December 26, 2007
The family of Milena Del Valle, a passenger killed in the Big Dig Tunnel in Boston, Massachusetts, settled for 6 million dollars yesterday from one of the defendants in a wrongful death suit filed against 17 defendants.
While riding as a passenger with her husband in the tunnel, Del Valle was killed when 3 3-4 ton ceiling panels gave way overhead, falling and crushing her.Her husband escaped through the window of his sedan.
October 29, 2007
Recently, the Georgia Court of Appeals reversed a grant of summary judgment to the defendant in an interesting case involving the use of a cell phone by an employee enroute to work.In Hunter vs. Modern Continental Construction Company, the employee shift supervisor was enroute to work when he was involved in a car accident with the plaintiff.Plaintiff sought to bring her lawsuit against not only the driver/supervisor, but his employer as well.
The employer moved for summary judgment (a dismissal of the case before it gets to trial) on the basis of established case law that driving to and from work is an act for the employee’s own purposes and not in pursuit of the employer’s business.
October 16, 2007
When a drunk driver causes an accident and someone is injured, the drunk driver may be liable for more than just the plaintiff’s injuries and property damage. Georgia juries are allowed to “fine” the defendant by awarding punitive damages. Punitive damages not only punish the defendant for his or her egregious conduct, but they are also intended to discourage this type of behavior in the future.
Last year in Georgia over four hundred automobile accident fatalites were the result of drunk drivers. Drunk driving fatalities accounted for over twenty-seven percent of all the accident fatalities. Moreover, last year drunk driving fatalities increased over seven percent from the year 2005. In Georgia, a driver is considered to be driving under the influence of alcohol if his blood alcohol content (BAC) registers .08 or above.
Commonly, insurance policies include an endorsement which provides the insurer “will pay reasonable expenses incurred for necessary medical and funeral services because of bodily injury caused by accident and sustained by an ‘insured.’”Medical payments coverage for car accidents is optional under Georgia insurance policies and is available to the insured regardless of fault.These endorsements typically provide for recovery up to a certain amount for a certain amount of time, generally three years.Furthermore, the insurance carrier must pay benefits within sixty days of the demand by the insured who has suffered a personal injury in a car accident.
The question of who is covered under a medical payments endorsement for medical bills incurred due to a personal injury in a car accident is set out by statute.OCGA § 33-34-2(1) provides: “Coverage shall be available to the named insured, resident spouse, and any resident relative while occupying the covered motor vehicle, and to any other person legally occupying a covered motor vehicle.”
Individuals injured in automobile accidents should look to their health insurance carrier for payment of their medical bills first, as coverage is provided under contract with the health insurance carrier.The injured should then look to the medical payments carrier which will pay funds directly to the injured party and will reimburse the injured insured for any out of pocket expenses not paid by the injured insured’s health insurance carrier.It is important to remember that most automobile policies contain notice provisions which will also apply to medical payments coverage and in all cases, the injured insured should notify their own insurance carrier as soon as possible.
In 2001, auto accident injury victims received what was thought to be good news from the U.S. Supreme Court in Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002). In Knudson, the Plaintiff was injured in an auto accident. Her medical bills related to injuries sustained in the auto accident were paid by her ERISA health insurance plan. Upon settlement, the settlement proceeds were paid into a special needs trust. The Plaintiff’s ERISA plan attempted to obtain reimbursement directly from the Plaintiff for the medical bills the health insurance carrier paid for treatment related to the auto accident injuries. The Knudson Court ruled that the plan had no right to reimbursement since such payments would constitute enforcement of a legal remedy, something not allowed under ERISA.
However, through Sereboff v. Mid Atlantic Medical Services, 547 U.S. 1015, 126 S.Ct. 1869 (2006) and its progeny, the Supreme Court illuminated the fact that the Court will not interpret every plan as seeking a prohibited legal remedy. The Court will look to the plan language on a case by case basis to determine whether the plan creates an equitable remedy – specifically, whether a fund has been specifically identified by the plan language, and if so, to what part of the fund the plan will be entitled to recover reimbursement. The plan’s right to reimbursement will fail if the plan itself fails to create a lien by agreement, by “specifically identifyi[ng] a particular fund, distinct from [the plan beneficiaries’] general assets. . . and a particular share of that fund to which [the plan] was entitled.”
Georgia Injury Law Blog