GETTING FULL VALUE FOR YOUR PERSONAL INJURY CLAIM

GETTING FULL VALUE FOR YOUR PERSONAL INJURY CLAIM
by Attorney Mark Wolfe
mark@brwlawyers.com

Most people who have a personal injury claim from a car accident or a slip and fall have no idea how the insurance company analyzes that claim to determine how much money it should pay as compensation. Regrettably, many attorneys do not know this information either. This lack of knowledge often results in settlements that are not reflective of the full value of the claim.

There are two primary areas for evaluation and assessment of the value of a personal injury claim. These are liability and the injuries that are claimed to have been suffered. But before the adjuster begins the analysis of these two areas, the first thing to be determined is coverage. That is, was the at-fault party’s coverage in effect at the time of the incident and/or is the claim a “covered loss” under the policy.

If the claim is determined to be covered under the policy, the next step is to determine liability. That is was the insurance company’s customer responsible for the accident or the incident and are there any viable defenses to the liability claim such as contributory negligence by the claimant. If the claim can not be denied based upon the liability analysis then the next question for the insurance company to answer is “how much money should we pay on this claim?” This is where understanding the personal injury claim “valuation” process is critical for claimants and their attorneys!.

Every major insurance company that provides liability coverage to its customers now uses a Computer Assisted Claim Evaluation (CACE) program to assess and determine the “value” of a personal injury claim. Understanding how these programs work is critical in assuring full value for a claim. These programs have been around for over 30 years and are always being refined and “improved.” Data and information is input into the program and the program establishes a “value” for the claim. Every company has rules and guidelines for their adjusters on how much they can deviate from the CACE valuation. These programs can analyze and assess hundreds of data points. These data points are commonly called “value drivers” and they can either be positive, meaning higher value, or negative, meaning lower value. These value drivers are applied to pre-set parameters or concepts and can include hundreds of data points for consideration.

The most common and fundamental value drivers for a personal injury claim are the treating doctor’s diagnostic code(ICD) and treatment code (CPT). See: https://www.simplepractice.com/blog/icd-codes-and-cpt-codes/ for a more detailed explanation of these codes. But these codes only establish a “baseline” for evaluation and many other value drivers are analyzed by CACE programs to arrive at a final evaluation. The following example will clarify how these value drivers work and how insurance companies are constantly refining these programs.

Medications are a common value driver that are factored into the value of an injury claim. The CACE program will have a standard or anticipated “normal” medication level and duration for the CPT codes for an injury. The “value” of pain medication for the CACE program works under the pre-set parameter that the stronger the medication and the longer it was taken the more pain the claimant must have experienced. Therefore “pain and suffering” values are often correlated to the medication and usage data input by the adjuster with the ICD and CPT codes. Recently more and more insurance companies have “disconnected” the automatic pain medication value driver for certain injuries nor are they giving credit for medication simply because a medication or prescription is referenced in the medical records. Many CACE programs now require an actual receipt for the medication before the adjuster can input the medication into the CACE program for pain and suffering consideration. The insurance company’s logic is that just because a pain medication was prescribed does not mean it was taken. And if there is no proof the prescription was filled then the program defaults to an assumption it was not taken and then the computer assumes the claimant was not hurt bad enough to need the medication and therefore no enhancement for “pain and suffering” in the final evaluation. Also for example, if a pain medication had two refills but there is no proof of a refill the CACE program assumes the claimant was no longer having significant pain complaints so as to require the refills. Therefore the valuation is reflective of this assumption.

There are many other value drivers that can positively or negatively effect the insurance company’s evaluation of a personal injury claim. Issues such as a delay in care or inconsistency of care are “red flag” value drivers that quickly push down the insurance company’s evaluation. Yet often these negative value drivers can be nullified or eliminated with simple documentation or information. Some value drivers are subjective and require an adjuster to input his or her opinion about the claimant. One such value driver is “Claimant Veracity.” Insurance companies have many different ways to input this information but many use a simple numerical rating scale. “On a sale of one to five, rate the claimant’s honesty.” A strong veracity rating is important especially since many adjusters are trained to believe most injury claimants are faking or exaggerating their injury for monetary gain. Therefore they are often quick to assign a lower veracity rating to a claimant. Again, there are several simple things a claimant can do to insure a high veracity rating for the adjuster and the CACE program.

