Skip to main content
Juan Pablo Gonzalez-Sirgo

Juan Gonzalez-Sirgo’s Legal Cases

40 total

  • Miami Court Awards Over $147,000 for Attorney's Fees and Costs on a $6,000 Insurance Claim

    Practice Area:
    Insurance fraud
    Date:
    Jan 05, 2016
    Outcome:
    Court Award
    Description:
    Our client was accused of insurance fraud after his car caught on fire after colliding into a tree. The vehicle was totaled. After numerous depositions and hearings, we recovered for our client more than what he paid for the car. We also obtained an award against the insurance company for all of our client's attorney's fees and costs. Our client was very happy that we were able to clear his name, that we recovered more than what he paid for the car, and that he was not out of pocket for any attorney's fees or costs.
  • Life Insurance Recovery

    Practice Area:
    Life insurance
    Date:
    Jun 01, 2015
    Outcome:
    Full Recovery
    Description:
    The insured purchased a life insurance policy via her employer (a hospital). As part of the application process she was required to answer a question regarding her use of tobacco during the twelve month period before the date of application. The insured answered that she had not used tobacco during the relevant 12 month period. During the two year contestability period, the insured died of cancer. The surviving husband, daughter, and son, as the named beneficiaries of the insurance policy, filed a claim for benefits with the insurance carrier. The insurance carrier initiated a post claims underwriting investigation of the claim. To that end, they ordered all of the insured's medical records. Based on this investigation, the insurance company concluded that the insured was a lifetime smoker. The claim was denied based on the insurance company's position that the insured materially misrepresented her smoking history on the application for insurance. On behalf of the beneficiaries, we filed a lawsuit in state court. The insurance carrier removed the case to federal court taking the position that the policy and claim were governed by ERISA, an anti-consumer, anti-employee, federal law. The Plaintiffs contested the applicability of ERISA to the subject policy. As part of the litigation regarding the jurisdiction of the federal court, we obtained documents related to the employee plan through discovery and took the deposition of the employer hospital. Thereafter, we moved to remand the case back to state court. We proved to the court that the subject policy did not fall under the ambit of ERISA because (1) the Policy fell under the safe-harbor exception of the ERISA statute and (2) the employer did not “establish or maintain” the policy according to the statutory definition of an “employee welfare benefit plan” under 29 U.S.C. §1002(1), (3) to qualify as an ERISA plan. The federal court judge agreed with our position and remanded the case to state court. Once the litigation re-commenced in state court, we focused on showing that the insured was not a smoker during the relevant time period. Through our own investigation of the insured's smoking history, we were able to show that the insured’s employer required that all employees complete a smoking cessation program. We showed that the insured in our case successfully completed the employer’s smoking cessation program approximately one year before she applied for the subject insurance benefits. In fact, the insured would not have been able to keep her job at the hospital had she not stopped smoking. We also secured the testimony of family and friends that the insured had quit smoking after completion of the smoking cessation program. We also showed that the medical records that the insurance carrier was relying on were lacking certainty or clarity. The medical records were confusing because the insured went back to smoking after she was diagnosed with terminal cancer. We contacted the insured’s primary care physician who shed some light on the medical history. In light of the above, at the time that the insured applied for life insurance benefits she answered the tobacco question truthfully. She had not smoked during the relevant 12 month period. Shortly before trial, and after two mediations failed to reach a settlement, the case settled for the full policy limits plus payment of the beneficiaries attorney’s fees and costs. But the case did not end there. After reaching a settlement on the amounts to be paid, a dispute arose over the taxability of the benefits to be paid to the beneficiaries. After several hearings on this issue, we prevailed on our position that the benefits were not taxable to the beneficiaries. Finally, the case was concluded and the beneficiaries were happy to move on from this case which only served as a reminder that their loved one was no longer with them.
  • $2,500,000 Gross Recovery for Condominium Association in Federal Court Flood Insurance Claim

    Practice Area:
    Insurance
    Date:
    Jan 06, 2015
    Outcome:
    Settlement
    Description:
    A condominium association sustained flood damages to its property from Hurricane Wilma. The condominium association retained public adjusters to represent its interests in the insurance claim. The insurance company estimated the damages and made certain payments. The condo association disagreed with the amounts paid by the insurance company and invoked the appraisal provision of the insurance policy. After years of the parties going back and forth over a number of issues, we were retained in 2013. We filed a lawsuit in federal court. The insurance company argued that the condo association failed to submit legally sufficient proofs of loss and that appraisal was not appropriate under the insurance policy because the parties did not agree on the scope of damages. The case was set for trial. With pending motions to compel appraisal and for summary judgment the case settled at mediation giving the condo association a gross recovery of over $2,500,000, just over one year after our involvement in this protracted claim.
  • $167,800.48 Insurance Recovery for Murdered Policyholder

