. The major legal hurdles including working with his own personal injury protection (PIP) carrier, The Hartford, to waive its subrogation interest and getting Medicare to waive its lien.
Almost all car insurance policies have PIP or med pay coverage. Contractually, car insurance companies have a subrogation right – or a right to be paid back - associated with these payments. However, the subrogation theory is based on the plaintiff not being entitled to a double recovery (a payment by both PIP and the defendant’s liability carrier). In this case, the medical bills far exceeded the amount of coverage through American Family of $100,000. As such, there was no double recovery and The Hartford agreed not to seek subrogation on the PIP payments
Medicare paid the majority of the hospital bills. MSPRC is charged with pursuing a subrogation interest for Medicare. By staying on top of MSPRC, we were able to obtain written confirmation that no “conditional payments” had been made. “Conditional payments” are payments made by Medicare that it believes should be paid by a third party. As such, plaintiff was able to keep the entire amount of the $100,000 liability payments from American Family.
This case a perfect example of the need for underinsured motorist coverage. Underinsured motorist coverage enables an injured plaintiff to recover against her own car insurance if the defendant does have enough insurance for all the damages. A person is much more likely to be hit by a driver that is not adequately insured and underinsurance coverage is designed to address this problem.
Past results afford no guarantee of future results and every case is different and must be judged on its own merits.