Health Insurance and Accidental Injuries

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If you or a loved one has suffered an injury, whether from a car accident, slip and fall accident, or some other type of incident it is extremely beneficial for the accident victim that has their own health insurance coverage. Personal health insurance is helpful even if the negligent third party responsible for the injury will be ultimately covering your related medical bills.

With few exceptions the responsible party's insurance company will not be making any payments until the injury case comes to a final resolution. Consequently, having ones own medical coverage permits greater latitude in obtaining the necessary and appropriate medical care and provides a wider range of choices when it comes to medical providers for your injuries. Without personal insurance an accident or injury victim must rely on their attorney to locate the appropriate care for the victim. This may include not only doctor referrals, but referrals in the correct medical specialties in a convenient locale for the victim to undergo treatment for their accident related injuries. From time to time it is difficult to source such a health care provider, particularly if the victim is in need of surgery.

The most typical types of insurance that an attorney sees is either work related health insurance, and, or, any medical payments (med-pay) benefits under the victims own personal motor vehicle insurance policy, if a car accident related injury. In the case of personal or work related health insurance, the money that is paid out to settle the medical bills of the accident victim are typically reimbursable out of the proceeds of the third party injury settlement or award. This prevents the victim from a double recovery. Double recovery would mean that the victim's bills would be paid, and they would keep the award for those same bills. Obviously if there is no personal injury monies paid out by the negligent party then there is no duty to reimburse the health insurance for what they have paid out.

Often time's car owners have medical payments benefits ("med-pay") under their automobile insurance policy. Med-pay benefits require the automobile insurance company to pay reasonable and necessary medical bills for any of the injured occupants of the car up to the predesignated limits of the contracted benefits. In the past, many insurance companies did not have reimbursement clauses in their car insurance policies. Today most, but not all, car insurers have the right, per their contract of insurance, to reimbursement of monies paid out by them from the proceeds of the injury victim's third party settlement or award.

In most cases, the funds subjected to reimbursement are reduced by the same percentage as the victim paid in attorney's fees. In some cases the personal injury attorney may be able negotiate a greater reduction in the reimbursement amount. It is important to consider the benefit reimbursement issue when calculating what the net settlement that may be received by the injury client. An experienced personal injury lawyer can best advise their client on all matters surrounding insurance issues and the reimbursement issue.

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Looking Through the MIST - Minor Impact Soft Tissue Injury

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As a personal injury attorney in California I, or an attorney anywhere else for that matter can tell you, low impact cases resulting in soft tissue types of injuries, including whiplash, are specifically "red flagged" by the insurance industry as cases meriting special attention. Such cases have been labeled by the code word "MIST", short for Minor Impact Soft Tissue injury. The idea behind the "MIST" injury originated with insurance companies to allow for lower pay outs for claims resulting in little or no damage to the vehicles involved in an auto accident, and to also permit the insurance companies to pay less for injury claims that cannot be easily seen by the naked eye.

MIST cases are typically denied in their entirety by the defendant's insurance company. If the MIST claims are not denied categorically, the defendant's insurance company will often make an extremely low offer to settle, often not enough to even cover all the related injury expenses. This holds true even in cases where the defendant is clearly at fault in the accident. What can be even more frustrating is the fact that often, fault is admitted by the defendant in the accident. The insurance companies simply state that these "low ball" settlement offers are in keeping with what they see jury verdicts rendering in these kinds of related personal injury cases. As a result of the difficulty in litigating MIST injuries, many personal injury attorneys will no longer accept auto accident cases involving low property damage to a vehicle when the injury involved is a soft tissue injury.

The difficulty of litigating soft tissue injuries creates a quandary, leaving an auto accident victim with only two options: accepting the insurance company settlement offer or proceeding to take the defendant to court. Although one does not have to accept an insurance company settlement offer, there are a several facts to keep in mind during the decision making process. The first thing to remember is that going to court involves a substantial commitment of time for both the representing attorney and the recovering client. The second idea to consider is that bringing a case to trial and ultimately through to a verdict is often costly in terms of the expenses required to so, including but not limited to the costs of specialists, medical experts, and accident re-constructionists. Thirdly, it must also be noted that litigation can be risky and that there are absolutely no guarantees as to a successful result. It is up to the client to request their personal injury attorney to proceed through a cost-benefit analysis to determine if the case can be successfully litigated in a cost effective manner.

For victims of MIST injuries, it is important to engage in an active discussion about the possible outcomes of the options comprising soft tissue litigation. It is also important that one question their attorney about the bottom line when obtaining advice for an appropriate course of action to best resolve the soft tissue injury case.

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Do You Have a Case? Facts and FAQ's About Premises Liability

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In California, if you are injured on someone else's property, and your injury resulted from an unsafe condition, you may have a legal claim against the property owner. Here are some FAQ's about California premises liability and your rights under state law.

What kinds of property are covered by California law?

Property includes stores, parking lots, and other commercial buildings and their surrounds. It also includes job sites, including constructions sites, and land and buildings owned or controlled by municipal entities such as cities and towns, water districts, and the state itself.

What does the law require of property owners?

The person who owns or controls a property has a duty under the law to maintain that property in a safe condition for anyone who enters the property, including visitors, customers, suppliers, contractors and other tradespeople, and workers.

What kinds of unsafe conditions are covered?

The property owner is responsible for unsafe conditions that the owner created or allowed to develop. Examples would be broken pavement that made a walkway unsafe, an unsafe elevator that is not repaired, a failure to keep stairwells properly lit, or a spill that was not cleaned up. Property owners or their designated representatives are expected to show reasonable diligence in inspecting property for hazards, and seeing that they are resolved.