    Practice Area:
    Insurance
    Date:
    Jan 05, 2015
    Outcome:
    $167,800.48 Recovery
    Description:
    In this claim, the insured was the victim of multiple gunshots and died. The insured owned a life insurance policy that contained an Accidental Death Benefit Rider. The death occurred during the two year contestability period of the policy. The beneficiary under the life insurance policy filed a claim. First, the insurance company conducted a post-claims underwriting investigation, as is routine. When that investigation did not reveal any basis for denial of the claim, the insurance company claimed that it was investigating whether the death of the policyholder was “accidental”. The focus of the investigation was whether the insured's conduct contributed to his death so as to make his death reasonably foreseeable, and therefore, in the insurance company’s world, not accidental. This is when the beneficiary hired us. Since the killer was arrested and charged with the murder of the insured, we contacted the detective investigating the case. We also made a public records request for the records related to the investigation of the crime in the possession of the prosecutor. We were then able to put together the events leading to the murder. We proved that the insured was a victim of a crime and not involved in the commission of any crime. A recovery of the full benefits available under the insurance policy was made, plus interest.
  • Six Figures for Damage Caused by Busted Drain Line

    Practice Area:
    Insurance
    Date:
    Jul 25, 2014
    Outcome:
    Settlement
    Description:
    The insured suffered damage to her house when a drain line broke. She notified her insurance company. The insurance carrier inspected the house and made payment for about $1,000. We were not retained until three years later. Before we got involved, the insured had filed a lawsuit with another lawyer. She also had hired consultants and a public adjuster. The insured hired us after she had a falling out with her lawyer and public adjuster over the value of the claim and other things. The public adjuster had written an estimate for about $37,000. We brought in some new experts and prosecuted the case. One week prior to trial and less than one year after being hired, we were able to obtain a six figure settlement for our client.
  • $940,000 Policy Limits Recovery for Injured Motorist

    Practice Area:
    Car accident
    Date:
    Jul 21, 2014
    Outcome:
    $940,000 Recovery
    Description:
    Lawyers Russell A. Dohan and J.P. Gonzalez-Sirgo recover $940,000 for injured driver. Our 49 year old client was involved in a car accident. The other driver, in a 2005 GMC Large Cargo Van, moving at a rate of speed of 45mph on the Palmetto Expressway in Miami, Florida, rear-ended a stopped car which in turn hit the stopped car of our client. Our client was described as having a “possible” injury at the scene on the police report, due to his complaints to the police officer. Fire rescue did come to the scene, and even though our client did once again complain to fire rescue of general shock and pain, our client did not request to be taken to the emergency room, as he had a job appointment to attend to and was headed to the job location that morning. Subsequently, our client went home, rested and took some pain medication. The following day he made an appointment with an orthopedic medical doctor. The doctor diagnosed him with left shoulder, neck, and back sprains. During the next three years, our client suffered $350,000 in medical bills, as a result of a number of major surgeries, including a rotator cuff repair, lumbar diskogram, and a lumbar fusion. He also underwent a number of outpatient medical procedures, such as epidural injections. Our client’s injuries left him totally disabled at 50 years old. In addition, as a result of his pain and disability, he was admitted to the hospital for a major psychiatric depression. He was unable to work and applied for Social Security Disability benefits. Citing our client’s pre-existing medical conditions (which were extensive), the other driver's insurance carrier only offered to settle the case for the amount of our client’s medical bills. We then filed a lawsuit and commenced discovery. After mediation failed and just before the trial of the case, the other driver's insurance carrier paid the entire insurance policy limits available.
  • $325,000 Policy Limits Underinsured Motorist Insurance Claim Recovery for Florida Crash Victim With Frozen Shoulder Injury

    Practice Area:
    Car accident
    Date:
    Jun 06, 2014
    Outcome:
    Settlement
    Description:
    Our client was injured while working as a bus driver when another vehicle collided into his bus. Following the accident, our client consulted doctors via his workers compensation insurance because of pain to his left shoulder. An MRI was taken of his shoulder that showed a micro size stress fracture involving the shoulder bone head. Also, rotator cuff tendon inflammation was seen. He was then referred to an orthopedic surgeon who provided an injection into his shoulder, gave him the pain medication Percocet, and ordered physical therapy three times a week. He was told not to go back to work as a bus driver because he was limited to the use of one arm. At the follow up meeting with the doctor it was assessed that our client possibly developed scar tissue which prevented him from having full range of motion. He was provided Ambien for sleep, because the shoulder pain was detrimentally affecting his sleep and more physical therapy was ordered. After still seeing no improvement, the orthopedic surgeon recommended surgery as a result of his decreased range of motion and ongoing pain. The doctor advised of the need for our client to discuss his Coumdain dosing (when to stop taking it, before or after surgery, as our client was chronically on a blood thinner, Coumadin, due to two previous deep vein blood clots which prevent him from taking anti-inflammatory medication). Our client underwent surgery after receiving clearance from his primary care physician. While our client was under anesthesia his range of motion was tested and established to be limited in all planes. He was manipulated in all planes with steady pressure until the adhesion released. A scope was then inserted inside the shoulder to clear away any extra growth and inflamed tissue. After the surgery, our client was seen by the surgeon and some improvement was noted. He continued on his physical therapy regimen but still complained of pain going down his arm and back with swelling below his shoulder blade. Two months after his operation his range of motion, especially reaching behind, was not as full in the left arm compared to the right. Our client suffered what is commonly described as a frozen shoulder or adhesive capsulitis. The pain in the shoulder is due to inflammation of the surrounding tendons; as a result, range of motion in the shoulder is lost. The driver of the car that crashed into our client’s bus only carried $25,000 of insurance which they paid. Our client was also covered for up to $300,000 of underinsured motorist coverage (UIM) available under the insurance policy for the bus. Based on our review of the case, we concluded that the value of our client’s case required payment of the $300,000 of UIM coverage. As such, we demanded that the UIM insurance company tender or pay the $300,000. In response, the insurance company mailed us a check for $24,000. We rejected this offer, returned the check, and filed a lawsuit on behalf of our client in the Circuit Court for Miami-Dade County. In response, the insurance company removed the case to federal court and litigation began. Eventually, we succeeded in getting the insurance company to pay the full $300,000 of available UIM coverage.
  • Jury Verdict for Victim of Automobile Crash Who Suffered Spinal Cord Injuries

