Insurance Denials

Motorcycle v. Auto Collision

The client was operating his motorcycle safely on a public street when he was struck head-on by an automobile that drove onto his side of the road. He had numerous serious and life-threatening injuries but managed to survive with the help of excellent medical care.

The insurer of the automobile that struck the client had a $1 million policy in effect on the day of the collision. However, a few weeks after Attorney McMaster contacted the automobile insurer, it tried to claim that the policy had been canceled two days before the collision.

Attorney McMaster pursued a bad faith insurance practices claim against the insurance company to obtain compensation for his badly injured client. After a hard-fought battle, he proved that the insurance company had wrongfully denied his client’s claims and that they improperly canceled the policy. The claim settled for $2.4 million dollars.

This case is a good example that in order to successfully make a claim for an injured person, the attorney not only has to be experienced in personal injury law but needs to have the knowledge and experience to understand insurance policies. Many times, insurers will try to deny claims saying that, for one reason or another, the policy does not provide coverage for the injuries. It is then that an attorney experienced in “coverage issues” can separate the legitimate denials from the improper denials and hold the insurer accountable for those improper denials. This is the difference between obtaining compensation for your injuries and closing your case with no recovery because you and your inexperienced attorney assume the insurer is correct.

Environmental Claims on a Business Policy

The business was notified by the Massachusetts Department of Environmental Protection that pollution was found in the ground of the property in which it was conducting operations.  The business notified its insurer to have the policy cover the defense costs and the clean-up costs.  The insurer denied coverage for four years.  The client then brought on Attorney McMaster and an attorney from Illinois who handles pollution cases.  Together, the attorneys brought suit against the insurer and received a decision from the court that the policy did cover the costs.
The insurer then sought to dismiss the bad faith claims action brought against it and the matter was taken all the way to the Massachusetts Supreme Judicial Court. The client prevailed in an important decision when the Supreme Judicial Court stated that the insurer’s payment of out-of-pocket expenses did not invalidate the bad faith claim – an issue of first impression in Massachusetts.

See: Auto Flat Car Crushers, Inc. v. Hanover Insurance Company, 469 Mass 813 (2014)

Additional Policies Found for a
Client in an Automobile Collision

The client was a passenger in her grandmother’s car, which was being driven by the client’s cousin, when it was struck by another vehicle.  As a result of the crash, the client suffered a broken wrist that required surgery. There was no question that the driver of the other vehicle was primarily at fault but that vehicle only carried a $20,000 insurance policy. The client was told by her prior attorney that the $20,000 was the maximum she would be able to recover, and after payment of healthcare liens, nothing would be left.

The client came to Attorney John McMaster and requested that he look over the case to determine if there was any further coverage. The injuries she received kept her out of work and she wanted to be compensated for the financial loss she was suffering.  She worked in a physically demanding job and was not able to work with a broken wrist. After reviewing the case, Attorney McMaster found two additional policies totaling $100,000, and made a claim for those funds. That is, the automobile in which she was a passenger had a $50,000 policy, and her cousin’s mother had a policy with an additional $50,000 in coverage.

The insurer initially denied the claim stating that only the first driver was at fault. Eventually, all parties agreed to go to arbitration and the client was awarded the full $120,000.  This helped the client recover from the financial loss created when she could not work because of her injuries.

Compensation Recovered after a Denial by a Homeowner’s Insurer

A police officer was injured when a suspect resisted arrest. He broke his ankle and lost a great deal of time from work. Attorney McMaster brought a claim on behalf of the police officer against the suspect’s homeowner’s insurer for the injury. The insurer denied the claim. Attorney McMaster then filed a law suit against the suspect and then the insurer brought its own suit against the suspect to deny the claim. The insurer failed to defend the suspect and a default judgment was entered against the suspect for almost $100,000. Thereafter, the insurer won the suit that stated that its exclusion applied, and it should not have to pay the claim. The case was appealed to the Supreme Judicial Court which stated that, although the insurer was not contractually obligated to pay the claim, it was obligated to defend the suspect. Since it failed to defend the suspect, it was required to pay the default judgment, plus interest and attorney’s fees. The case was then settled through negotiation for $140,000.

See: Metropolitan Property & Casualty Insurance Company v. Morrison, 460 Mass. 352 (2011)