Brent Adams & Associates Legal Blog

Suit Claims Insurance Company Canceled Policy After Woman's Costly Surgery

A man from Madison County, Illinois has filed suit against his former insurance provider, claiming that the company canceled his insurance after his wife underwent a costly surgical procedure.

According to Dale Warner, he was insured by Group Health Plan, Inc., a Coventry Health Care Plan, when his wife, who was also insured through his plan, sought pre-certification for a medical procedure she intended to have performed in August 2008.

According to the complaint Werner filed on August 19 in Madison County Circuit Court, he called Group Health Plan in July 2008, at the same time his wife was seeking pre-certification, to inquire about his premium payment.

The suit claims that Group Health Plan approved Werner’s wife’s pre-certification and informed him that he had no premium due and, in fact, had a credit balance in his favor.

The suit says Werner’s wife then underwent the costly procedure, based upon said reliance.

However, after Werner’s wife underwent the procedure, Group Health Plan canceled his insurance on the basis of his alleged non-payment of which he was unaware. The company refused to reinstate the policy and refused to pay the remaining medical claims for the surgery.

The suit says Group Health Plan also asked Warner to pay for bills it had already paid following the surgery.

Werner claims that due to Group Health Plan’s actions, his credit scoring has been degraded, which could affect his future ability to obtain credit, and he incurred costs and expenses related to missed days from work, telephone calls, and legal costs.

Suit Filed Against Insurance Company Over Apartment Explosion

Tenants who suffered personal injuries in an apartment explosion two years ago and the administrator of a deceased tenant’s estate are seeking declaratory judgment against an insurance company.

According to the suit filed in Illinois’ St. Clair County Circuit Court on May 13 by Michael Stifle, Roger Osborn, and Tammy Wood, on behalf of Harry Yargus, Church Mutual Insurance Co. has refused to provide liability coverage for an incident that occurred at an apartment building on May 29, 2007.

The suit says that a gas explosion and subsequent fire occurred at the apartment building. Stifle and Osborn suffered injuries in the incident and have pending injury suits in Crawford County. Yargus died in the incident and Wood, on his behalf, has a pending case in St. Clair County.

According to the plaintiffs, the insurance company has two liability policies, each with limits of $1 million.

The suit has also named Five Star Management, A.J. Mason, Inc. and Rena Smith, the property manager, as defendants.

The suit claims the insurance company is contractually obligated to indemnify the other defendants in their capacities of maintaining and managing the building.

Man Files Suit Against All State After Crash

A man has filed suit against Allstate County Mutual Insurance Co., claiming the company refused to pay for the personal injuries he suffered in an auto wreck.

According to the suit filed on March 27 in Texas’ Jefferson County District Court, Darrik Reynolds was injured in a November 15, 2007 collision with Ernest Lee Hicks II, who failed to yield right-of-way at an intersection.

The suit says that Hicks’ vehicle “suddenly and unexpectedly” collided with the front of Reynolds’ vehicle, causing it and the trailer it was pulling to jackknife and the boat on the trailer to fall off.

Reynolds claims the collision caused him to suffer severe and permanent back injuries and incur medical expenses.

The suit says that at the time of the crash, Reynolds was insured by Allstate.

Reynolds says that before he filed a claim with Allstate, he tried to file suit against Hicks. However, he discovered that Hicks had no insurance coverage.

Reynolds then filed a claim for his uninsured motorist protection benefits However, the suit says that Allstate has failed to respond.

Reynolds seeks unspecified damages.

Wrongful Death Claim on Behalf of EMS Personnel Settled by County

Wrongful Death Claim on Behalf of EMS Personnel Settled by County

The wife of a young man who suffered from an asthma attack and died while under the care of the defendants claimed that her husband died as a result of carelessness on the part of the EMS workers. The defendants to pay $1,750,000.00 for the death of the man.

The plaintiff’s husband of eight days was a 37- year-old loan officer earning $41,000.00 a year. On May 7, 2006, his wife called 911 because he was suffering an asthma attack at their home. When the EMS workers arrived he was in respiratory distress. The EMS workers continued providing medical assistance to him for almost an hour. He was then transported to the hospital by ambulance, where he was pronounced dead.

The plaintiff claimed that the defendant EMS workers did not follow proper procedures such as failing to provide inhalation therapy, epinephrine or continual positive airway pressure. The plaintiff also contends that an IV line that had been established and dislodged was not replaced in a timely manner.

Although the victim lived only eight miles from the hospital, the EMS workers provided assistance at his home for nearly an hour before taking him to the hospital.

The plaintiff indicated her husband had suffered a heart attack while the EMS workers were working on him and they failed to use a defibrillator that was kept in the ambulance.  The plaintiff contends that the delay in treatment resulted in her husband’s death.

Two Saved From Fiery Crash

Gary Wright saw the smoldering car at the entrance to the I-95 rest stop. He quickley stopped and ran to help. Something was blocking the rear passenger door where Nina Milton sat unconscious.

Wright said he and three other passers-by removed the obstruction and  opened the door and got her out.

Nancy Milton, who had been sitting in the front seat of the vehicle, was already out  by the time help arrived. Because of the thick smoke, Wright didn’t realize Mrs. Milton's husband, Earnest, was trapped behind the wheel and a smoldering dashboard.

Mrs. Milton was pleading for someone to remove her husband.

Wright and another motorist, that had stopped to help, were finally able to remove him from the car. Moments later, flames engulfed the car’s interior.

Trooper Steven Spivey of the Highway Patrol says Earnest Milton, who is 81, his wife, Nancy, and his sister, Nina, were traveling south when the crash occurred.  Mr. Milton was attempting to turn into the I-95 rest stop. They are from Philadelphia. The cause of the accident is under investigation.

All three were transported to Cape Fear Valley Medical Center. Earnest Milton was listed in critical condition.

Wright, lives in Laurinburg. He was traveling with his wife when they saw the wreck.