Rich Low of Herr & Low, P.C. recently defeated an insurance company’s attempts to take a share of the recoveries our firm had obtained for two of its clients in personal injury matters.
Herr & Low’s clients were each injured in accidents that were the fault of another party (the defendant). Our clients’ medical bills for their injuries were paid by their health insurance policies (Both clients happened to have the same insurance company). Of course, our clients had paid premiums over the years for their insurance, but when Herr & Low was successful in obtaining a settlement, the health insurer said it had a right to be paid back everything it had paid out for medical care for our clients. It claimed the insurance contract with our clients gave them that right, called the right of subrogation.
We obtained a copy of the insurance company’s Plan Documents, the controlling contract that governed the rights of our clients and their insurance company. In reviewing the document, Mr. Low looked carefully at the language of the subrogation section of the policy. A close reading of the contract revealed that the health insurance company only had the right to be paid back if our clients were “fully compensated” for their injuries. This is known as the “made whole” doctrine. Research confirmed that the doctrine is recognized in Pennsylvania.
In one of the cases there was simply not enough insurance covering the defendant to “fully compensate” our client, despite the defendant’s payment of all available insurance. In the other case, evidence had been destroyed before our representation and that presented problems of proof at trial, leading to a compromise settlement. In each case, Mr. Low successfully argued to the health insurance company that our clients had not been “fully compensated” within the meaning of the insurance policy and therefore the health insurance company was not entitled to any part of our clients’ recoveries. This resulted in over $13,000.00 in additional compensation to one client and more than $18,000.00 to our other client.
At Herr & Low, we thoroughly analyze every aspect of every case to maximize our client’s recovery.