These simple examples show how complex the proper presentation of an injury claim can be. These programs are often the reason legitimate injury victims are under compensated when they try to handle their claim without a lawyer. Even if the claimant has a lawyer, he or she can still be under compensated if the attorney is not aware of how these programs and the “value drivers” can effect the settlement amount.

If you’ve been injured because of someone else’s carelessness or negligence, you deserve to get full compensation for your injuries. Yet the reality today is that the insurance companies use of Computer Assisted Claim Evaluation programs has made it difficult for victims to get full compensation on their own or with an attorney who does not fully understand the complexity of these programs. If you have a personal injury matter and would like a free consultation with Mark Wolfe or any of the BRW lawyers, please call Mark today at 251 410-7761 or text him at 251 533-9548. Consultations are free and our lawyers are licensed to practice in Alabama, Mississippi, Florida and Georgia.

 

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

 

 

 

Camp Lejeune Justice Act of 2022

Camp Lejeune Justice Act
by Mark Wolfe, Attorney at Law

What is the Camp Lejeune Justice Act? The Camp Lejeune Justice Act of 2022 is a proposed bill that will allow those harmed by exposure to toxic water supplies at Camp Lejeune from 1953-1987 to seek reparations and damages for harms they have suffered or may have suffered from exposure to the toxic water supply at Camp Lejeune, North Carolina. The bill passed the U.S. House of Representatives in March and passed the U.S. Senate on June 16, 2022. The Bill now awaits President Biden’s signature for enactment into law.

Why was the Camp Lejeune Justice Act Needed? Federal laws and North Carolina’s statute of repose prohibited service members or their families from making claims against the United States for injuries and damages suffered from the exposure to the toxic water supply. It has been estimated by the Department of Veterans Affairs that almost 900,000 service members along with their families were exposed to the contaminated water supply at Camp Lejeune.

How contaminated was the water at Camp Lejeune? The water supply at Camp Lejeune during the period between 1953 and 1987 was found to have contained a number of volatile organic chemicals (VOCs) at levels as high as 280 times the standard safety level for drinking water. The specific toxic chemicals detected in Camp Lejeune drinking water include trichloroethylene (TCE), tetrachloroethylene (also called perchloroethylene, or PCE), vinyl chloride, and benzene.

What illnesses or diseases have been linked to exposure to the contaminated drinking water at Camp Lejeune? Several years ago the Veterans Administration identified 8 diseases that were presumed to be caused by exposure to the contaminated drinking water at Camp Lejeune. This list included:

Kidney cancer,
Liver cancer,
Bladder cancer,
Non-Hodgkin’s lymphoma,
Adult leukemia,
Multiple myeloma,
Parkinson’s disease,
Aplastic anemia and other myelodysplastic syndromes (MDS cancers).

Because pregnant women and children were at highest risk for exposure it is suspected that various childhood cancers, breast cancer, miscarriages and various birth defects all may be attributable to exposure to the toxic water supply and Camp Lejeune. The list of additional diseases and damages which may be attributable to exposure to the contaminated water supply at Camp Lejeune continues to be expanded through ongoing medical research and studies.

Who qualifies to make a claim for damages from exposure to the contaminated drinking water at Camp Lejeune? Any service member or family of a service member that was exposed to the contaminated water supply at Camp Lejeune for more than 30 days from August 1, 1953 through December31, 1987 and who suffered one or more of the injuries or diseases associated with exposure is eligible to make a claim. The diseases and conditions associated with exposure to the contaminated water supply at Camp Lejeune are: Kidney cancer, liver cancer, bladder cancer, Non-Hodgkin’s lymphoma, Adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes (MDS cancers). Because pregnant women and children were at highest risk for exposure it is suspected that various childhood cancers, breast cancer, miscarriages and various birth defects all may be attributable to exposure to the toxic water supply and Camp Lejeune. The list of additional diseases and damages which may be attributable to exposure to the contaminated water supply at Camp Lejeune continues to be expanded through ongoing medical research and studies..

What’s the process for making a claim for damages for exposure to the contaminated drinking water at Camp Lejeune? A formal claim procedure has not yet been established but the bill will require that a claim be submitted to the appropriate Federal agency for consideration before a lawsuit can be filed. Any lawsuit that is filed must be in the Federal jurisdiction approved by the Bill.

