Healthcare is expensive. And if you have been in a car accident in Montgomery, you understand how stressful it can be to be forced to pay for injuries you sustained because of the fault of someone else.
Our team of experienced Montgomery injury attorneys can help you understand your rights and give you the guidance and support in your case.
Armisted v. State Farm is a recent Sixth Circuit personal injury case that explains the law surrounding no-fault benefits. This case involves a joint action by plaintiffs who were seriously injured in separate actions. They sued their no-fault insurance company, State Farm, alleging that State Farm had improperly decreased the amount of monthly benefits they were entitled to.
The six collective plaintiffs were involved in separate car accidents, and did not have their initial negotiations together. These plaintiffs all suffered catastrophic traumatic brain injuries as a result of their car accidents. These injuries left the plaintiffs home bound with the alleged necessity of in-home care. At differing times, plaintiffs all signed settlement agreements with State Farm where State Farm agreed to pay a specific amount for a specified time that the plaintiffs would receive home attendant care service. Although the hourly cost State Farm was paying was very high, State Farm completed its payment obligations to each plaintiff for the duration of their agreement.
Once the definite period was over, State Farm felt the amount they were paying was excessive so they conducted a market survey regarding costs of home attendant care. Upon finding that they were paying excessive plaintiff benefits, State Farm lowered the amount they were paying. Plaintiffs then sued State Farm asking the court to make State Farm pay the original amount agreed to in the settlement offer.
State Farm was not obligated to pay that high amount after the duration originally specified. Thus State Farm asked plaintiffs to provide them with evidence of the amount being paid for this home service and explained it would compensate plaintiffs for the exact amount that the home care was costing.
An insurance company needs evidence of the nature and extent of any policyholder’s injuries before it can continue to pay benefits. Also, an insurance company is only responsible for paying what is reasonable for the costs of healthcare and medical aid. For these reasons, State Farm was not justified in paying the higher rate of benefits.
State Farm asked for documentary evidence from the plaintiffs; however, upon advice from their respective attorneys, plaintiffs would not provide any proof of the cost of in home service or even proof that they were receiving this service at all.
The court in this case explains the applicable law. In determining whether expenses are allowable and covered by the laws governing no-fault statutes, the jury is responsible for evaluating the evidence and making a determination. Plaintiffs hold the burden of proving the medical conditions and treatment to support their entitlement to no-fault benefits. The benefits are not determined at the time of the injury, but at the time that the medical service was performed. In order to receive no-fault benefits a plaintiff must prove that they actually received medical care, the amount of the care was reasonable, and that the medical services and expenses were reasonably necessary.
It was emphasized that the present societal norm is that payment for services is reliant on documentation surrounding the rendered services. Because the plaintiffs failed to provide proof of this in home care, the court found in favor of State Farm.
If you have been injured contact Alabama Injury Attorneys at Allred & Allred, P.C. to schedule a free appointment. Call 334.396.9200.
Armisted, et al. v. State Farm Mutual Automobile Insurance Company, No. 09-2055/2113 (6th Cir. Apr. 12, 2012).