Insurance denying lost wages and pain and suffering, but paying medical bills?
I sustained an injury to my left ankle while going up the stairs to see an apartment for cleaning by my company. The assistant property manager was taking me upstairs to see the apartment. He showed me some damaged stairs that were not fixed yet at the bottom.
As we were coming down, about midway, I was holding onto the hand rail while talking to him, and there was a damaged part nearer the top where my heel got stuck. The assistant manager asked me if I was alright, and at the time I said yes because my ankle had not started hurting yet.
Within the next hour the pain and swelling began, and I went back to the complex and told him yep, it twisted and I was injured, so he told me to go home, put it up and ice it.
Also, after an incident report was filed, they then went from the implied employment of working for them as a cleaning subcontractor, to saying I was "someone on our list for cleaners," so from that point on, I no longer had the opportunity to subcontract cleaning.
My question is this: the complex, after filing an incident report, started asking me for my medical bills. I turned them in, and finally spoke with their insurance company's claims adjuster.
He did his investigation and said they were not liable because the asst mgr showed me the damaged stairs at the bottom, even though my ankle was twisted more towards the top, where I did not realize there was stair damage. I was looking sideways talking to the assistant manager and holding on to the stairs at that moment.
The asst mgr told the adjuster an untrue version of what happened, and he used that to deny liability. However, they are paying the medical bills, but deny liability for my loss of wages and my pain and suffering.
Can they do that, or do I have any recourse for making the adjuster pay my other losses? If they're paying my medical bills, doesn't that mean they accept liability, and then should pay the other related costs, like lost wages and pain and suffering? Thank you for any perspective you can give on this situation.
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ANSWER for "Insurance denying lost wages and pain and suffering, but paying medical bills?":
Jenny (Vancouver, WA):
Under liability law you are considered an "invitee." An invitee is a person who is impliedly or overtly invited onto a premises by the owner (or his or her agents or employees) for the purpose of performing a business function. Clearly, you were such a person.
Invitees are to be distinguished from licensees. Licensees are persons overtly or impliedly invited onto the property not for business purposes, but rather for personal reasons. An example of a licensee is a guest in an apartment complex.
Whether a licensee or invitee, the owner of the premises has a legal "duty of care" to make sure the premises are safe for normal use.
In your case the stair was broken, resulting in your injury. The landlord's (owner's) failure to properly repair the step before you were injured constituted a breach of his or her legal duty of care. That breach resulted in your injury and resultant medical bills, out-of-pocket expenses, lost wages (if any), and pain and suffering.
Because your injury is considered a "soft tissue" injury the amount of pain and suffering you can expect to receive will not be substantial. Soft tissue injuries are normally sprains and strains to muscles, tendons, ligaments, minor bruising, and the like. If the insurance company continues to refuse compensation for lost wages and pain and suffering, meet with a personal injury attorney.
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,
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