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Why won’t State Farm honor hip injury claims?

State Farm says car accident didn’t cause hip injury – but Michigan Court of Appeals smacks down insurance giant for “fractured ” liability theory once again in Connors v. State Farm

hip-injury

As an insurance attorney who writes an auto law blog, I tend to write often about State Farm and how they treat people who’ve been injured in automobile accidents. They just give me so much to write about (see last paragraph of this blog post for just a few examples). This is yet another true story about State Farm Mutual Automobile Insurance Company trying to dodge its responsibility to provide Michigan auto No Fault benefits (specifically for a hip injury claim) by stubbornly ignoring the facts and the law – and the obvious legal conclusions to be drawn from them.

The case is illustrative of what State Farm is doing in Michigan. I’m sure State Farm mistreats people in all 50 states, but since Michigan does not have insurance bad faith laws or punitive damages to deter this behavior, this type of claims handling in Michigan is sadly not unique.

Thankfully, the Michigan Court of Appeals was there on this case to apply the brakes.

Again.

In Conners v. State Farm Mutual Automobile Insurance Company, the auto insurer tried to get out of paying No Fault benefits for a Kalamazoo County car accident victim’s “revision” surgery for a non-healing, intertrochanteric hip fracture by arguing the condition wasn’t related to or caused by the accident.

Kenneth Conners, a pedestrian in Kalamazoo County, suffered a right intertrochanteric hip fracture injury when he was injured in a car accident. After his initial hip surgery didn’t take and the fracture refused to heal (thus creating a “nonunion” injury), Mr. Conners had to undergo a second, “revision” surgery.

State Farm didn’t want to pay the hip injury claim, insisting the “nonunion” injury of the hip fracture, which necessitated the “revision” surgery, was a “separate injury from the intertrochanteric fracture,” and thus, was not caused by the victim’s automobile accident – thereby removing it from medical coverage under our auto No Fault law.

The Michigan Court of Appeals disposed of State Farm’s irrational argument in short order:

  • “The nonunion was simply the failure of Conners’s intertrochanteric fracture (which arose from the [car] accident) to heal [or “reunite”] properly. … Absent the intertrochanteric fracture, there was no possibility of a nonunion—Conners’s bone would have still been in one piece. The failure of this injury to heal is a direct result of the first injury … Thus, the ‘revision’ surgery for that fracture was simply further treatment of the initial injury.”

The Court of Appeals concluded that a jury should hear the case:

“[E]vidence of … a causal connection exists because the ‘first injury’ (the intertrochanteric fracture) caused the ‘second injury’ (the nonunion) in a direct way. Accordingly, plaintiffs presented sufficient evidence to support a finding by a trier of fact that the nonunion of Conners’s intertrochanteric fracture arose out of the … motor vehicle accident. Thus, the trial court erred in granting summary disposition in favor of defendant as to the nonunion of the intertrochanteric fracture.”

Michigan No Fault PIP causation for second surgeries and for when injuries do not heal

This is an important ruling for Michigan auto accident attorneys. It both confirms existing law and further clarifies the level of causation that lawyers must show in order to be obtain No Fault PIP (“personal injury protection” insurance) medical benefits coverage:

  • There must be a “causal connection” which “is more than incidental, fortuitous, or ‘but for’” between the injury for which No Fault benefits coverage are sought and the car accident that caused the injury.”
  • However, motor vehicle accident victims “are not required to establish that the motor vehicle accident was the only, or even proximate, cause of the nonunion.”

Altered mental status and fever

State Farm’s stinginess wasn’t limited to its quest to avoid paying No Fault benefits to cover the hip “revision” surgery.  The auto insurer also wanted to skate on paying for Conners’s surgery-related “altered mental status” and fever. State Farm attorneys suggested the AMS and fever were “too attenuated” from the car accident that caused the initial hip fracture and the subsequent nonunion.

The appellate judges didn’t buy it:

  • “Plaintiffs present evidence sufficient to establish a question of fact whether the causal connection between the motor vehicle accident and Conners’s AMS and fever was more than incidental, fortuitous, or but for. Plaintiffs argue that the AMS and fever were the results of an adverse reaction to drugs given to Conners before and during the revision surgery, particularly Ativan. Viewing the evidence in the light most favorable to plaintiffs, but for the motor vehicle accident, Conners would not have suffered the intertrochanteric fracture, which would have not failed to heal, which would not have required the revision surgery, which would not have required Conners taking Ativan, which would not have caused Conners’s AMS and fever.”
  • “Conners’s AMS and fever were direct results of the medication being used in an attempt to ameliorate Conner’s ‘intermittent agitation’ caused by medication and to return him to his pre-existing ‘baseline agitation.’ There is evidence in the record to suggest that this ‘intermittent agitation’ was an aggravation of his ‘baseline agitation’ which arose from surgeries that in turn arose from the October 25, 2012 motor vehicle accident. Viewing the evidence and the inferences drawn therefrom in the light most favorable to plaintiffs, Conners’s AMS and fever were caused by medication that was being used to treat an injury that arose from the motor vehicle accident.”

As I wrote above, I’ve been writing about State Farm and how it treats car and truck accident victims – and its insured customers – terribly for years now on this  blog. This is why the insurance giant never fails to evade my list of the worst car insurance companies each year. Here are just a few of many, many ways State Farm has shirked its duty to protect people when they’re injured in auto accidents:

This entry was tagged Tags: personal injury, State Farm
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