Case Study Part III: The Wife

The wife’s case was a bit more difficult than the husband’s. Although she felt pain immediately in her neck and shoulder, she did not go to the emergency. When the pain increased the following day, she figured Advil and hot showers would be sufficient. After about two or three weeks, she decided that she should see a doctor. She contacted a local orthopedist and scheduled an appointment for the following week. The doctor noted pain in her neck and shoulder and diagnosed her with a sprain/strain and an impingement of her shoulder (inflammation in the rotator cuff of the shoulder). She underwent physical therapy, but did not improve quickly.

After treating about a month of physical therapy, the wife had a second accident. She was stopped in traffic and was rear ended. The property damage was not severe, but the wife was thrown forward and backward and suffered a worsening of her prior injury.

The wife went to the emergency room that night due to the pain and to the orthopedist the following day. The doctor confirmed that there was no new damage but that the second accident exacerbated the first. The wife required months of physical therapy.

Once the wife was better, the time came to send demand packages to the insurers. I obtained a written opinion from the treating orthopedist explaining which accident was responsible for which part of the wife’s injury. The wife was able to settle part of her claim initially, but I had file a lawsuit to force the insurance company to pay her for the second part of her injury.

As often happens with insurance companies, once the lawsuit was filed, they came to their senses and we were able to settle the case. The insurance company raised two major defenses against the wife. The easy one, was the second defense, that she had a second injury and that cut off any liability relating to the first accident. This was not in the wife’s control, she did not ask to be rear-ended. However, the first defense, and a very common defense used by insurance companies was that the wife did not seek treatment for the first injury until almost four weeks had passed and therefore she obviously was not really injured in the crash.

For non-life-threatening injuries many people do not go to the emergency room, but if you do not, the insurance company will conclude that you are not injured. Further, many people self treat for a week or have to wait over a week to get an appointment with a doctor. Again, the insurance companies cite these “gaps” in treatment or delays in treatment when denying claims. The wife should have gone to the emergency room and should have seen the orthopedist sooner. As a result, her case took a year longer than the husband’s. In the end, however, I obtained good results for both the husband and the wife.

By Craig I. Meyers, Esq.