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

Homeowner Insurance Claims: Six Things You Need to Know

Homeowner Insurance Claims: Six Things You Need to Know
You’ve notified your insurance company, what’s next?

Mark Wolfe, Attorney

“Many homeowner and commercial property insurance policies have a dispute resolution provision for valuation disputes. However, these provisions vary from policy to policy and often have legally binding requirements that must be complied with in order to resolve the dispute.”

As thousands of us along the Alabama and Florida Gulf Coast begin the recovery process after Hurricane Sally, many of us will be having to make insurance claims for damage to our homes and property. Here are some important things you need to know about your property damage and/or homeowner insurance claim. Keep in mind an insurance policy is a contract between you and your insurance company that details what each party must do related to a loss. Your failure to comply with these requirements can be grounds to void coverage! Also, when you are making an insurance claim it is your burden to prove the loss with proper documentation and credible evidence.

 

1. Notify Your Insurance Company Immediately. Most insurance policies require notification of a potential claim as soon as possible. A delay in notifying the insurance company of a potential claim could result in a denial of coverage.

2. Document & Mitigate Your Damages. There is no such thing as too many photographs or videos of your damage. Also, your policy requires you to undertake reasonable steps to help minimize the loss. This may mean putting a tarp over roof damage to prevent more damage or putting plywood over broken windows. Failure to mitigate your damages can result in the denial of benefits or reduced benefits. If you can not get to your property to assess and/or mitigate your damages because of government restrictions, make sure to print or screen shot the restriction.

3. Review Your Policy. There are several important things to know about your policy and the coverage it provides. While there is no “uniform” homeowner policy, most contain the following sections and parts. The starting point in your review is the Declarations Page. This tells you the amount of coverage available for the various losses and should document what real property is covered by the policy. It should also document the deductible for each claim. The Terms and Definition sections defines a “covered loss” and any exclusions as well as all the other relevant terms used in the policy. The Property Damage section of your policy outlines the what real property and personal property will be covered under the policy and it usually explains the loss of use coverage. The Personal Liability portion of the policy explains the personal protection afforded to you for liability claims made against you or a member of your household for negligence or careless actions. The Additional Terms & Conditions section of the policy may contain legal provisions such as assignment of benefits, subrogation and dispute resolution procedures.

4. Be Careful in Your Conversation with the Insurance Company. Always be truthful but only provide facts you know to be true. After a storm, insurance adjusters are working hard and moving quickly. Often when reporting your damage the insurance company will ask about other damage. If you assume you have no other reportable or claimable damages and say you have no other damage then the adjuster may not give your house a full inspection when he or she comes to adjust your loss and write an estimate. Always ask that the adjuster give your home or property a full and complete inspection. They are trained to identify damage and they may see storm damage that you did not realize.

5. What to do if  You and the Insurance Company Don’t Agree. Generally, there will be two potential areas for disagreement: coverage and valuation of the loss. If your insurance company is denying coverage for the damage then you have a right to have the denial in writing. Generally, you should ask for a written explanation of the denial and ask for a specific reference to the policy provision that supports the denial. E.g., A policy may exclude flood or rising water damage. Have the written denial letter and the policy reviewed by an experienced insurance claims attorney as soon as possible. If you disagree on the valuation of the loss, e.g., repair vs. replace, then you may want to consult with an experienced insurance attorney. Many homeowner and commercial property insurance policies have a dispute resolution provision for valuation disputes. This allows for a resolution without having to file a lawsuit! However, these provisions vary from policy to policy and often have legally binding requirements that must be complied with in order to resolve the dispute. Some States even allow for the recovery of attorney fees if you are successful

6. Consultations are Free! Almost all lawyers who represent people who have a dispute or disagreement with an insurance company provide free consultations. Many of these lawyers will represent a claimant under a contingency fee contract; that is, no money recovered for you, no fee owed. However, the percentage charged can vary greatly from law firm to law firm. Some may charge 15% of the total recovery while others may charge 25% of the amount in dispute. Also, some lawyers may advance the expenses related to the matter while others may require you to pay those expenses directly and as incurred. If you hire an attorney to assist you with your claim, you should know exactly how the fee will be calculated and how expenses will be handled. You should always get a copy of the representation agreement. If you don’t get a copy of the agreement at least send a written confirmation of your understanding as to how fees and expenses will be handled.