Are unsafe conditions on job sites covered?

The California Occupational Safety and Health Act of 1973 is very clear about employers' obligation to assure that employees have a safe and healthful workplace. This would include maintaining halls and stairwells in the workplace free of hazards, installation and use of safety equipment on machinery and provision of appropriate safety equipment for workers.

Are there other kinds of unsafe conditions?

Here is a list of additional conditions that frequently lead to injuries:

Trash or debris left where it can be a hazard
Broken or missing railings
Broken steps
Exposed electric wires
A hole left uncovered, and without warning signage
Failure to install smoke alarms, or smoke alarms not working >
Lack of security lighting, or lighting not working
Emergency exits not marked, or locked during working hours
Hazardous materials not stored safely.
Vehicles, tools, and other potentially dangerous objects not stored securely
Warning about worksite hazards absent or inadequate

What can I do if unsafe conditions on someone else's property caused my injury?

If you have been seriously injured because of unsafe conditions, you may have a claim against the person or entity that controls the property. You should consult as soon as possible with an experienced premises liability lawyer, who can help you determine how to proceed?

Why do I need to act as soon as possible?

If there is any question of negligence, it is critical to talk to witnesses while their memories are fresh, and to gather evidence before it is destroyed or lost. Moving quickly on your concern can improve your prospects of a successful resolution.

How do expert witnesses get involved in premises liability lawsuits?

An experienced premises liability lawyer may work with safety experts, including safety engineers who can testify about safety standards and legal requirement and point out the ways that a property owner failed to meet those requirements.

Lawsuits can be expensive. How can I pay for my case?

Premises liability lawyers usually work out a contingent fee agreement. This means that the lawyer will be paid only if the client's case is resolved successfully, either by a negotiated settlement with the property owner, or if this is not possible, by a court case resulting in a judgment in favor of the claimant. The lawyer's fee is an agreed-on percentage of the settlement. A contingent fee arrangement is helpful for many people, because the person who has been injured does not have to front any money for the cost of filing, depositions, expert witness fees and other costs of prosecuting an expensive lawsuit.

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California Boat Accident - Case Study - Boat Hits Water Skier

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If you or a family member are seriously injured in a boating accident in California, then it is important for you to understand how maritime law operates. This article is a case study of a vessel collision between a small inflatable power boat and a water ski boat that illustrates boat accident law.

A maritime legal analysis is performed in order to illustrate boat accident negligence and vessel collision legal principals. This is a recreational boating accident in California.

A Case Study - A Boat Accident on Mission Bay

Picture this, a typically beautiful chamber of commerce weekend on Mission Bay in San Diego. It's Saturday morning at the beginning of spring, so the water park is busy, but not the zoo it will be in a few hours.

A ski boat is slowly towing a young girl and is going in the proper counter-clockwise rotation flow of traffic. As is usually the case in recreational boat accidents, a day of pleasure quickly turns to danger and danger in turn quickly turns to disaster.

A small inflatable power boat pops up from behind an anchored luxury yacht. The inflatable boat is going the wrong way. That is, clockwise, against the flow of traffic. Further, the inflatable boat is going way too fast. The ski boat driver takes the proper evasive maneuver to starboard and turns the ski boat in order to pass the inflatable boat port to port.

After passing the ski boat the inflatable boat driver takes a radical turn to port - - apparently in an effort to try and "catch air" over the ski boat's wake. The young girl's skis go under the inflatable boat, launching her and slamming her into the inflatable boat's engine, seriously injuring both of her legs and right arm.

Maritime Law Analysis: Rules of the Road Violations:

Federal Navigational Rules are also referred to as "Rules of the Road." The following is a thumbnail analysis of the Rules of the Road violations presented in this Case Study.

The young girl has a strong liability case against the operator of the inflatable boat. The inflatable boat operator is in violation of the following Navigational Rules:

Rule 5 - - Lookout

The vessel failed to keep a proper look-out.

Rule 6 - - Safe Speed

The vessel proceeded at a speed too fast for the conditions.

Rule 10 - - Traffic Separation Schemes

The vessel failed to proceed in the appropriate traffic lane in the general direction of traffic flow for that lane.

Rule 18 - - Responsibilities between Vessels

The vessel failed to keep out of the way of a vessel restricted in her ability to maneuver.

Defeating the Limitation Action

The inflatable boat was launched from the luxury yacht and is owned by the yacht owner. The yacht owner filed a Limitation of Liability Action in Federal District Court. The Limitation Action was defeated because the yacht owner was deemed to have privity and knowledge of the inflatable boat driver being up partying hard the night before and drinking 2 hours before the collision. The inflatable boat driver blew a.09 on the Breathalyzer and was booked by the San Diego Police for boating while under the influence.

Applying the Pennsylvania Rule

Under maritime law, when a vessel violates one of the Rules of the Road the burden rests upon the violating vessel to show not merely that their fault might not have been one of the causes, or that it probably was not, but that it could not have been. This is called the Pennsylvania Rule, or as I like to call it, "Check Mate." The Pennsylvania Rule is used to establish liability for boat collisions. Used properly, the Rule is a powerful weapon in boat collision lawsuits.

Case Result:

The insurance company for the yacht / inflatable power boat owner paid a high six figure settlement to the Guardian ad Litem of the young girl.

Disclaimer:

The foregoing is a California boat accident case study. It is not legal advice. Any resemblance to actual events, persons and/or vessels is purely coincidental. I am simplistic in order to achieve clarity. Each boat accident case is different and has separate challenges, difficulties and/or nuances. There is no guarantee that your boating accident case will have a similar result as discussed in this vessel collision case study.

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