Most Buffalo personal injury lawsuits involve a defendant whose damages are – at least to some extent – covered by insurance.  Motor vehicle, homeowners and other types of insurance often provide the defense, including hiring attorneys, in personal injury litigation.  When doing so, an insurance company is legally required to protect not just its own interests, but also the interests of its insured.  When it fails to do so, it may be accused of acting in “bad faith.”

There are several acts that may lead to an accusation that an insurance company is acting in bad faith, but in personal injury lawsuits, this issue usually arises when a jury returns a verdict in excess of the policy held by the insured.  While an insurance company is not required to settle every lawsuit if it has a legitimate reason to believe it has a meritorious defense or the value of the injury is well below the policy limits, it is required to take reasonable steps to protect the assets of the insured. 

As an example, an insurance company has an opportunity to settle a personal injury lawsuit within the policy limits.  The injury is likely to be worth more than the policy limits and the insurance company’s client is clearly at fault.  The insurance company decides not to settle the lawsuit.  The matter is then taken to trial and the jury renders a verdict far above the policy limits.  Under this scenario, the insurance company may be found to have acted in bad faith and subject to civil litigation to recover the additional amount the defendant is required to pay.

New York State Law requires all Buffalo car owners to carry what is known as Supplementary Uninsured/Underinsured Motorist (SUM) coverage.  The purpose of this insurance is to provide additional insurance coverage when the owner of the car responsible for a personal injury accident did not carry any insurance or did not carry enough.

When the owner of the vehicle driven by the injured plaintiff carries more SUM insurance than the defendant who caused the accident, the plaintiff may be able to make a claim against that SUM insurance in some cases.  Such a claim, however, usually cannot be pursued until the initial personal injury lawsuit is completed.  This is because the SUM insurance cannot kick in until the amount available from the defendant’s insurance is exhausted.

If the injured party obtains the full amount of the defendant’s insurance, he or she may seek additional compensation from the SUM carrier up to the difference between the two insurances.  For example, a defendant carried $25,000 in insurance and the available SUM insurance was $100,000.  If the plaintiff obtained the full $25,000 from the defendant’s insurance, he or she may then make a claim against the SUM insurance and obtain up to an additional $75,000 from that insurer.

The SUM insurer, however, is not required to automatically turn over this money just because the defendant paid.  As a result, a separate lawsuit may need to be initiated against the SUM insurance carrier after the first case is completed.

The initial medical and lost wage expenses associated with a Buffalo motor vehicle accident are paid under New York State’s No-Fault Insurance Law.  This law requires the vehicle owner’s insurance to pay at least the first $50,000 in medical and lost wage expenses for that vehicle’s occupants following a motor vehicle accident, regardless of who is at fault.

As a result, the victim’s medical provider and employer will be submitting various bills and reports to the No-Fault provider to receive payment, and – when a victim’s injuries are serious – the No-Fault provider will have an extensive record of the victim’s treatment as a result.  Also, it is not unusual for the No-Fault provider to have an injured person examined by a medical provider of their choosing to determine if treatment is actually necessary, and reports from those medical providers will also be in the No-Fault file.

Because the No-Fault file contains an extensive record of the victim’s treatment, the attorneys for the both the victim and the defendant in a personal injury lawsuit will usually want a copy of this file so that they can review its contents.  It can be a convenient way of double checking the information submitted by medical providers, obtaining a complete listing of all treatment, and confirming that no treatment providers have been inadvertently omitted when obtaining medical records.

Buffalo residents who suffer a personal injury in a motor vehicle accident will – in nearly all cases – have their initial medical bills and lost wages paid by their own automobile insurance provider under New York State’s No-Fault law.  Basically, this law requires the No-Fault provider to pay at least the first $50,000 in medical bills, lost wages and other necessary expenses following a motor vehicle accident.

As part of making such payments, however, the No-Fault provider often will require an injured party to submit to a medical examination by a doctor chosen by them.  The purpose of this examination is to determine if the treatment the injured party is receiving is actually necessary and whether further treatment should be paid for.  In cases involving long term injuries and extensive treatment, an injured person may be
required to submit to examinations on multiple occasions – and even from doctors with different specialties – as the insurance company attempts to keep track of the condition of the insured.

It is necessary to attend these examinations.  Failure to do so may result in the No-Fault provider cutting off future payments to your medical providers.  Bear in mind, however, that the doctor examining you is hired by the insurance company to protect them, not you.

Most Buffalo personal injury attorneys have, at some point, dealt with an overly-aggressive insurance company.  If you have suffered a personal injury and are even contemplating pursuing damages against the other party, you should absolutely avoid talking to anyone working for that party’s insurer.

While the agent for the insurance company may be asking you seemingly innocent questions regarding how the accident happened and your injuries, it should always be kept in mind that part of their job is to minimize the amount of money the insurance company is required to pay as compensation for your injuries.  As a result, any statement you make that can be interpreted in a way that minimizes the other party’s responsibility for the accident or your degree of injury is likely to be used against you in the future.

If you are contacted and have an attorney, you should in all cases refuse to speak with the insurer and refer them to your attorney’s office.  Most personal injuries attorneys will contact the other party’s insurance company shortly after being hired and inform them that they are no longer to contact you directly.  The insurer is legally required to comply with this request, and most will do so.  Occasionally, however, a particularly aggressive agent will continue to call.  If this happens to you, inform your personal injury attorney immediately. 