When should a claim for damages from exposure to the contaminated water supply at Camp Lejeune be started? The Bill as currently approved by the House allows 2 years from the date of enactment to bring a claim and an additional 180 days after the claim is denied to file a lawsuit for damages.

Do I need to hire an attorney to help me with my claim for damages for exposure to the contaminated water supply at Camp Lejeune? From a practical stand point the answer to this question is YES! Navigating the Federal Tort Claims Act, complying with the burden of proof regarding medical causation as defined in the Bill and following the statutory guidelines for presenting and prosecuting a claim will most likely require the assistance of an attorney. The good news for claimants is that most lawyers who present and prosecute these type of claims and cases do so on a contingency fee. This means you only pay legal fees if there is a monetary recovery on your behalf. If there is no monetary recovery then the client pays nothing for legal fees.

What if I need more information about the Camp Lejeune Justice Act and my claim? Please feel free to contact attorney Mark Wolfe at 251 410-7761 or by email at mark@brwlawyers.com Subject: Camp Lejeune for more information or to discuss your potential claim.

Attorney Mark Wolfe has been helping injury victims and their families since 1987

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

 

USE OF PRESCRIPTION MEDICATION ELMIRON® LINKED TO VISION LOSS

USE OF PRESCRIPTION MEDICATION ELMIRON ® LINKED TO VISION LOSS

BY: Attorney Mark Wolfe

Elmiron is an oral medication approved by the FDA to treat the pain and discomfort of the bladder condition known as interstitial cystitis (IC). Numerous recent medical studies have now been released that have linked those who have taken Elmiron to a vision loss condition known as pigmentary maculopathy. Maculopathy is a pathological condition of the macula, which is the area of the retina that is associated with highly sensitive and accurate vision. In the case of those who have taken Elmiron, there is evidence that a buildup of pentosan polysulfate sodium, the active ingredient in Elmiron, in the retinal cells causes these irreversible vision problems. These problems appear to be more common with women who have used Elmiron.

Elmiron has not been recalled despite studies linking long-term use of the IC drug to potentially permanent vision damage. The drug is manufactured by Janseen Pharmaceuticals (Janssen). Janssen is a pharmaceutical company headquartered in Beerse, Belgium, and wholly-owned by Johnson & Johnson. The drug has been on the market since 1996. However, Janssen did not warn about the risk of retinal pigmentary maculopathy until it updated the drug’s prescribing information at the direction of the FDA in June of 2020. The FDA published the new label with the maculopathy warning but it has not issued a statement or safety communication about it. At this point, the agency has not required Janssen to recall the drug and the drug maker has not said it plans to issue a voluntary recall.

Some of the most common symptoms associated with pigmentary maculopathy include the following:
– Difficulty reading
– Blindness
– Eye pain
– Difficulty adapting to dim lighting
– Vision disturbances or distorted vision, or
– Trouble seeing things up close

If you or a loved one has suffered vision loss or vision difficulty and taken the drug Elmiron before June 2020, you may have a claim for compensation and restitution. Please call Mark Wolfe at Boteler Richardson Wolfe – Injury Lawyers today. 251 410-7761. Or email Mark at mark@brwlawyers.com, please put “Vision Loss Claim” in the subject line. Consultations are always free. Boteler Richardson Wolfe – Injury Lawyers have been helping people with injury claims and cases since 1987. Our lawyers are licensed in Mississippi, Alabama, Florida and Georgia.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

 

Ride a Motorcycle? Get a GoPro®!

Ride a Motorcycle? Get a GoPro® !
By Mark Wolfe, Attorney at Law

In my 35 years as a personal injury attorney I’ve represented thousands of motor vehicle crash victims. A number of my clients have been motorcyclists. Motorcycle vs car personal injury claims and cases tend to be more difficult than the typical car vs car matter. Why is that? I’ll tell you in just a second but first let me tell you about the law. Whenever you make a claim against someone (and their insurance company) for negligently hurting you, you carry the burden of proof. That means you have to prove they were at-fault with credible evidence. This burden of proof is what makes motorcycle vs car crash claims a little harder.