If you are an Alabama or Florida Gulf Coast resident and you have a question about your insurance claim, please contact Boteler Richardson Wolfe – Attorneys at 251 433-7766. We’ve been helping Gulf Coast residents with insurance claims since 1987. Offices in Mobile, AL  and Foley, AL

 

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.

 

Can Boat Owners Rely on an Act of God to Avoid Hurricane Sally Liability?

Can Boat Owners Rely on an “Act of God” to Avoid Hurricane Sally Liability?

With boats strewn all over the Alabama and Florida coastline from the unsuspecting ferocity of Hurricane Sally, many are asking the question: Is a boat owner liable to a landowner for damage caused by the unmoored boat in a hurricane? An unpublished 5th Circuit Court of Appeals opinion provides a well written analysis to answer this question. In Simmons v. Berglin, 2011 U.S. App. LEXIS 23499, a sailboat became unmoored from its dock during Hurricane Katrina, washed ashore, and damaged the Plaintiffs’ property. Finding for the sailboat owner, the 5th Circuit Court of Appeals concluded the unmooring and resulting damage was an Act of God.

In reaching its conclusion, the Simmons Court, first, acknowledged a presumption that has existed in admiralty law for well over 150 years – there is a presumption that when a moving vessel causes damage to a stationary object, the moving vessel is at fault. This said, the Court, also, pointed out a drifting vessel may overcome this presumption with evidence that “the accident could not have been prevented by human skill and precaution and proper display of nautical skill.” In other words, if a boat owner undertook reasonable preparations in anticipation of an impending hurricane, the boat owner will be relieved from liability as the damage resulted from an Act of God.

The facts found in the Simmons case are analogous to the stories being shared following Hurricane Sally. As such, the factual analysis in Simmons can be readily applied to those seeking claims against boat owners in the aftermath of Hurricane Sally. In that case, the Court’s recognition of the high storm surge recordings in the area where the sailboat was docked was, undoubtedly, a significant factor in its decision. Too, an important factor in the Court’s rationale was its acknowledgment of the testimony from the two men who made hurricane preparations to the sailboat – both were found to be well experienced mariners. Finally, the Court assessed the devastation inflicted upon the docks and boats in the area where the sail boat was moored in finding the damage resulted from an Act of God.

In conclusion, for a landowner to present a claim against a boat owner for damage caused by his/her’s unmoored boat in a Hurricane Sally, it will, first, be necessary for the landowner to prove the boat owner failed to undertake reasonable preparations. For example, those boats that were poorly anchored resulting in damage to landowners may be liable for damages. However, know the court may balance a mariner’s inexperience with the fact Hurricane Sally brought a significant storm surge in Alabama and Florida causing devastation upon docks and boats throughout the area in finding for the boat owner, instead of the landowner. Simply put, the landowner will have to overcome an assumption that Hurricane Sally subjected all local mariners to an Act of God. (AP Photo/Gerald Herbert)

Knox Boteler
Boteler Richardson Wolfe
knox@brwlawyers.com
(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.

Personal Injury Claims: What Are “Value Drivers?”

Today most major automobile insurance companies use some form of Computer Assisted Claim Evaluation Program to help them establish a “value” for a personal injury claim. These programs evaluate data about the injury claim and then provide the adjuster with a value or compensation amount they should pay the victim. Depending on the company, adjusters may have to strictly follow the evaluation or they may be able to offer more than the program’s “evaluation.”  Desktop Computer Free vector in Adobe Illustrator ai ( .AI ), Encapsulated PostScript eps ( .EPS ) format for free download 3.28MB

Central to all of these programs are value-drivers. These are certain facts or factors that are input into the program. A value-driver can be either positive or negative. Meaning they can either increase the amount of compensation the victim receives or reduce the amount of compensation the victim receives. These programs can evaluate thousands of different value drivers. Even for a simple auto-crash injury claim there can be over 100 value drivers analyzed by these programs.