When a Buffalo driver is involved in an injury auto accident, his or her initial medical bills and lost wages will usually be paid by No-Fault Insurance.  No-Fault Insurance is required for every vehicle registered in New York State.  It covers the first $50,000 in medical expenses and lost wages, regardless of who was at fault for the accident.

In the past year, nine out of ten cases of suspected health care fraud in New York State reported to the Insurance Fraud Department involved No-Fault Insurance.  A total of 12,807 suspected No-Fault fraud cases were reported in 2010, down slightly from the 13,433 reported in 2009.  159 individuals were arrested in related cases in 2010.

The Insurance Fraud Bureau has proposed several changes to the No-Fault Law to help close some of the loopholes that have led to fraud and streamline the insurance process.  The Fraud Bureau’s proposals have undergone several revisions over the past year based on conversations with medical providers, attorneys and insurers.  They include some provisions that should also help to protect the rights of those legitimately injured, such as limiting examinations of an injured person by insurance doctors to locations convenient to the injured person and not allowing more than one such examination to be scheduled on the same day.

If you have suffered a personal injury in an auto accident and have any questions, we would be happy to help you.  Please call us at 716-542-5444.

The types of automobile insurance available to Buffalo residents are governed under New York State Law.  Generally, there are two types of automobile insurance required by law that protect the motorist who purchases the insurance (or someone else in their vehicle):  Supplementary Uninsured/Underinsured Motorist Coverage (SUM) and Personal Injury Protection (PIP).

The minimum SUM coverage required by law is $25,000 per person/$50,000 per accident.  These are the minimum amounts required, but additional amounts may be purchased, and drivers should strongly consider doing so.  SUM coverage may cover your damages if the other driver had no insurance or carried less insurance than your level of SUM coverage.

PIP coverage pays for your first $50,000 in medical expenses and lost wages.  This dollar amount also is set by law.  Beyond this, drivers may purchase Optional Basic Economic Loss (O.B.E.L.) insurance.  This insurance provides an additional $25,000 toward basic economic loss.  Often, Additional PIP (APIP) is also available for purchase.  

There are different forms of all these insurances, and it’s a good idea to check with your insurance agent to make sure you have the coverage you desire when exploring these options to ensure that you will have the protection needed in an auto accident.

Buffalo personal injury lawsuits involving automobile accidents require that the victim suffer a “serious injury” before recovering damages.  The definition of serious injury under New York State Law has remained unchanged since the 1970s.  The New York State legislature is currently considering adding a new category to this definition.

Currently, a serious injury is defined as death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system;  permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system; or a medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the  material acts which constitute such person’s usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.

The legislature is considering two new categories to add to this definition:  “a complete tear or rupture of a nerve, tendon, ligament, cartilage or muscle”; and “a tear, rupture or impingement of a nerve, tendon, ligament, cartilage or muscle which results in a significant impairment of a body organ, member, function or system.” Neither of these categories require a finding that the injury is permanent.

If you have suffered a serious injury and have any questions, please feel free to call us with your questions at 716-542-5444.

New York State Law requires all Buffalo drivers to carry No-Fault automobile insurance.  This insurance usually pays for the driver’s initial $50,000 in medical expenses and lost wages, regardless of who was at fault for the injury accident.  Previously, No-Fault insurance coverage could be denied to an injured drunk driver who had caused an accident as a result of his or her intoxication. 

On January 26, 2011, however, a change in this law went into effect that modified this right of insurance companies to deny coverage to a drunk driver who caused an accident.  This new law prohibits no-fault insurers from excluding coverage to drunk drivers for necessary emergency services rendered in a hospital.  This includes ambulance service and any needed medical screening.  

This change was deemed necessary because hospitals and ambulance services that were required to render emergency services to stabilize a drunk driver immediately after an accident often had no means of being paid for these services.  The insurance coverage could be denied, and the driver often would not have the funds to pay for their treatment.  The bill’s Sponsor’s Memorandum also noted that under the old system, emergency health care providers were discouraged from testing for impairment by alcohol or drugs because it may lead to a denial of payment.

While it remains to be seen exactly how the term “necessary emergency health services” will be interpreted under this law, the New York State Insurance Department has issued a letter indicating that it is their position that once the condition of the drunk driver has been stabilized, no-fault coverage may cease.  No-fault is not required to pay for long term treatment or lost wages of a drunk driver who caused a car accident.

All Buffalo drivers are required to have $50,000 in Personal Injury Protection Insurance on their automobiles.  When a person suffers a personal injury in an automobile accident, this $50,000 may be used to pay for lost wages and medical expenses.

Personal Injury Protection Insurance only covers expenses for three years following the accident and is limited to a maximum compensation for lost wages of $2,000 per month.  As a result, for individuals with a higher income or long term injuries, it is possible that the amounts available under mandatory Personal Injury Protection Insurance will not meet their needs.

New York State Law also allows for the purchase of Additional Personal Injury Protection.  When doing so, a driver should give careful consideration to his or her anticipated needs should an injury occur.  If, for example, the driver will need more than $2,000 per month to pay normal expenses, he or she should make sure that when adding Additional Personal Injury Protection, the total amount that may be distributed per month in lost wages is increased.  This is not necessary an automatic change made to the policy when adding Additional Personal Injury Protection – it is possible to increase the total amount of Personal Injury Protection available without changing the monthly lost wage compensation.  As a result, the driver should make sure the policy is being adjusted in a way that meets his or her own needs should a personal injury accident occur.