If you’ve ridden a motorcycle for any length of time, you know there is a stereotypical prejudice against motorcyclists. People believe motorcyclists “go too fast”, are “risk takers”, are “reckless”, are “disobedient to the rules of the road”, etc. Herein is the problem. It’s very common in a car crash scenario for the at-fault driver to either blame the other driver completely or deflect some degree of responsibility for the crash to the other driver. My experience tells me that this occurs at a higher level in a motorcycle vs car crash. The driver of the car is more likely to either try and blame the motorcyclist completely for the crash or say the motorcyclist contributed to the crash by some “unsafe” manner of operating the motorcycle. Usually, “the motorcyclist was speeding.” Because many law enforcement officers have the same stereotypical prejudices mentioned above, these allegations against the motorcyclist often find their way onto the accident report and can weigh heavily on the officers determination of fault for the accident. Insurance companies use the information in the accident report as the main part of their liability investigation. If an unfounded or false accusation against the motorcyclist is in the accident report, it could result in a legitimate claim being delayed or even denied.

So what can you do? Two things. First, consider using a GoPro® or similar video recording device while riding your motorcycle. If you do this and you are in a crash, DO NOT immediately tell the investigating officer you have a video of the crash or give the officer the recording card or chip. (Sometimes a crash video may reveal something that the other side can use to argue the motorcyclist contributed to the accident. Also, if the officer maintains the original card or chip it may not be available to you because it is now being held as “evidence.”) Rather save the video card or upload the video to a permanent hard drive and get a copy of the accident report as soon as the report is available. Then once you have a copy of the accident report immediately consult with an experienced motor vehicle crash attorney. (Do this even if you don’t have a video of the crash.) Most injury attorneys offer free consultation and he or she can review the accident report, and the video, and determine the best way to proceed. It may be everything is in order and you may not need to retain an attorney. But if the report needs to be amended or producing the video will be helpful with the other driver’s insurance company, the attorney will be able to effectively and efficiently help you do this and keep your claim moving forward. Read more about motorcycle crash statistics here. CLICK.

At Boteler Richardson Wolfe consultations about a motor vehicle crash situation are always free: call 251 410-7761 to speak directly with Mark Wolfe or send him an email: mark@brwlawyers.com (include “Motorcycle Crash” in the subject line). The law firm handles motor vehicle crash claims and cases in multiple states and has lawyers licensed to practice law in Alabama, Mississippi, Florida and Georgia.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Life Insurance Claim Denied? What to Do Next.

Reasons Life Insurance Claims Are Denied & What to do Next.

There are several reasons why life insurance claims can be denied. Knowing those reasons and how to appeal or challenge a denial of benefits can be critical for families in their time of need. The following information from Life Insurance Claims Specialist and Attorney, Mark Wolfe may be helpful to you or a family member. Mark’s Number One Rule: Do Not Try to Handle the Denial of Benefits on Your Own! (See the last section of this article for important information.) For a free consultation please email your life insurance benefit questions to Mark Wolfe at mark@brwlawyers.com Please put Life Insurance Question in the subject line. Or call him at 251 410-7761.
_____________________
denied life insurance

I have been helping families and clients for many years with legal issues related to life insurance benefits. Most specifically with contesting or challenging the denial of life insurance benefits. Some times a lawsuit is required to secure benefits and some times the benefits can be recovered through a pre-litigation request for reconsideration. If you’ve been the victim of denied life insurance benefits, I think the most important thing is for you to fully understand why the benefits were denied and how you may contest or challenge the denial of benefits. What follows are the most common reasons life insurance benefits are denied with some general legal information about the basis for the denial.

1. Death Occurs During the Contestability Period. Most life insurance policies have a contestability period. This is a period of time, usually two years, after the policy has been issued where the insurance company can take a look back at the application and conduct an investigation to make sure all “relevant and material information” was disclosed on the application. This is sometimes called “retroactive underwriting” and is most likely to apply to policies with no formal medical examination before the policy is issued. An example of this type of denial would be if the applicant says his or her weight is 200 lbs but then the insurance company finds medical records right before the application was submitted showing the applicant’s weight to have been 250 lbs. If this weight is higher than the underwriting guidelines for the policy, then the company may deny the claim and refund the premiums claiming had they known of the higher weight, they would not have issued the policy. Even a minor undisclosed medical condition on the application such as high blood pressure can be deemed a material misrepresentation and can be grounds for denial. In general, the undisclosed information does not have to be a contributing factor to the death to support a denial of benefits and it does not have to have been an intentional misrepresentation. Simply forgetting to disclose material information or even an inadvertent mistake can be enough to support the denial of benefits.

