Samsel vs Allstate Insurance Co, 204 Ariz 1, 59 P3 281
Dec 12, 2002OUTCOME: Allstate paid in full.
Injured in an auto collision, Samsel incurred $16,313 in medical/hospital bills. Her HMO paid all but $313 of the bills. At the same time, Samsel made claim under her Allstate $10,000 medical pay cove ... rage. Allstate denied all but the unpaid S$313, arguing that because the $16,000 had been paid by the HMO, it was not "actually incurred" under the terms of the Allstate policy. The trial court disagreed. Allstate appealed. The Appellate Court sustained the Trial Court. Allstate again appealed arguing the meaning of "actually incurred" and the old canard: "double recovery" resulting in a "windfall profit" which should be denied its insured. The Supreme Court sustained the Appellate Court, ruling that the HMO payment did not exempt medical/hospital bills from Allstate's medical pay insurance liability. We ripened the case into a class action, which resulted in Allstate paying its full medial pay coverage to medical pay claimants that, over the years, had been similarly denied.