Obviously the diagnosis code for an injury is an important value driver but so are the treatment codes as well as the timing of the treatment. The “value” of a diagnosis code may also depend on what type of doctor made the diagnosis. A delay in care or a gap in treatment can be a negative value driver as well as inconsistent pain complaints in the medical records. Many times these negative value drivers can be limited or overridden by the adjuster but he or she has strict criteria or guidelines on what documents and/or facts must be presented to limit the negative value driver.

If you have a serious injury claim from a car crash, you need a law firm that understands Computer Assisted Claim Evaluation programs and knows how to properly document all of the positive value drivers and limit the negative value drivers. At Boteler Richardson Wolfe we’ve been helping car crash victims present and prosecute their insurance claims for over 30 years. We know and understand Computer Assisted Claim Evaluation Programs better than most attorneys. We can help you get the full compensation you deserve! Give us a call today: 251 433-7766 or email Mark Wolfe at mark@brwlawyers today for a free consultation.

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.

What’s Up with the Zantac Recall Ads?

What’s Up with the Zantac Recall Ads?

On April 1, 2020, the FDA announced the immediate withdrawal of all prescription and over the counter Ranitidine and Zantac ® from the market. In its announcement, the agency stated that it “determined that the impurity in some ranitidine products increases over time and when stored at higher than room temperatures and may result in consumer exposure to unacceptable levels of this impurity.” The impurity, NDMA, is a known cancer causing chemical. Before April’s announcement, it was thought the impurity formed in the body. While this continues to be a common thought in the scientific community, thzantace FDA cautioned in its announcement that the impurity may result from when the drug is stored for longer periods of time at temperatures above 72 degrees. There are additional studies that will, hopefully, shed light on the reason for the impurity, but, for now, those studies have been delayed due to Covid-19.

According to studies of the contaminant NDMA (N-nitrosodimethylamine), possible side effects of ingestion are:

Bladder Cancer
Colorectal Cancer
Esophageal Cancer
Intestinal Cancer
Kidney Cancer
Liver Cancer
Ovarian Cancer
Pancreatic Cancer
Stomach Cancer
Testicular Cancer
Uterine Cancer

Currently, lawsuits and claims filed throughout the country have been consolidated in the U.S. Federal District Court for the Southern District of Florida through a multi-district litigation (MDL) process. While this litigation is in its infancy, there have been several thousand claims filed with the court through a census program. The utilization of this program is incredibly important as it will assist with determining the cause of the impurity found in ranitidine and Zantac ® and the effect NDMA has on the drug’s users.

Proof of cause and effect will be incredibly important and complex in this litigation as there are several hurdles consumers face in this litigation. For instance, those who were prescribed, generic Ranitidine was prescribed much more often than Zantac. This poses a significant problem as the U.S. Supreme Court has held that state law failure to warn claims against manufacturers of generic drugs are preempted be federal drug regulations. In other words, those consumers taking Ranitidine by prescription, only, are prohibited by law from making a claim against a generic manufacturer under a theory the company failed to warn the drug’s usage may cause cancer. Thus, in those cases, consumers will be forced to show evidence there is a defect in the manufacturing process of the generic manufacturer. Another concern, is proof of usage for those who purchased Ranitidine and Zantac ® over-the-counter. Requesting documents from pharmacy reward programs and/or medical savings accounts (MSA) will be imperative. Last, determining the manufacturer responsible for the consumer’s injury will be tasking; there are over 15 manufacturers of Ranitidine and Zantac ®. In summation, given the widespread usage of Ranitidine and Zantac ® and the complex evidentiary and legal theories that must be overcome by the consumer, this litigation pending in Miami, FL may, very well, take several years to reach a conclusion.

For more information related to this article and Ranitidine and Zantac ® claims, call Knox Boteler at 251-433-7766 or email, Knox@BRWlawyers.com

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? Three Things You Need to Know.