IMPORTANT INFORMATION: Insurance rules and regulations vary greatly from State to State and some life insurance policies are even governed or controlled by Federal law. The legal definition as to what is or is not “relevant and material information” on an application can be different from State to State. Before accepting the denial of benefits and cashing the premium refund check, consider consulting with a Life Insurance Claims Specialist or an experienced Attorney to have the denial of benefits reviewed. Also, even if you have cashed the premium refund check, some State laws will still allow you to contest the denial of benefits.

2. Deceit or Fraud. This covers a number of different situations and may extend past the contestability period. This basis for denial covers more than an inadvertent mistake on the application such as mistakenly putting the wrong weight. It would apply to situations were the intent of the applicant was intentionally misleading or deceitful. For example a person is diagnosed with terminal cancer and then buys a life insurance policy and intentionally and knowingly does not disclose the cancer diagnosis. Even if the death occurs outside the contestability period, the insurance company may deny the benefits claiming the policy was secured by the fraudulent suppression of material information. This can also apply to beneficiaries if they secure a policy for a loved one under fraudulent or unscrupulous circumstances.

3. The Cause of Death is Excluded or Not Covered Under the Policy. Most life insurance policies exclude coverage for suicide. However, some policies only exclude suicide during the contestability period. Some life insurance policies exclude benefits if the death occurs “related to or while engaged in a dangerous activity” such as scuba diving or sky diving. Accidental Death (AD) benefit policies often exclude coverage if the accidental death is contributed to by any number of conditions or even pre-existing conditions. A very common exclusion under AD policies or clauses is if the decedent was intoxicated at the time of death.

IMPORTANT INFORMATION: Exclusion clauses in life insurance policies can be legally and/or medically difficult for the insurance company to prove; however, they will often send the beneficiaries a denial of benefit letter referencing complex medical and/or legal terminology. Even if you think the exclusion sounds legitimate, you should have the denial of benefits reviewed by a Life Insurance Claims Specialist or an experienced Attorney.

4. Premium Payments Were Not Made. When premium payments are not made in accordance with the terms of the policy the policy lapses and no benefits are owed. Some policies have a short grace period for late payments. Some policies have reinstatement provisions that allow for past due premiums to be paid and the policy to be “reinstated;” however, the reinstatement provisions often require a new reinstatement application and establish a new contestability period. Some times the “reinstated” policy is basically a new policy with new exclusions and conditions. One of the most common causes for non-payment of premiums is when an automatic payment withdraw is not increased periodically as premiums increase. For example, person takes out a Universal or Whole Life policy that builds cash value over time. The policy has a 10 year level premium and for the first 10 years the premium is paid timely via an automatic withdraw from a bank account. After 10 years the premium for the policy increases but the automatic payment remains the same. The accumulated cash value is then used to make up the premium difference until it is used up. Once the cash value is depleted the policy will lapse for non-payment of premiums. Unfortunately, many Universal and Whole Life Insurance policies were sold with the representation that the cash value would accumulate at such a high rate that the premiums would always be covered or even diminish or go way at some point in the future. This has led many people, especially elderly people, to inadvertently disregard notices and information from the insurance company about premium increases and/or premium payments made via the accumulated cash value of their policy.

IMPORTANT INFORMATION: There have been several class action lawsuits against insurance companies for misrepresenting or misleading consumers about the viability and achievability of “diminishing premiums” or “vanishing premiums.” You can Google those terms and the Company to see if you may be a class member or have any rights under a related class action settlement.

5. Dispute as to Beneficiaries. While not necessarily a denial of benefits, a life insurance company may delay the payment of benefits if there is a dispute as to the beneficiaries under a life insurance policy. In some cases, the life insurance company may require a legal determination as to who is entitled to the benefits. As a simple rule of thumb, life insurance benefits are paid to the named beneficiary of record. This could be the person or persons identified on the application or someone identified on a legitimate change of beneficiary form on record with the company. However, issues can arise if a former beneficiary challenges the legitimacy of a change of beneficiary form. Also, if there are no contingent beneficiaries listed and the primary beneficiary is deceased, then legal action may be required to determine who is entitled to the life insurance benefits. Finally, some States have provisions that automatically remove a named spouse as beneficiary upon divorce.

