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Get Claims Adjuster’s PIP File in Every No Fault Case

April 4, 2012 by Steven M. Gursten

There is gold in PIP files.

Here, PIP stands for personal injury protection, as in, personal injury protection benefits related to no-fault auto insurance.

There are only 4 or 5 law firms that really understand no fault litigation in Michigan, and for these firms, the importance of getting the insurance company’s PIP File is known as rule #1 in any no fault case. But most attorneys who litigate No-Fault cases never do secure the PIP file.

And insurance defense attorneys do everything they can to frustrate efforts to turn over the PIP file.

The PIP File contains the adjuster’s log notes, the payment logs, the dates of receipts of benefits incurred, the investigation of the insured and the basis of the adjuster’s testimony. A lot of no fault insurance attorneys will leave the review of the PIP File until the deposition of the adjuster (which is often reserved up until 2 weeks before trial). However, I am of the belief that waiting that long to truly understand the PIP File is a huge mistake and costing you and your client multiple thousands of dollars.

The PIP File is the essence into the insurance company’s defense. Both attorneys will know what the medical records state, what the Plaintiff’s previous conditions were, what the treatment of the Plaintiff was, and what the Plaintiff’s proofs are. Failure to review the PIP File means that you don’t know what the Defendant’s key witness – the adjuster – has to say.

Why would you not want to know the Defendant’s case (ie. the excuses for not paying PIP benefits to your client)?

Of course, the PIP File is voluminous. And it will take hours to read. But it would be inexcusable -and legal malpractice – for any insurance lawyer to say they did not review the medical records in a case because the medical records were voluminous. It is similarly inexcusable not to review the PIP File because that will contain the Defendant’s own key admissions.

In every case, there are key decision points which impact the direction of the case. One of the key central decision points for no fault cases filed in Michigan courts is something called case evaluation, where three attorneys will determine a potential settlement value for your case and put a number down for your client to accept or reject. Why would any no fault insurance attorney wait until after the case evaluation is over, and after that settlement number which is used to “value” the case, to depose the adjuster?

In my most recent review of a few PIP Files, I have learned the following pieces of information which I am confident will get my client thousands of extra dollars in case evaluations and, hopefully, result in successful motions for summary dispositions where interest and attorney fees will be granted:

  1. The adjuster log notes admitted that the adjuster failed to send my client notification of
    its termination but adjuster did admit in writing that the adjuster owed all benefits for their pre-
    termination Household Replacement Services which were in the file but were simply not paid;
  2. A PIP adjuster approved payment of certain medical bills which were received on April 21, 2011 in May of 2011 but simply did not send the check until October 14, 2011 after the adjuster received notification that the insured’s account had been sent to collection; and
  3. the adjuster sent the medical records that it deemed pertinent, but not the main treating physicians medical records, to its DME to “evaluate” my client. These are just some examples from some of my most recent cases.

These real case examples will now be used in my upcoming motions for Summary Disposition where I’m asking for penalty interest and no fault attorney fees on these unreasonable refusals and overdue payments. Furthermore, it will be these real-life examples which I will already be keying in on to show that the Defendant’s termination was unreasonable.

Obviously, these are some extreme examples that do not happen in every case. But they happen more often than most people would believe. If I was the injured, I would certainly want my attorney to utilize these facts when three random attorney’s are putting a case evaluation number on my claim which they deem to be a fair number to settle the claim and if I disagree, I could face serious sanctions.

Lastly, early review and use of the PIP file has already shown to improve the total recovery for my client. For example, I had a case which just recently settled. This was not the “strongest” case. The client had a series of relevant pre-existing injuries. Pre-existing injuries certainly do not kill a case; however, I am not out there looking for clients who have a history of back surgeries and social security disabilities, either. Regardless, in this case, after the termination of benefits, the Defendant had a series of pre-termination bills that it simply failed to pay. The review of the PIP file shows that the Defendant’s adjuster acknowledged this and tried to pay those benefits while hiding it from Plaintiff’s counsel. Obviously, the PIP File did not say “LET’S PAY THIS SO PLAINTIFF’S COUNSEL DOESN’T SEE IT”, but it was obvious that it was only done to lessen the amount owed and because it was a pre-termination bill.
Presenting the PIP File to Defense counsel and showing the date of receipt by the adjuster and date of payment not only increased the Case Evaluation Award, but then resulted in a settlement which was significantly higher than what the case was valued at by the Defense counsel and took into account bills which were not owed at the time of settlement – thus resulting in a much greater award to the client.

The fact of the matter is the PIP File can be the strongest tool on the Plaintiff’s side. No Defense counsel would wait until two weeks before trial to learn what Plaintiff’s version of his injuries are. Failure to understand the PIP File is the equivalent and would be costing your client and your firm a significant amount of money.

Being aggressive is one of the most important services you can offer to your clients in PIP cases, and getting the PIP file early is an important part of this. After all, if you can file a Motion for Summary Disposition about pre-termination of medical bills and help get your
client back to the doctors that he or she needs for necessary medical treatment, and be awarded $15,000.00 in no fault attorney fees on these bills, why wouldn’t you?

Joshua R. Terebelo works in the law firm’s litigation division, where he focuses on No-Fault insurance lawsuits and helps auto accident victims receive their first-party personal injury protection (PIP) benefits.

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