Roda Law, LLC has filed a lawsuit on behalf of a single, working woman, whose first party medical benefits were cut off, retroactively, by her automobile insurer. The insured suffered serious injuries in two motor vehicle accidents and suffers from chronic pain. As a result, she needs prescription medications to manage her pain and to enable her to work a full-time job, which she wants and needs to do. Without notice to the insured, her doctors, or her pharmacy, the insurance company stopped paying for her prescription medications. Months later, the insurance company sought a medical examination to support its decision, misleading the insured that she had to undergo the examination, even though her policy did not require one unless the company got a court order showing that the examination was sought for good cause.
The insurer then used that examination as a basis to support its earlier decision to stop benefits payments, based on the examiner’s conclusion that the insured’s medical condition had returned to where it was before the second of the two accidents.
In addition to claiming that the insurer’s conduct unreasonably failed to follow the proper procedures, the lawsuit alleges two key flaws in the insurer’s conclusion.
The first is that the insured has not returned to the condition in which she was before the second accident. The insured’s medical doctors wrote letters to the insurance company explaining this, and asking it to reconsider its decision, but the company declined to change its position.
The second alleged flaw is that even if the insured had returned to her condition as it existed before the second accident, she would still be suffering from chronic injuries from the first accident, and the insurance company, which insured her for both accidents, would still owe her benefits from the first accident.
Because the insurer stopped paying the insured’s benefits without telling her—and because her pharmacy continued filling her prescriptions, also not having been told that its bills would not be paid—the insured now has an outstanding balance of thousands of dollars with the pharmacy.
The lawsuit alleges that the insurer’s conduct was unreasonable, that the insurer knew or recklessly disregarded this fact, and that the insurer has violated Pennsylvania’s insurance bad faith statute, has breached the implied contractual duty of good faith and fair dealing, and has violated Pennsylvania’s consumer protection and motor vehicle laws.