Do Not Try to Handle the Denial of Benefits on Your Own! Life insurance policies are complex legal documents that contain lots of defined terms and conditions. How those terms and conditions stand up against the laws and regulations of your State requires knowledge and expertise. Many policies have guidelines and rules for how to appeal the denial of benefits but those may or may not be binding or required. However, some life insurance policies are subject to Federal laws and regulations which require strict adherence to procedures for how appeals must be presented. In those situations, failure to properly file the appeal can prevent any further legal action to obtain benefits. Some times the denial of benefits is blatantly wrong and may entitle the victim to additional compensation over and above the policy benefit amount. If you are the victim of denied life insurance benefits, in the very least you should consult with a Life Insurance Claims Specialist or an experienced Attorney as soon as you are notified that the benefits are denied and before responding or appealing the denial of benefits. He or she should be able to give you an overview of your rights and explain the legal issues you are facing and provide you with a strategy to try and recover the benefits.

About the author: Mark Wolfe is a licensed and practicing attorney in the State of Alabama. Through his law firm he has handled denied life insurance cases in Alabama and Mississippi. He has also been a consultant on life insurance claims and cases in other States where he works with local attorneys to help secure life insurance benefits for clients and customers. He has helped families recover over one million dollars in denied life insurance benefits with the average policy value being $50,000.00. Mark provides free consultations for people who have questions about life insurance policies or benefits. Please email your life insurance benefit questions to Mark Wolfe at mark@brwlawyers.com for a free consultation. Please put Life Insurance Question in the subject line. Or call him at 251 410-7761.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

FDA links Rheumatoid Arthritis Drug XELJANZ® to Serious Medical Conditions

FDA links RA Drug XELJANZ® to Serious Medical Conditions

If you or a loved one took the drug Xeljanz® amd Xeljanz® XR for rheumatoid arthritis, psoriatic arthritis or ulcerative colitis and suffered blood clots, cardiovascular problems or cancer you may have a claim for compensation. FDA safety alerts in 2019 and 2021 warned that Xeljanz® may increase the risk of blood clots, heart problems, death and cancer. [Read more here] In response to these findings, the make of Xeljanz® has recently modified the warnings for users of this drug. If you believe you may have a claim because of blood clots, cardiovascular problems or cancer diagnosed after using the medication Xeljanz® or Xeljanz® XR, please give us a call as soon as possible so that we can review your claim! Call Mat Richardson, Esq. at 251 410-7762 or email, mat@brwlawyers.com or you can talk with any of the lawyers at our firm, Boteler Richardson Wolfe – Injury Lawyers 251 433-7766, to learn more about your potential claim. No charge for consultations and no legal fees unless money is recovered for the client. Lawyers licensed in Florida, Alabama, Georgia and Mississippi.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. Georgia Rule of Professional Conduct 7.2 requires the physical location of the firm be disclosed: 3290 Dauphin Street, Suite 505, Mobile, AL 36606. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Hyper link for [Read more here] https://www.fda.gov/drugs/drug-safety-and-availability/fda-requires-warnings-about-increased-risk-serious-heart-related-events-cancer-blood-clots-and-death

Life Insurance Beneficiary Dispute

Wolfe Wins Beneficiary Dispute in Life Insurance Case

Mark Wolfe of Boteler Richardson Wolfe recently won a life insurance case In the United States District Court of Alabama – Southern Division involving a dispute as to the rightful beneficiaries of the policy. Mark’s client was a contingent beneficiary under the policy. The heirs of the decedent tried to argue the changes made by the owner of the policy were not valid and therefore nullified Mark’s client as the contingent beneficiary. A contingent beneficiary is the person who receives the benefits if the primary beneficiary dies before the insured person dies. If a life insurance policy does not have a valid primary beneficiary or a valid contingent beneficiary, the life insurance proceeds go to the Estate of the deceased and the funds are distributed to the heirs of the Estate. In this case the heirs of the decedent attempted to overturn the contingent beneficiary designation of the policy so they could get the life insurance proceeds. Because their claim and the claim of Mark’s client were in conflict, the life insurance company paid the full life insurance proceeds into Court and asked the Court to determine who was legally entitled to the benefits. This is known as an Interpleader action. The heirs and their attorney failed to establish a legitimate basis for their allegations and the Court awarded the full benefits to Mark’s client.

