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Armendarez v. Progressive Insurance Company

Case Conclusion Date: 04.30.2010

Practice Area: Insurance

Outcome: Confidential Settlement Reached.

Description: Allegations in Complaint: That on February 11, 2009, Plaintiff was injured in a hit-and-run automobile collision and required medical treatment. Plaintiff promptly notified her insurance carrier, Progressive Insurance Company, of the collision. On February 11, 2009, Progressive Insurance Company took Plaintiff’s recorded statement. Progressive Insurance Company investigated the collision and determined that Plaintiff would be entitled to uninsured motorist benefits under her insurance policy. On or about March 10, 2009, Progressive Insurance Company transferred the handling of the claim from Progressive’s adjuster Brandon Whitener to Progressive’s Adjuster Kjell A. Griebesland. Progressive Insurance Company demanded a second recorded statement from Plaintiff. On or about March 17, 2009, Progressive Insurance Company took a second recorded statement of Plaintiff. On September 3, 2009, Plaintiff provided copies of her medical records to Progressive Insurance Company and made a claim for the uninsured motorist benefits to which she was entitled. On or about September 12, 2009, Progressive Insurance Company evaluated Plaintiff’s claim at $6,005.00. Progressive Insurance Company represented that it had determined that all of Plaintiff’s medical treatment was reasonable and necessary except for $122.00 of treatment from a chiropractor. Thus, Progressive Insurance Company determined that Plaintiff was only entitled to $930.84 in general damages for pain, suffering, inconvenience, etc. Progressive Insurance Company indicated that if Plaintiff did not agree with the evaluation amount her insurance policy required her to request arbitration. On September 12, 2009, Plaintiff requested the undisputed, uninsured motorist benefits for the medical specials per Progressive Insurance Company’s evaluation. Plaintiff also requested a written explanation as to how Progressive Insurance Company evaluated this particular claim and determined that Plaintiff only suffered $930.84 in general damages, i.e., pain, suffering, loss of enjoyment of life, etc. Plaintiff also requested an explanation as to how Progressive Insurance Company determined that only $6,005.00 in uninsured motorist benefits were due. Progressive Insurance Company’s insurance policy forces its insureds to demand arbitration if Progressive Insurance Company and its insured person cannot agree on the amount of damages sustained. On September 12, 2009, Plaintiff demanded arbitration. On or about September 16, 2009, Progressive Insurance Company transferred the claim to Progressive’s adjuster Katie Wakeham. Progressive Insurance Company failed to provide an explanation for its evaluation and indicated that it would “be contacting you periodically to address the status of the claim.” Progressive Insurance Company failed to pay the undisputed, medical specials. On September 21, 2009, Plaintiff again requested the undisputed benefits in the amount of the undisputed medical specials. Plaintiff again requested an explanation as to how Progressive Insurance Company determined that Plaintiff was only entitled to $930.84 in general damages. On September 21, 2009, despite its prior evaluation, Progressive Insurance Company represented that “the amount of the medical bills incurred by your client is subject to debate of what is reasonable and necessary.” Progressive Insurance Company refused to pay the undisputed, medical specials because “there is not any explicit provision in the contract language under the uninsured motorist bodily injury coverage, which provides for the immediate payment of medical bills.” Progressive Insurance Company further represented that “the prior adjuster, Kjell Greibesland, relied on his independent professional judgment when he made an offer to settle [Plaintiff’s] uninsured motorist bodily injury claim.” Progressive Insurance Company failed to provide an explanation as to how it evaluated Plaintiff’s general damages at $930.84

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