GUIDE FOR LIFE INSURANCE CLAIMS©
By: Mark Wolfe, Attorney at Law
Boteler Richardson Wolfe – Injury Lawyers*
mark@brwlawyers.com

*The firm handles denied life insurance claims in Alabama, Mississippi and Florida

 

denied life insurance

While most of us hope that a life insurance claim arising from the death of a loved one will be a simple and hassle free process, the fact is some life insurance claims are initially denied. These denials can be for many reasons. Some times the reasons for such a denial are legitimate, but many times they are wrong. In fact many insurance industry experts say that up to 40% of life insurance claim denials are done so wrongly. This guide will help you with some basic information about life insurance claims and locating policies. Then it reviews common reasons why life insurance claims are initially denied and concludes with important information for claimants if the claim is denied. Note from the author: If you are reviewing this publication or link during a time of loss, please accept my condolences and sympathy for your loss. I pray that you find comfort and understanding for your loss and that the passage of time will replace the sorrow of your loss with the joy and blessing of the memories of your time shared together. – Mark 

 

I. THE FIRST STEP

Notify the Company of the Claim. While this is a very basic step it can be a little difficult if the policy is older. Mergers and acquisitions of life insurance companies can make locating the correct successor or remainder company a little difficult. However, internet searches can usually help you quickly identify the correct company name and location for claim notification. Also, many life insurance agents or attorneys who handle life insurance claims have this information available or access to the correct resources to help identify where and how the claim should be submitted.

What You Need to Do. Once you’ve contacted the company you must complete the claim form. Many of these claim forms can now be downloaded from the company’s web site. At the very least you will have to submit a copy of the death certificate and the company may require additional records related to the claim. Always reference the claim number or policy number (or both) on all documents or material submitted. Until the claim is paid in full: Keep copies of all correspondence and documents sent to the life insurance company. Keep all letters and material sent from the life insurance company. If a claim is denied, make sure you understand and comply with the requirements for an appeal. (IMPORTANT: Please make sure to read more about appealing a denial below.)

II. LOCATING OTHER LIFE INSURANCE POLICIES

Locating Additional Policies. It’s a fact, many life insurance benefits go unclaimed because beneficiaries do not realize a policy exists. Below are some tips for locating additional life insurance policies.

1. Review the deceased’s check book or bank statements looking for premium payments.

2. Review the deceased’s tax returns for the last several years to see if interest or cash dividends from a life insurance policy were listed. There should be a corresponding 1099-INT from the life insurance company. These payments will be reported directly on form 1040, 1040A and 1040EZ or on Schedule B if an itemized tax return was filed,

3. Contact the decedent’s employer and/or former employers to see if any type of life insurance was offered through the company’s group benefit programs and if the decedent purchased a life insurance policy or was provided a life insurance policy through employment,

4. Review all disability policies for the decedent to see if death benefits are also provided,

5. Review any known life insurance policy to see if additional benefits such as double indemnity for accidental death may apply,

6. Check with the decedent’s auto insurance company or homeowner insurance company. Many of these companies will also offer life insurance policies for their customers,

7. Check with the decedent’s bank or financial institutions to see if life insurance benefits or policies were offered in connection with a checking or savings account or in connection with a brokerage account.

III. DENIAL OF LIFE BENEFITS AND APPEALS

Many times if a basic life insurance claim is denied, it is done so based upon a process known as “retroactive underwriting.” This usually occurs if the insured dies while the policy is the “contestability” period (usually 2 years from date of issue). This is a claim investigation technique that allows the insurance company to more fully and completely examine the deceased’s prior medical history. These prior medical records are reviewed thoroughly to see if the deceased left out or failed to disclose a pre-existing medical condition when completing the life insurance application. This “failure to disclose” is then used as grounds to deny the life insurance benefits. However, most claimants are not aware that such a denial must have materially affected the underwriting risk associated with issuing the policy. Simply put, the company must be able to legitimately argue that “but for” the undisclosed prior medical condition, the policy would not have been issued or the rates for the policy would have been significantly different. The issue of “material risk” is a complex issue that is often legally debatable.

Accidental death or double indemnity benefits. Some companies issue stand alone accidental death life insurance policies or some standard life insurance policies have a “double indemnity clause” which pays twice the face value of the policy if the death is caused by an accident. Yet the policy language concerning the term “accidental death” is often drafted so vaguely that it gives the company lots of “wiggle” room to initially deny accidental death benefits. Terms like “sole and only proximate cause of death” often involve complex medical and legal analysis but give the company a very legalistic sounding reason not to pay.