If you believe your claim for life insurance benefits has been wrongfully denied or you have questions about life insurance benefits, please consider consulting with an experienced attorney who knows and understands this area of the law.  At Boteler Richardson Wolfe consultations are always free: call 251 410-7761 to speak directly with Mark Wolfe or send him an email: mark@brwlawyers.com (include “Life Insurance” in the subject line). The law firm handles life insurance claims in multi-states and has lawyers licensed to practice law in Alabama, Mississippi, Florida and Georgia.

 

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

 

Slip & Fall FAQs

I slipped and fell on someone else’s property. What are my rights?          

man falling on wet floor

If the fall was caused by the actions of the property owner or premise manager you may be entitled to compensatory damages for your injury. Slip and fall claims are commonly known as “Premise Liability” claims. The owner’s liability (legal responsibility) for the injuries of someone on his or her property depends on the status of the person on the property.

When you are on someone’s property you are classified in one of three categories: 1) Invitee, 2) Licensee, or 3) Trespasser. The premise owner’s legal duty to protect you from injury while on his or her property varies depending on your status.

Invitees are owed the highest duty of care by the property owner or premise manager. Invitees includes business customers, visitors, guests and others who are present on the property for the financial benefit of the owner or occupier. Owners and occupiers of land or property have a legal duty  to maintain the property in a safe condition and provide reasonable warnings of possible dangerous or hazardous conditions. Property owners or premise managers can be held liable for injuries to an invitee because of a  dangerous conditions they should have known about and remedied.

Licensees are people who have received an invitation to be on the property of someone else but they are not there for business or financial purposes. This is often someone on property for social purposes. These visitors to the property are commonly referred to as “social guests”. Property owners or premise managers are responsible for correcting and warning against dangerous conditions and hazardous situations. However, owners can only be held responsible for dangers they actually knew about.

Trespasser: Owners and occupiers of a premise or property owe the lowest duty of care to a trespasser.  A a trespasser is on the property uninvited and without permission. Property owners are not responsible for keeping their property safe for trespassers. The only duty owed to trespassers is to refrain from engaging in intentional or reckless conduct that causes injuries and to warn the trespasser if you have actual knowledge they are in peril or danger. If the property owner has reasonable knowledge that children trespass onto the property, owners should post warnings of unsafe conditions and take reasonable steps to prevent the children from being exposed to such dangers.

 

What are the different types of Premise Liability Claims?

There are many different situations where a property owner or premise manager may be legally responsible (liable) for the injury or death of a guest. These include:

Slip and Falls

Trip and Falls

Property Maintenance Issues

Defective Steps

Defective Handrails

Defective Decks

Dangerous Carpets, Rugs or Mats

Falling Products

Wet or Slippery Floors

Elevator and Escalator Injuries

Swimming Pool Accidents and Drownings

Dog and Animal Bites

Defective or Dangerous Playground Equipment

Electrocution and Electric Shock Injuries

Lack of Adequate Security

 

The property owner’s insurance company says they are not responsible for my fall on their customer’s property. How can they not be responsible?

Generally under the law in order to hold a property owner or premise manager liable (legally responsible) for your injury on their property, you must prove they did something negligent to cause your fall. The law affords property owners or premise managers certain defenses to a claim of negligence and these defenses can block their liability or reduce the money damages they may owe. The two most common defenses raised are: 1) Open and Obvious and 2) Contributory Negligence.

Open and Obvious: The hazard or dangerous condition is such that it should have been seen and the danger appreciated by the premise guest.

Contributory Negligence: The premise guest failed to exercise reasonable care to see and appreciate the condition that caused the fall.

These two defenses may negate the liability claim or reduce the damages owed by the property owner or premise manager. These are often raised by the property owner’s insurance company to try and defeat or discourage an injured guest from pursuing a claim for damages. Trying to determine the validity of these defenses often requires the assistance of an attorney who can review the facts and legal standards to better assess the viability of the claim.

