Medical Causation Often Overlooked in Personal Injury Claims

No matter the type of personal injury –  automobile accident claim, worker’s compensation claim, longshoreman’s claim, slip and fall claim, or product liability claim – an often overlooked legal issue is medical causation.  In any personal injury case, the burden is on the injured person to establish the incident/accident caused or was the contributing cause of the injury.  Said another way, proof that an injury “could have” or “possibly” resulted from an incident/accident does not meet an injured’s legal burden.  Instead, it is necessary the evidence reflect that the injury “more than likely” or “ to a reasonable degree of medical certainty” resulted from the incident/accident.  While typically this “test” requires the testimony of a doctor, the courts often look at the full context of all the lay and expert witnesses’ testimony before determining whether the injured person has met his/her burden.  This said, in a majority of personal injury cases in the southeast, testimony from the injured’s treating physician is often sought to satisfy the medical causation “test.”  As a consequence, it is important, if not critical, for the injured person to be patient and forthright with his/her treating physician.  Additionally, it is important to explain the mechanism of injury to the doctor early on so that the provider’s records provide a date certain the incident/accident causing the injury occurred.

Insurance Claims: Five Tips for Giving an Effective Recorded Statement

READ THIS BEFORE YOU GIVE A RECORDED STATEMENT TO AN INSURANCE ADJUSTER. The Boteler, Finley & Wolfe Insurance Guide for Recorded Statements is a four page publication that can be downloaded at no charge. It provides five tips for insurance claimants that will help you avoid common mistakes that can delay claim payment or even result in a claim being denied. Tips include why it is important to get a copy or transcript of the recorded statement, how to prepare for the recorded statement, how to respond and answer questions during the recorded statement and what not to do or say during a recorded statement. It also explains how adjusters sometimes use recorded statements to “profile” claimants and what you can do to help your “claimant profile.” At BF&W we understand that not every insurance claim requires a lawyer. However, we believe every person or business making an insurance claim needs to know their rights and understand the insurance claim process. That is why we offer more free insurance claim information material than any other law firm on the Gulf Coast area. We also believe a consultation early in the insurance claim process can be very beneficial to better understand what legal issues may be involved in a specific insurance claim. Consultations are free. Here is a list of free guides and resources available from the Boteler, Finley & Wolfe web site: Motor Vehicle Collisions: A Victim’s Handbook – Ala ed Motor Vehicle Accidents: Property Damage Claims – Ala ed Alabama Guide for Insurance Claims Insurance Claims: Guide for Effective Recorded Statements Medical Malpractice Laws in Alabama Alabama Law for Slip & Fall Claims Small Claims Court: A User’s Guide Alabama Guide for Life Insurance Claims 10 Tips for Locating Life Insurance Policies

Denied Life Insurance Benefits

IMPORTANT INFORMATION ABOUT LIFE INSURANCE CLAIMS© By: Mark Wolfe, Attorney at Law insurance_claim_form_424While most of us hope that a life insurance claim arising from the loss of a loved one will be a simple and hassle free process, the fact is many life insurance claims are wrongly denied. The denial of life insurance benefits 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 improperly.  [IMPORTANT: If you are a beneficiary of a denied life insurance claim, please read the last section on appealing the denial of life insurance benefits.] Why are so many legitimate life insurance claims denied? Most life insurance claims adjusters recognize that many life insurance claimants do not question or challenge a denial of life insurance benefits. This means that if there is a “close call” on whether or not benefits should be paid, they automatically opt for denial first in hopes the claimants will just “go away.” Insurance companies often use legalistic terminology in their denial of benefits letter and may also reference complex medical terms or conditions.  These type of denial of benefit letters are so well crafted they often discourage beneficiaries from seeking legal advice or consultations about the legitimacy of the denial.  Our experience in this area of law has shown there are two common areas of life insurance benefit denial. These are “material risk” and “accidental death.” Material risk as a  reason for denial of life insurance benefits.  Many times if a basic life insurance claim is denied, it is done so based upon a process known as “retroactive underwriting.” 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 effected the underwriting risk associated with issuing the policy.  In other words the insurance company must prove that “but for” the undisclosed medical information, they would not have issued the policy. The issue of “material risk” is a complex legal issue that is often debatable and framed by case law interpretation of that term and/or insurance regulations. The case law and regulations can vary from State to State. Read more here. Denial of accidental death or double indemnity life insurance 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. These type policies often have provisions or clauses that require the “accident” to be “the only cause of death without contribution from any other medical condition.”  They may also include vague activity restrictions at the time of death such as “strenuous or dangerous sporting events.”  Even when a death certificate lists cause of death as “accidental” many companies still try to use these vagaries in the policy to deny benefits.   BEFORE YOU FILE AN APPEAL OF A LIFE INSURANCE DENIAL. 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 denial of life insurance benefits. Yet many times claimants are unaware of the potential consequences of simply “appealing” the denial.  They send a quick letter back to the company saying, “I appeal the denial of life insurance benefits.” 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, the failure to comply with the appeal requirements can be extremely detrimental. In one extreme example a Federal Court determined that the claimant’s failure to submit any “new evidence” during the appeal process precluded the claimant from presenting that new evidence at trial. What You Need to Do. 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. Also, 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. About the author: Mark Wolfe is recognized as one one of the Most Qualified Attorneys for Injury Victims and Insurance Claimants. He has represented numerous families in Alabama and Mississippi regarding denied life insurance claims with a 90% success rate. If you have questions about a denied life insurance claim, call him today at 1 866 975-7766 or e-mail him at and put Life Insurance in the subject line. Consultations are free and all claims and cases are handled on a contingency fee, meaning no recovery, no attorney fees.   Required Disclaimers:

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).
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.
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.

Ten Tips for Locating Life Insurance Policies

by Mark Wolfe, Attorney at Law and Advocate for Insurance Claimants

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 decedent’s check book or bank statements looking for premium payments to a life insurance company.

2. Review the decedent’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.

8. If the decedent’s death was accidental and in conjunction with travel or a trip, check with the credit card company to see if it offered accidental death benefits for travel or trips paid for with the credit card.

9. Check with any Union, Trade Organization or Professional Association the decedent may have belonged to to see if they offered life insurance benefits to members and if the decedent had purchased a policy through the organization.

10. Use a policy search internet site. There are several internet sites that, for a fee, offer to search for life insurance policies.