BEFORE YOU FILE AN APPEAL OF A DENIAL OF LIFE INSURANCE BENEFITS. If you have questions about the denial of any life insurance benefits, make sure you fully understand your rights and obligations under the policy. Most life insurance policies allow claimants to file an appeal of the decision to deny benefits. Yet many times claimants are unaware of the potential consequences of simply “appealing” the denial without knowing the exact appeal protocol set forth in the policy. Generally, once a company has denied the life insurance claim, the claimant has the burden of identifying specific reasons for the appeal and providing supporting documents or records to support the appeal. If the life insurance policy in question has been provided through the decedent’s employment or through a group plan, the failure to comply with the appeal requirements can be extremely detrimental. In one recent example a Federal Court determined that the claimant’s failure to submit any “new evidence” during the appeal process provided for in the plan, precluded the claimant from presenting that new evidence at trial. [See Hancock v. MetLife, 590 F.3d 1141 (10th Circuit 2009).]

NOTE: If the claim is denied consider consulting immediately with an experienced life insurance claims attorney in your State. Note: Most attorneys who handle life insurance claims for beneficiaries do not charge for a consultation and work on a contingency fee (no benefits = no fees). Also, many times an experienced attorney can help resolve a denied claim before having to resort to filing a lawsuit.

IV. CONCLUSION

While life insurance claims should be simple and easy, they can often times become arduous and legally complex. The simple fact is insurance companies do not like to pay claims and have tremendous resources to fight claims. With many claimants of life insurance benefits in a state of grief and mourning, the insurance company knows it has the upper hand and this often results in the wrongful denial of life insurance benefits. If you believe your claim for life insurance benefits has been wrongfully denied, please consider consulting with an experienced attorney who knows and understands this area of the law.  Boteler Richardson Wolfe consultations are 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.)  * Prosecuting denied life insurance claims in Alabama, Mississippi & Florida

 

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.

 

Car Crash Insurance Claim Questions? We have the answers.

Car Crash Insurance Claim Questions? We have the answers.

The Guide for Auto-Crash Insurance Claims – Ala edition is a comprehensive 16 page booklet that provides car crash victims all the information they need to know about their auto-crash insurance claims. This consumer booklet was written by an attorney with over 30 years of experience in presenting and prosecuting auto-crash insurance claims. This free guide covers the following areas:

– What to do at the accident scene,
– The two types of auto-crash insurance claims and how the claim process works,
– The various insurance coverages that may be available,
– Property damage claims,
– Personal Injury and Wrongful Death claims,
– How insurance companies use computer programs to help evaluate claims (and what you need to know about these programs!),
– Information about consulting with and/or hiring a lawyer for your claim, AND
– What you need to know about giving a recorded statement to the insurance company.

This guide was written by Mark Wolfe of Boteler Richardson Wolfe – Injury Lawyers and has been distributed to over 5,000 people. When asked about the purpose of the guide Wolfe said, “the main purpose is to educate consumers about the auto-crash insurance claim process because it’s not as simple as people may think.” He also said, “over the years I have seen too many claims that were compromised because the claimant was trying to handle the claim without an attorney AND without knowing how the process worked or knowing their rights.”

When asked about the public’s biggest misconceptions about the auto-crash insurance claim process he said, “There are really three main misconceptions or misunderstandings. First, most people don’t realize the process is adversarial. This means the insurance company has no duty or obligation to help you present your claim. Second, most people do not know or understand the various insurance coverages that may be available to them and how to effectively utilize those coverages, and finally, many claimants do not know that they have the burden of proving every aspect of their claim pursuant to the applicable legal standards.” Wolfe says these problems can often result in the denial or underpayment of a claim and that’s the main reasons he wrote the guide.

“Not every car crash insurance claim requires the hiring of an attorney, but if you’re not going to get a free consultation with an attorney after your crash, you should at least know your rights,” said Wolfe.

The publication can be downloaded free at brwlawyers.com or a hard copy can be ordered by calling their office at 251 433-7766 or emailing Mark directly at mark@brwlawyers.com or send him a text at 251 533-9548.   CONSULTATIONS ARE FREE

 

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.

The insurance adjuster wants to take a recorded statement from me. What do I need to know?

