Tag Archives: insurance settlement

Timely Payment of Claims

There are a ton of laws.  That may be the biggest understatement I’ve ever written.

I mention this because it’s a reason to hire an attorney.  How many people have heard of the “Timely Payment of Claims” Statute.  It’s Section 628.46 of Wisconsin’s Statutes.  It applies to first party insurance payments and also third party insurance payments.  So, if you are injured by someone without insurance and you file an uninsured motorist claim this statute applies.   Because of the “recent” Kontowicz case it applies to claims against an at fault insurance company also.

Attorneys for injured people can push insurance companies to review and make offers to settle cases within 30 days of receiving all of the documents related to an injury.  If the insurance company drags its feet it may be subject to 12% interest.  Or, if the insurance company agrees to that a portion of an injury is definitely related to an accident that insurance company, under the statute, should pay the undisputed amount asap.

For your information the statutes says:

(1) Unless otherwise provided by law, an insurer shall promptly pay every insurance claim. A claim shall be overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of the loss. If such written notice is not furnished to the insurer as to the entire claim, any partial amount supported by written notice is overdue if not paid within 30 days after such written notice is furnished to the insurer. Any part or all of the remainder of the claim that is subsequently supported by written notice is overdue if not paid within 30 days after written notice is furnished to the insurer. Any payment shall not be deemed overdue when the insurer has reasonable proof to establish that the insurer is not responsible for the payment, notwithstanding that written notice has been furnished to the insurer… All overdue payments shall bear simple interest at the rate of 12% per year.

Who Is Looking?

What happens if a medical facility releases your medical records to the general public?  What happens if an insurance company releases medical records to the general public?

Well, according to Section 146.84 Wisconsin Statutes that facility or person may be liable for tens of thousands of dollars in addition to actual damages and ACTUAL attorneys fees.  Believe me, that can be a lot of money.

I found an article from a few years ago written by a couple Michael, Best and Friedrich attorneys concerning this issue.  I hope it will continue to be available.    Finerty and Barlament state:

This statute may apply to entities other than health care entities. The statute’s penalty provisions for example, Wis. Stat. § 146.84, apply to “[a]ny person, including the state or any political subdivision of the state” who violates Wis. Stat. § 146.82 or 146.83. Wis. Stat. § 146.84(1)(b), (bm). Similarly, penalties (including a fine of up to $25,000 and up to 9 months in prison) can be applied to “[w]hoever” obtains certain confidential information under false pretenses or with knowledge that the disclosure is unlawful and not reasonably necessary to protect another from harm. Wis. Stat. § 146.84(2)(a).

I was thinking about this after a client asked me what protection she/he has when medical records are released to an at-fault insurance provider.  In all honesty the liability of the company who discloses to the public certain records depends on the authorization that was signed and the particular facts of the release of those records.  But, if a company or hospital releases records improperly at least this statute exists as a pretty significant penalty.

Take The Time To Read Your Policy

John Bryan a West Virginia Car Accident Attorney recently wrote about the effect of your personal auto policy on a rental car.  In short, he reminds everyone that just because you have auto insurance this does not mean your policy will cover you when you rent a vehicle.

Many of the policies out there cover rental cars being driven if their primary vehicle has broken-down or is otherwise being worked-on or out of commission.  However, many of those same policies do not cover rental cars being driven if the policyholder’s primary vehicle is operational – for instance if you rent a car while on vacation.  This means that if you choose not to purchase the insurance on the rental car and you are involved in an accident, you may be liable to the rental car company for the complete property damage to the rental car.  This is because you will be signing a contract with the rental car company agreeing to pay for any property damage that is not covered by insurance.

Before you rent a vehicle make sure you’ve read your auto insurance policy to see whether you have coverage.  Believe me, the last thing you want is to be driving around without any car insurance.

Update on Crazy Loophole

I just blogged about this crazy loophole that Great American Insurance Company is trying to use to get out of paying for a number of wrongful deaths.

The Houston Chronicle’s Lisa Falkenberg wrote an opinion piece about this loophole:

Earlier this week, the Houston Chronicle’s Mary Flood reported that the Cincinnati-based insurer asked a federal court judge to help it avoid a potential $25 million liability in a Houston office fire last year that killed three people. Vocational nurse Misty Ann Weaver lit the fire to hide the fact that she hadn’t met a paperwork deadline.

Now Great American officials are trying to hide from responsibility in the deaths, which isn’t as shocking as the legal argument they’re trying to employ.

Families of the fire victims shouldn’t be compensated for their losses since the deaths were caused by smoke inhalation instead of actual flames, the company argued in a federal court brief.

I can see why the insurance company is trying to avoid paying based on this loophole.  They’ll save a ton of money.  Lisa did a little investigation:

And “fire, lightning and debris removal” were the No. 1 causes for homeowners’ insured losses nationwide at nearly 35 percent in 2006, the most recent year for which statistics were available from the New York-based Insurance Information Institute.

For the sake of the family of the victims I hope Great American Insurance doesn’t win.  Talk about adding insult to injury.

Jon Groth is a Wisconsin Personal Injury Attorney handling cases throughout Wisconsin and most recently in Fond du lac, West Bend, Kenosha and Wauwatosa.

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Crazy Loophole

Does this strike anyone else as outrageous? 

 An insurance company has asked a federal judge to dismiss it from several lawsuits arising from a 2007 office fire because smoke that killed occupants should be considered “pollution,” something not covered by its policy. Great American Insurance Company argues that its policy includes specific exclusions for certain types of pollution including smoke, fumes and soot. The insurer potentially faces $25 million in liability from the fire.  Mary Flood, Houston Chronicle  

Jon Groth is a Wisconsin Personal Injury Attorney handling cases throughout Wisconsin and most recently in West AllisSheboygan,  Plymouth,  and  Germantown.

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