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As Reported In:

WylieLaw Client v. Allstate Insurance Company

Causes of Action

Breach of Contract - Wrongful Denial of No-Fault Insurance Claim

Recovery

$87,819.43

   

Court

United States District Court, Eastern District of New York

Judge

Honorable Judge Frederic Bloc

Mediator

Honorable Irwin Kahn


Description

A WylieLaw Client was driving her three children when her vehicle was struck by a vehicle that had proceeded through a stop sign. The client filed a no-fault claim for medical benefits with her insurance carrier, Allstate.

Allstate attempted to schedule an early assessment evaluation for the WylieLaw Client a few weeks after the accident. WylieLaw lobbied the Allstate adjusters, supervisors and office managers in order to have them accommodate the client's serious injuries and avoid an early medical exam. WylieLaw also informed Allstate that their notice of the early appointment was not sent to the correct address and that the WylieLaw Client would attend a conveniently scheduled evaluation.

Allstate unilaterally set another examination date, which the WylieLaw Client could not attend as it coincided with another medical appointment she had with her surgeon. Allstate then denied the WylieLaw Client's no-fault claim in total on the premise that she had missed two no-fault examinations. The denial led to a 2-1/2 year delay in her treatment. Although the WylieLaw Client was able to have surgery on her shoulder in a timely fashion, due to this no-fault denial, she was unable to have a second needed surgery, on her knee, for 2-1/2 years.

Allstate's summary judgment motion successfully defeated the GBL §349 claim. However, the Honorable Judge Frederic Block did not dismiss the breach of contract claim and held that the WylieLaw Client could collect extra-contractual damages in excess of the $50,000 no-fault policy limit, provided that she could prove her damages exceeded $50,000.

In a separate no-fault benefits arbitration, which had been filed by one of the WylieLaw Client's medical providers, an arbitrator found that Allstate's no-fault benefits denial was wrongful and ordered Allstate to pay the WylieLaw Client's provider for her treatment. WylieLaw then sought a pre-motion conference to have the breach of contract issue granted in the client's favor. In conference, the Honorable Judge Frederic Block offered verbal assurances that the motion, when made, would be granted in the client's favor and against Allstate. He stated that the breach of contract was no longer an issue and ordered both parties to participate in mediation.


Injuries

The WylieLaw Client sustained a torn medial and lateral menisci of her right knee; a torn right rotator cuff; herniated discs at C5-6, C6-7 and L5-S1 and multiple bulging discs. She underwent a surgical procedure to her right should and a surgical procedure to her right knee two years later.

Experts

Plaintiff's Experts:

Dr. Jerome Greenberg, D.C.
Richard Bachrach, President, The Bachrach Group, Executive Recruiters

Result

The matter settled for $87,819 at mediation, which was held within the Eastern District Federal Mediation Program. The settlement was unique as it was in excess of the applicable no-fault policy limits.

WylieLaw Client also recovered the full $25,000 policy from the other driver's insurer.