5 Things you Need to Know BEFORE Giving a Recorded Statement to the Insurance Company.

by Mark Wolfe

NUMBER ONE: Set up the recorded statement for a time and date that is convenient for your schedule and get a transcript or copy of your statement. As you will see below you will need to do some basic preparation before your give your recorded statement so make sure you schedule the statement in advance so you can prepare. Also, make sure you have enough time for the statement so you are not rushed or hurried. Most recorded statements do no last more than fifteen to thirty minutes, but you may want to allow up to an hour just in case it runs longer. Ask if you will be given a chance to review the statement or at least be given a transcript or copy of the statement. [Most legitimate insurance companies will provide a copy but you must ask for it.] If the adjuster wants to know why you want a copy you can explain it is simply to make sure the transcript is accurate and that you would like to have a chance to correct any misstatements, inaccurate responses or mistakes you may have made. If the company agrees to give you a transcript or copy, verify this in a written communication. Some companies such as Omni Insurance Company now require the claimant to pay $15.00 for a transcript of the recorded statement. Even if you have to pay for the copy or transcript, it’s worth it to make sure it is correct.

NUMBER TWO: Prepare for the recorded statement: 1) Review the accident report before giving the statement. If you do not have the accident report, get a copy or ask the adjuster to furnish you with a copy before scheduling the statement. [Again, most legitimate insurance companies will mail, fax or e-mail you a copy of the accident report but just as with getting a transcript of your statement, you have to ask for it.] 2) Make sure you know your direction of travel and the name of the road you were on. You will also need to be able to identify the direction of travel for the other driver and what road he or she was on. 3) Make sure you know the time of the collision. 4) Review in your mind your route of travel and be able to tell the adjuster where you were going and the purpose of your trip. 5) Know the names of all passengers and if possible their contact information, especially if you believe they can help validate your account of how the collision occurred. 6) You will need to know the weather conditions and if safety belts and/or child restraints were being used by you and your passengers. 7) You will need to be prepared to describe the property damage to your vehicle and the other involved vehicles as well as describe the post-collision position of the vehicles. 8) You will need to have the contact information for any witnesses known to you. 9) You will probably be asked for information about your employment such as how long you have been employed, the type of work you do and your job’s physical requirements, your pay rate and the name and telephone number of your immediate supervisor. NOTE: If you are making a lost wage claim or loss of revenue claim, you can anticipate a more detailed inquiry into these areas. 10) If you were injured, even slightly, you need to be prepared to describe your injuries with specificity and in detail. Your description of your injuries should always be honest and never exaggerated but you need to make sure all injuries are mentioned. Bruises and small contusions from seat belts are often forgotten or not mentioned as are small cuts or abrasions. If you have received medical attention, or are still receiving medical care for injuries from the collision, be sure you have the healthcare providers name, address and telephone number available and be prepared to tell the adjuster about the number of visits and what you have been told about your injuries. Also, if you were injured in the collision and making a bodily injury claim for medical bills and related damages, be prepared to answer questions about your past medical history, i.e., other similar injuries, other prior accidents or incidents, etc.