    Practice Area:
    Car accident
    Date:
    May 27, 2014
    Outcome:
    Jury Verdict
    Description:
    Lawyers Russell A. Dohan and J.P. Gonzalez-Sirgo secured a jury verdict above State Farm’s pre-trial offers in favor of a victim of an automobile collision. Our client was a passenger in a car that was struck from behind by a tow truck. The driver that caused the accident admitted that he was responsible for the crash but contested the cause and degree of the injuries claimed by our client. Our client suffered spinal cord injuries to her neck and back caused by the accident. The driver of the tow truck alleged that our client’s complaints pre-existed the accident. Our client did have certain pre-existing complaints along with other extensive medical problems that were not related to the accident. After listening to both sides, the jury awarded an amount in excess of State Farm’s pre-trial offers.
  • $240,000 Settlement for Victim of Trip and Fall Injury

    Practice Area:
    Personal injury
    Date:
    Apr 01, 2014
    Outcome:
    Settlement
    Description:
    Lawyers Russell A. Dohan and J.P. Gonzalez-Sirgo recovered $240,000 for injured trip and fall victim. As our client walked next to her mother, who went with hour client to the doctor's appointment, her mother tripped and started to lose her balance. Our client attempted to keep her mother from falling, but instead tripped and fell herself as a consequence of the same dangerous condition. When our client, her mother, and other witnesses searched for the reason for the trip and fall, they noticed that the tiles on the floor (which looked symmetrical and flat to the eye) were actually raised from the rest of the floor. Our client was not able to get up from the ground, and hospital employees came to assist her, including a nurse who blurted out that “people trip on those tiles there all the time”. The security officer later testified at his deposition that right after our client’s fall, he put a yellow caution sign over the misaligned tiles to prevent other accidents. The photos of the scene that were taken before the tile repair, also depicted that duct tape was placed directly over the elevated tiles. Two weeks after our client’s fall, the tiles were fixed. Although a number of cameras were directly aimed at the area of our client’s fall, the Defendant stated that they did not have any video of the fall. Our client suffered a left hip fracture. Surgery was required to repair her femur fracture. Our client had significant pre-existing medical conditions and had been previously awarded Social Security Disability benefits for unrelated conditions. Shortly before trial, the case was settled for $240,000.
  • Seven Figure Recovery for Tow Truck Driver Reached After Mistrial

    Practice Area:
    Wrongful death
    Date:
    Apr 04, 2013
    Outcome:
    Settlement
    Description:
    Lawyers Russell A. Dohan and J.P. Gonzalez-Sirgo reached a seven figure above policy limits settlement, after a 1 week jury trial where the jury deadlocked 5 to 1 in favor of our client’s case resulting in a mistrial. The case stemmed from a wrongful death single vehicle accident. The decedent was a 35 year old husband and father of three young girls (one of whom had not yet been born), who had just started a job with the Defendant Towing Company. The vehicle involved was a tow truck which suffered a right front tire failure while traveling on the highway. This tire failure caused the large tow truck to leave the roadway and enter a canal, where our client drowned. Our client's allegation was that the tow truck company failed to maintain the vehicle's tires properly. It was eventually discovered that the tow truck company knew the tire needed to be replaced before the incident, as early as when the vehicle was purchased several months earlier. It was also discovered that four days before the incident, the Florida Highway Patrol had inspected the tire and failed the truck for use by FHP because of the poor condition of the tire. The defense was essentially that our client took the wrong truck that day, and that he knew or should have known the tire was unsafe to drive on. The defense also argued that our client’s driving following the tire failure itself negligently contributed to the vehicle ending up in the canal. After a 1 week jury trial where the jury deadlocked 5 to 1 in favor of our client’s case resulting in a mistrial, a seven figures above policy limits settlement was reached by the parties.