A 39 year old Kentucky woman went to Lourdes Hospital in Paducah to undergo a hysterectomy. While there, her Ob-Gyn, Dr. David Grimes, recommended that she also have a tummy tuck. The procedure Dr. Grimes used was so rare that he is the only physician in the U.S. that performs it using that procedure. The injuries resulting from the surgery were severe and Ms. Daniels suffered a bowel obstruction and a permanent large abdominal wound. After the surgery Ms. Daniels was restricted to the lightest of activity as any moderate amount of activity could lead to a hernia. Since this first surgery, Ms. Daniels had to endure ten additional surgeries and remained on constant pain medications and has been unable to work. After filing suit, the plaintiff sent a settlement package and demanded the one million ($1,000,000) policy limit of the doctor with American Physicians Assurance Corporation (APA). Dr. Grimes filed for bankruptcy during this time and thus was not liable for any judgment in excess of his policy limit. Moreover, because of the bankruptcy, the insurance company was in complete control of authority to settle the case with Ms. Daniels.
The first medical witness APA obtained for this case indicated that after learning the facts of the case , she was appalled at the care Ms. Daniels received by Dr. Grimes and that his conduct was "inexcusable and indefensible." Through the course of discovery and up to mediation, while the Plaintiff's medicals totaled $380,000 and her lost wages totaled $890,000, APA's highest offer was $75,000. It wasn't until the eve of trial that APA paid $650,000 on the case with Daniels reserving the right to sue APA for bad faith.
Daniels filed a separate action against APA alleging bad faith on the part of the insurance company. She alleged that despite the low offers, APA internal documents valued the case at more than $1,000,000. Daniels also alleged that when APA's own witness expressed her opinion on the case, APA knew or should have known that the actions of their physician were not defensible and liability was reasonably clear. Tactics of the insurance company were also addressed, specifically providing incentives to its adjusters to reduce payouts and increase the number of cases that were tried to a jury. Also noted by Daniels was the goal of APA to have its adjusters cut her claims by $3,479,277. APA offered their adjuster incentives to meet this goal.
Daniels won at trial on several counts of insurance bad faith concerning APA's delay in settlement, misrepresentation of the policy coverage, APA's failure to adopt reasonable standards and failing to act in good faith to effectuate a settlement. As for damages, the jury awarded Ms. Daniels $205,000 for the difference in the value of her settlement plus $145,000 more for emotional distress. The award for punitive damages was $3,479,277, equal to the incentive goal for APA's adjuster.
Unfortunately, cases like Ms. Daniels are increasingly common. Insurance companies use a variety of tactics to reduce the amount they pay. See our blog entry Kentucky and Indiana Insurance "Bad Faith" Tactics to Be Aware of and Avoid for some of the most common bad faith tactics of insurance companies.
If you have been injured, an experienced personal injury attorney at Miller and Falkner can work to get the settlement you deserve from the insurance companies and protect you from their bad faith tactics. Contact us today.