Can a Negligent Insurance Company Be Held Responsible for a Chronically Ill Patient's Condition?

by Elda
(Willingboro, New Jersey)

On August 28, 2012, my house had severe damage to the roof and interior, and the basement was flooded, damaging the heating system and the 40 gallon water heater. I called my homeowner's insurance company the following Sunday to report the damage. I received a claim number and was told that an adjuster would come to the house within 24 hours.

After that call I called FEMA to report the flooded basement because since I did not have flood insurance, I was told by the State to get assistance from FEMA for the replacement of the heating system and the 40-gallon water heater.

When my insurance company's adjuster did not come or call after 4 days, I called back and was told that he would call soon. During this time the FEMA adjuster did come and was troubled by the thought that my insurance company was dropping the ball with my case. He took all the information and tried to contact the adjuster. When the adjuster finally called, he stated he lived too far and was not coming.

So my contractor placed a cover on the roof and took pictures of everything. To make a long story short, my insurance company knew I was been taken care of by a nurses aid at the house 4 hours everyday, due to a heart condition caused by RA and Lupus.

FEMA, the contractor and myself had completed all of the documents for repairs and when they tried to get the necessary documents from my insurance company they gave everybody the run around, just saying "the documents are in the mail."

This went on for months, the stress caused my heart to weaken and my treatments stopped working. Several times I came close to dying, literary. In January, FEMA denied my case because my insurance company kept sending the wrong documents. When I spoke with management in FEMA, they found out I had done everything in my power to get my insurance to turn in the correct documents. So FEMA reopened my case and is now dealing with my contractor to get the systems replaced.

But in a meeting with my Cardiologist, he informed me that all of the stress and extra activities have weakened my heart and now I have to be checked weekly by a Cardio Nurse at home and use an oxygen machine for bedtime. I stop breathing during the night more than 5 times an hour and I tend to faint two to three times daily.

What happens in a case like this, when an insurance company continues making mistakes and causes a chronically ill patient to end up in the hospital ICU 3 times due to a weakened heart? Is there anything I can do to get compensated for this negligence on the part of my insurance company? Thank you.

Visitor Question:
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ANSWER for "Can a Negligent Insurance Company Be Held Responsible for a Chronically Ill Patient's Condition?":

Elda (Willingboro, New Jersey):

Your trauma seems perfectly understandable. Dealing with insurance companies can sometimes be so frustrating as to cause great anxiety and related illnesses.

Instead of attempting to prove the insurance company's actions, or in your case inactions, were a "direct and proximate" cause of your illness, your best interests might be better served by considering filing a lawsuit against the insurance company for "bad faith dealings" with you.

Bad faith lawsuits and the court awards sometimes rendered on behalf of plaintiffs like yourself can include compensation not only for the actual damages you might be able to prove, but for "punitive damages" as well. Punitive damages are a jury's way of telling the insurance company they behaved badly, and as a result should be "punished" - hence the word punitive.

There is usually no limit to the amount of money a jury can award a plaintiff in punitive damages. Jury awards have often been in the hundreds of thousands of dollars for some cases.

The difficulty you may have will be in proving to a jury the manner in which the insurance company's actions actually caused or exacerbated your illness. That is going to take specific and credible medical testimony from the physician or physicians who have treated you for the debilitation you say the insurance company caused. You can be confident getting your physicians to testify to those facts will be very, very difficult.

Call the local bar association and see if they can refer you to civil trial lawyers in your area. You want to find several who have experience with insurance bad faith cases.

It is possible one of these attorneys may accept your case on a contingency basis, meaning you won't have to pay any fees until such time as the attorney either settles your case or wins at trial.

Most of these attorneys will not charge a fee for an initial office consultation. So don't be frustrated if you call these attorneys and they won't discuss your case on the telephone. They aren't able to do that with every prospective client; if they did, they would be on the phone all day, not being able to either work or visit in their office with clients.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.

Best of luck,

Judge Calisi

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