RS vs State Farm
Jan 01, 2013OUTCOME: Policy limits
Client sustained a left shoulder injury after his car was struck on driver side door on April 6, 2011. State Farm opened a claim for first-party Personal Injury Protection (PIP) benefits to pay for cl ... ient’s medical expenses. Client received physical therapy for approximately one year before being diagnosed with left shoulder rotator cuff tear with surgical repair recommended. State Farm requested an Insurance Medical Exam (IME) after paying for over one year of physical therapy. After providing additional information regarding the biomechanics of the motor vehicle collision, mechanism of injury, and proposed treatment, the carrier agreed to withdraw the IME request one week before surgery. Approximately 30 days after surgery, the carrier advised it had requested a records review by an out of state orthopedist, not licensed to practice in Washington State. Based on the conclusions of the records reviewer, State Farm denied the expenses for surgery and post-operative rehabilitation. Prior to commencing a bad faith lawsuit against State Farm, we sent a 20 Day Notice of Claim as required by the Insurance Fair Conduct Act (IFCA). Within one week, State Farm agreed to reverse its denial of benefits and tendered the balance of its insured’s first party policy limits and waive any right of subrogation on the liability claim. We subsequently settled with the tortfeasor for their liability policy limits.