 

I fell and was hurt on someone’s property. What compensation am I entitled to?

If you can prove the property owner or premise manager was legally responsible (liable) for causing your fall AND there are no viable defenses to your claim, you may be entitled to collect the following types of compensatory damages from the property owner’s insurance company:

Medical bills for injuries caused by the fall,

Lost Wages for medically necessary time missed from work,

Pain & Suffering related to the injuries caused by the fall,

Mental Anguish (also known as worry and concern), and

Future Compensatory Damages that are reasonably certain to be incurred.

Injuries caused by the fall can include the aggravation or exacerbation of a pre-existing condition. Also, it is important to remember that the issue of medical causation will often require medical documentation. The compensatory damages are usually paid in one lump sum that includes all claimable damages and once the damages are paid, the claim is closed forever and no future claims will be considered.

 

How much will it cost to consult with a BRW lawyer about my slip and fall claim?

At Boteler Richardson Wolfe, our lawyers offer free consultations on all injury related claims and cases. The free consultation will include a review of the facts and related issues presented in your situation. It will also include an honest assessment about whether your claim or case warrants hiring an attorney. If you select a BRW lawyer to assist with your claim or case there are no fees charged up front and you only pay attorney fees if we win your claim or case! Call us today to speak with one of our lawyers: 251 433-7766.

 

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Wolfe Leads Seminar on Life Insurance Claims

 

Mark Wolfe of Boteler Richardson Wolfe recently led a Continuing Legal Education (CLE) seminar for Gulf Coast attorneys on Life Insurance Claims. The program was sponsored by the Baldwin County Bar Association as part of their 2020 CLE series and was conducted via Zoom. The program covered a wide range of legal issues regarding life insurance claims including beneficiary disputes, common reasons for denial of benefits and the impact Federal laws and regulations have upon benefit dispute resolution. Wolfe’s presentation included common legal issues that arise in accidental death benefit claims and he also covered a section on the impact of Federal laws and regulations on disputed life insurance claims.   If you have questions about life insurance benefits or your claim for life insurance benefits has been denied, call mark today at 251 410-7761 for a free consultation or email him at mark@brwlawyers.com.  Mark has over 33 years of legal experience and over the last 20 years he has handled and resolved many life insurance claims and cases.  In his legal career Wolfe has taught over 30 CLE seminars for other lawyers and has had numerous law articles published in National and Regional law journals. Click here for a full list of Wolfe’s articles and seminars.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

TV Lawyer Ads

TV Lawyer Ads?  Read the Fine Print.

Recently there have been numerous TV commercials for lawyers where someone brags about how much money the lawyer recovered for them. as seen on tvThese people generally appear fine and gush about what a financial windfall the lawyer got them for their injury claim. The problem is the fine print disclaimers that accompany the commercials usually scroll across the screen so quickly, or are so small, you can’t read them. Many people don’t even see them, let alone read them. Here’s a compilation of some of these disclaimers from some recent TV lawyer ads in our area: – Dramatization: Not an actual case. – Not an actual client testimonial or based upon a specific case.  – Actor portrayal, not a real client or case. – The monetary result referenced is not from an actual case.  – The monetary recoveries referenced are not typical of most injury claims and [law firm name omitted] in no way guarantees or promises similar results for specific injury claims. – Not a typical injury case recovery. – Not a real client or case result. – Not an actual case result or recovery. [Law firm name omitted] processes claims and cases via a referral to an affiliate law firm. Referral law firms are solely responsible for claim and case presentation and remit a portion of the attorney fees to [law firm name omitted.] – Actor and/or spokesperson is compensated for services and any reference to financial recoveries are of non-typical personal injury matters. – Actual results may vary. Not licensed to practice law in Alabama. Legal? Maybe. But doesn’t this smell of deception? A commercial runs with a “client” boasting of a huge financial recovery but hidden in the commercial is one of the above fine print disclaimers stating the results are not true or not typical. Seems like the old bait and switch sales tactics used by shady salesmen of days gone by. Trust between an attorney and his or her client is critical to a good relationship. Clients must rely on and trust their attorney to help them through a difficult time. There is a better way to go about hiring a personal injury attorney. Here’s a link to an article about how to hire the right personal injury attorney for your claim or case.  Tips for Hiring the Right Personal Injury Lawyer