3P Policy Limits: $100k
Liability has been accepted
Property Damage: $10k
Current Medical Bills: $65k
MRI findings (lumbar): 4mm
Client has received 3 injections and a surgery rec for laser discectomy

Sent 2 policy limits demands. Adjuster offered $60k both times because they don’t see a “causal relationship” without offering us any articulated supporting facts.

The insured is a Radiologist, he appears to own a home valued over $2M.

Is this policy open? Best approach? Thoughts?

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From FL: Do a civil remedy notice. You should get the 100K presuit or go for extra contractual on bad faith (especially if you’re clients willing to get the discectomy) If your state doesn’t have presuit requirements to argue bad faith I would just go ahead and file.

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Depends on the state. We litigate these regularly. If you want to email me at joe@ott.law I will review the case and give you my opinion.

The state matters greatly. Charged vs outstanding Medicals, causation, etc.

This occurred in California.
Medical bills are all from lien providers.
Client had prior accidents dating back over 2 years ago. For those prior accidents he received minimal treatment in the form of physical therapy (never any need for an MRI).
Client has not seen any doctor for any reason for 2 years prior to the accident we represent him for.

They’re screwing with you because they don’t think you’re going to sue. The doctor’s notes should make causation clear and pre-litigation the carrier likely has nothing to dispute it other than their feelings. File and fight them for 6 months and the $100,000 should open up. As for taking it to trial to exceed the policy and get more from the defendant directly, your client will have to decide whether that’s worth it. Having you spend $30,000 on trial prep for your client to ultimately get a judgment for $150,000 might be a worse deal than just taking $100,000 early into litigation.

Policy demands pre-suit do not pop the policy.

File and then make a policy limit demand after Defendant answers. If rejected then you can make a claim for a popped policy.

I think you’re going to have to file to bust the policy in pretty much any state.

Any future care recommendations?
UIM?

Stop sending policy limits demands. File suit and move case towards trial swiftly. Don’t ever back off your policy limits demand. If you’ve given them a reasonable time to evaluate, their limits are open. Send 998 for 100k with service of complaint to get their insured to lean on carrier to pay limits.

Have your client post expiration of 998 get the surgery on lien basis. Push forward. They will ultimately pay more than policy.

A 998 served with the Complaint won’t hold up. There’s case law that holds that a 998 is only valid and proper after the opposing side has had an opportunity to investigate and evaluate the claim.

Just because Plaintiff has been dealing with the carrier doesn’t count. The only thing that will count is the status of the lawsuit. Anything pre-lit is immaterial.

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In CA this policy is totally open. Don’t send another demand and file suit.

Try it if you have causation.

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