NUMBER THREE: What to do when giving the statement: 1) Relax and try not to be nervous. 2) Be polite and use yes or no instead on unghn-hughn or ungh-ungh’s. The later responses can be very difficult to discern and transcribe and are easily transcribed incorrectly. Also, remember this may be your only chance to interact directly with the insurance company. For the remainder of the claim process, you are primarily just another claim number to the insurance company. You want to make a good impression. See Claimant Profiling information in Suggestion Five. 3) Answer the question. Many times people go into a long narrative in response to a simple question. Try to be concise and accurate in your response. 4) Confirm on the record that you will be getting a transcript or copy of the statement. Many companies will now send you a digital sound document of your statement by e-mail. 5) If you were injured in the collision and anticipate making a bodily injury claim, ask the adjuster on the record and at the end of the statement if he or she has a preferred healthcare provider or doctor you need to go see to verify or validate your injury. Most of the time at the end of the statement the adjuster will give you an opportunity to say or add anything to the statement and this is the perfect time to ask the adjuster about a preferred healthcare provider. WHY THIS IS IMPORTANT. Most companies do not have preferred healthcare providers for you to see and most will not ask you to see a doctor of their choice to validate the claim, but by offering to do so, you are telling the adjuster early on that your injury claim is legitimate and meritorious because you are willing to allow them to “independently verify” the truthfulness of your injury claim. Obviously in catastrophic injury situations or broken bone claims, this offer is not as important, but if you have a soft-tissue injury such an offer can help establish in the adjuster’s mind that your claim is legitimate and you are not trying to present a fraudulent or exaggerated claim.
NUMBER FOUR: What not to do when giving the recorded statement: 1) Do not exaggerate or overstate any aspect of the collision or your injuries. Be honest and candid in your account of the collision and your injuries. 2) Do not speculate. If you do not know an answer it is OK to say you do not know; however, try to give an estimate if at all possible. NOTE: Excessive use of “I don’t know” is often considered by adjusters as being deceitful or not completely honest or candid. 3) Do not give out personal information such as your date of birth and your social security number during the statement. You can confirm the last four digits of your social security number but in this day and age of identity theft it’s better not put your personal information into a statement that will be transcribed by someone you do not know. Understand the adjuster will need this information to process your claim. We are not advocating that you not provide said information, we just do not believe the recorded statement is the appropriate place to disclose said information. Often times this information can be confirmed with the adjuster after the statement is over and the recorder turned off. 4) Do not agree with any commentary or suppositions asserted by the adjuster about your actions or details of the collision. In other words, do not let the adjuster “put words in your mouth.” NOTE: Most legitimate insurance companies do not allow adjusters to do this, but some companies encourage, or do not strongly discourage, this type of gamesmanship by their adjusters. Some examples: “So you’re saying you’re really not hurt that bad and aren’t going to need medical care.” – “OK, if I understand what you’ve said, you’re not really really 100% certain the accident was our insured’s fault.” – “Based on what you’ve told me so far, wouldn’t you agree that you could have avoided this collision if you would’ve swerved just a split second sooner?” – “So based upon what you’ve told me about your work requirements, wouldn’t you agree you could probably be working even though your doctor told you to stay off work for two to three weeks.” If you find yourself confronted with this situation, you can simply tell the adjuster you are not going to agree or disagree with any of his or her characterizations. Also, if you do not believe the adjuster is being fair to you because of these type of forced questions, stop the statement. Giving a recorded statement is a courtesy and if the adjuster is going to abuse that courtesy then you have a right to stop or cancel the statement. NOTE: If you stop or cancel the recorded statement for whatever reason, send a written communication to the adjuster documenting why you felt it necessary to cancel or adjourn the statement. If you do not believe the adjuster was being fair or if he or she was rude and/or ugly, describe the adjuster’s behavior in detail.

NUMBER FIVE: A few last things to consider. 1) While the adjuster’s main job in a recorded statement is to gather information related to the claim, he or she will also be gleaning notes for your “Claimant Profile.” Most major insurance companies now use some sort of “claimant profile” in the claims process. A claimant profile can be very detailed and complex or it can be something very simple but the main idea is to bring into the claims process some sort of general assessment about the personality and background of the claimant. We live in the information age and information is power. The more information about you an insurance company can gather the more accurate their profile of you will be. This profiling can be very complex and include personality traits, such as “likelihood to consult an attorney,” “easily discouraged,” “financially distressed, “ ”very anxious and impatient for claim resolution,”etc. The company will have also reviewed your past insurance claims history and may bring that into your claimant profile: “Past bodily injury litigant.” Your driving history will also be pulled in to your claimant profile. How you handle yourself during the recorded statement may also find it’s way into your claimant profile: “Claimant was polite and well spoken during statement. High credibility assigned.” So remember to be polite and courteous during the recorded statement. 2) Try to be understanding of the adjusters job and position. While most adjusters handle themselves in a professional and civil manner please remember because of continued cut-backs by insurance companies, most adjusters are overworked, underpaid and mostly unappreciated by their company. Sometimes the stress of their job is reflected in the way they communicate with claimants. So even if the adjuster is having a bad day, try not to react in-kind. Stay calm and polite. Finally, 3) if the insurance company sends you a transcript or digital recording of your statement, take time to review it as soon as possible. Send a written communication to the adjuster with any corrections. Also, if you think one of your responses may need further explanation or more details, make the additions in the written communication.

If you would like a free consultation with Mark (or any of our attorneys) about your insurance claim, please email him at mark@brwlawyers.com or send a text to 251 533-9548 (cell). You can also call Mark directly 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). 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.