Thursday, August 19, 2021

$300,000.00 Settlement for Injured Triathlete Shows Importance of Fighting for Underinsured Motorist Insurance Coverage

Last spring on a beautiful day a local bicyclist and her adult daughter went on a bicycle ride through Naperville. Their pleasant day was cut short when a motorist failed to notice them and turned immediately in front of the bicyclists. The daughter was able to avoid the driver but the other bicyclist slammed into the side of the motor vehicle and was thrown off of her bicycle. She landed hard and struck her head in the process.
The Naperville police issued a citation to the motorist for failing to yield the right of way to the bicyclists. The driver of the motor vehicle - who had a troubled history of traffic tickets - pled guilty to the ticket in court and was fined and sentenced to supervision. 

The bicyclist was taken by ambulance to the hospital. Radiological exams later showed that the bicyclist suffered severe injuries including a lacerated spleen and a fractured left rib. The exams also showed some bleeding in the brain but doctors later considered this condition to be the result of a pre-existing condition and not necessarily directly related to the crash. The bicyclist was required to stay in the hospital for days while under observation, a circumstance made even more painful when she couldn't have any visitors due to Covid-19 precautions at the hospital. 

Underinsured Motorist Coverage 

The insurance company for the driver immediately paid the $100,000.00 policy limits for the claim. The driver was clearly at fault and the bicyclist suffered serious injuries. However, this case became complicated when pursuing additional insurance. 

The bicyclist and her husband also had what is known as Underinsured Motorist Coverage as a part of their insurance coverage with their insurance company. This Underinsured Motorist Coverage is for exactly this type of situation where the settlement value of the insurance claim far exceeded the $100,000.00 available through the driver's insurance company. In this instance the injured bicyclist was eligible for an additional $200,000.00 in insurance coverage. 

As her attorneys on the case, we immediately made what is known as a "policy limits demand" of the bicyclist's insurance company. In Illinois, the Illinois Insurance Code requires insurance companies to promptly pay valid claims. However, in this instance the bicyclist's insurance company attempted to claim that because the brain issue may have been pre-existing, that they did not have to provide insurance coverage. The insurance company flat out denied the claim.

Attorney Mike Keating refused to accept this argument and the denial. The reality is that in Illinois our laws provide protections for injured persons even in a situation such as this. What the insurance company failed to take into account was that the bicyclist was a nationally ranked triathlete in her age group. She obviously was not suffering from any kind of ailment. In other words, the insurance company was trying to take advantage of the situation to not pay the claim. 

Illinois Law on Pre-Existing Injuries

In law school we are taught about the "egg shell skulled" injured person. This old analogy is used to teach that even if someone is very fragile, an insurance company should not argue that an injury happened because of who they are. If they're legitimately injured, they're legitimately injured and the insurance company should provide insurance coverage to compensate the injured person. For example, you can't compare a senior citizen to an N.F.L. linebacker. 

Insurance companies are required to follow the personal injury laws in Illinois. In Illinois the law is that an injury can be proven to be "caused" by an incident even if it is a combination of factors that cause the injury. This is what is known as "proximate cause" and in Illinois the definition of that is "A cause that, in the natural or ordinary course of events, produced the plaintiff's injury. It need not be the only cause, nor the last or nearest cause. It is sufficient if it combines with another cause resulting in the injury.” In this case it was the pre-existing condition combined with the crash that led to the injuries. 

Moreover, in Illinois an insurance company can not claim that an injury was "only an aggravation" or "just a pre-existing condition" that caused the injury. If the injured person legitimately gets hurt, then the insurance company should provide coverage. This is how Illinois law is written on this issue, "You may not deny or limit the plaintiff's right to damages resulting from this occurrence because any injury resulted from an aggravation of a pre-existing condition or a pre-existing condition which rendered the plaintiff more susceptible to injury.”

Experienced Attorneys Are Here To Help

This case was a prime example of where experience and dedication to the case made all the difference. Refusing to "accept no for an answer" and continuously pushing back on the insurance company's misguided evaluation made a substantial difference to this client. Also, by aggressively pursuing the case from the onset both insurance claims were resolved relatively quickly given these issues.