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An Insurance Company Horror Story from Grand Rapids

October 6, 2009 by Steven M. Gursten

As a no-fault insurance lawyer, I have seen many, many dishonest tactics insurance companies employ to avoid paying benefits to very injured car accident victims. But this is by far, one of the most appalling. In the published Michigan Court of Appeals case Roberts v. Farmers Insurance Exchange, Farmers Insurance unilaterally scheduled a mandatory insurance medical examination (also known as an IME), for a child with a traumatic brain injury. The insurance company did this without first checking to see if the appointment date and time would conflict with the child’s working and indigent mother’s schedule.

Two days before the insurance exam, the injured child’s mother became acutely ill and was taken to the hospital emergency room. A significant lung infection left her hospitalized for more than two weeks. Part of that time, the mother was in ICU with a chest tube. Obviously, the minor (14 years old) with TBI was unable to drive herself to the insurance appointment and understandably, was also very concerned with her mother’s health.

The child’s traumatic brain injury lawyer contacted the insurance company about the Grand Rapids case. But despite the fact that the brain-injured minor did absolutely nothing to contribute to the missed appointment, Farmers Insurance punished her for her mother’s work conflicts and acute hospitalization, by cutting off and refusing to pay all insurance benefits for the child’s care and medical treatment.

The Court in Roberts allowed the insurance company to stop insurance benefits, and wrote that the brain-injured child, whose mother was in acute care in a hospital, should have instead called a taxi or have taken a bus to an adversarial insurance medical appointment and then also find her way home.

As my personal friend, Bill Decker, the attorney who represented the brain-injured child wrote: “No parent in their right mind would ever allow a child to be exposed to those kinds of risks, especially a brain-injured child.”

Additionally, no facts about taxi cabs or buses were ever introduced at the trial court level nor did the insurance carrier ever suggest this idea.

Nevertheless, Roberts v. Farmers Insurance Exchange is now used by insurance companies and adjusters as a justification to suspend all insurance benefits whenever an insured person misses an appointment with a doctor assigned by a no-fault insurance company — even if the exam is arbitrarily scheduled and even if there are important reasons, such as an emergency hospitalization.

Regrettably, Roberts is hailed by defense lawyers in Michigan as another “insurance win.” Meanwhile, it’s yet another way people with personal injuries are being completely taken advantage of in Michigan. Read here on Michigan’s 10 worst insurance companies and claims adjuster tactics. Also, if you have been mistreated by your auto insurance company, please give our attorneys feedback by making a comment below.

There are some very important facts that did not make it into the published Roberts decision. On Thursday I will post a blog including a letter from Bill Decker about his experience trying to help the injured child. I’d like to say congratulations, Bill, for being a credit to the Michigan Bar, someone who deeply cares about his clients, a fantastic lawyer and friend.

If you have been in a car accident or truck accident, and are unsure about the language on your insurance policy or you are having trouble with your insurance company, please call one of our no-fault attorneys at (248) 353-7575 for a free case evaluation.

Steven M. Gursten is recognized as one of the nation’s top experts in serious car and truck accident injury cases and automobile insurance no-fault litigation. Steve has received the largest jury verdict for an automobile accident case in Michigan in four of the past seven years, including 2008, according to a published, year-end verdicts and settlements report.

Related information:

Important Insurance Coverage Issues

Don’t Settle With Your Insurance Company Without a Lawyer

The Set-Off Insurance Company Scam

Michigan Auto Law is the largest law firm exclusively handling car accident, truck accident and motorcycle accident cases throughout the entire state. We have offices in Farmington Hills, Detroit, Ann Arbor, Grand Rapids and Sterling Heights.

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2 Replies to “An Insurance Company Horror Story from Grand Rapids”

  1. Thank you for calling out an extreme practice used by certain insurance companies. Not only did the plaintiffs suffer a life altering accident, but also a substantial backdoor rogering by the insurance company, which, unfortunately is the rule these days. To these companies who boast how well they will cover and care for you after a calamity (and after they get your money), human life and the quality of it is really only meaured by the profit in the coffers. How can these people sleep at night?

  2. Thank you for the sensitive article on a very insensitive subject and sector that continues to sink into the abyss of greed rather than strengthen the backbone of our country: the working-class public.

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