Martinez vs. Mercury Insurance
What can happen to a med pay insurance co when they don’t pay

Mercury hit for over $660K for not paying $5000 Med pay

For years, Juan Martinez had always paid his insurance premiums. He believed that paying for med pay would protect his family no matter what. He purchased $5,000 med pay.

Read the following fun facts and see if this look familiar to your experience:

  Martinez had his accident on March 17, 2011.
  Martinez incurred $8,512 in medical bills
  On September 13, 2011, Martinez sent his bills to a Mercury med pay investigator.
  On November 1, 2011, Mercury asked Martinez to sign authorizations. He did.
  On November 11, 2011, Mercury claimed the records were not sufficient or readable.
  On January 6, 2012, Mercury claimed they would be copying the records,
  On March 12, 2012, Mercury demanded a ‘recorded statement,’ which was given.
  On July 13, 2012, Mercury claimed that one doctor would not return their calls.
  On September 7, 2012, Mercury claimed that one owner of a PT clinic was not currently licensed.
  Mercury refused to pay any of the med pay.
  Mercury refused even to pay the uncontested med pay for the MRI or the orthopedic surgeon.

We go into detail because many hard-working doctors hear the same excuses day after day.

Now we learn that this case was tried against Mercury, in a first of its kind case. The jury was unhappy with Mercury’s delay & deny tactics.

On June 17, 2014, the jury returned a General Verdict for Martinez for:

  Contractual damages:   $ 4,323  
  Attorney Fees:   $ 56,360  
  Emotional distress:   $ 600,000  

Martinez vs. Mercury Insurance Company

LA Superior Court case number BC5 117 01, June 9, 2014, Judge Ginger L. Bower

Everyone is talking about this case.



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Allstate gets spanked in Riverside

Motorcycle vs. auto accidents are usually not good for the motorcyclist. Officer Goodner, while getting off his motorcycle, was struck by defendant, who backed up into his motorcycle.

Defendant claimed that the officer moved too closely to his truck and he could not see the officer. Defendant also claimed the alleged injuries were not as severe as Goodner claimed and that Goodner suffered years of pre-existing low back problems.

Plaintiff Goodner suffered injuries to his lower back and exacerbation of a degenerative disc condition requiring chiropractic care.

Goodner asked the jury for $7,963 in past medical costs and $15,000 in future care. The jury voted unanimously $65,205.83. Before trial, defendant offered $20,000 and the plaintiff demanded $40,000 to settle.

David Madison, DC, Riverside, won this case. Good job.

Goodner vs. Putnam : Riverside Superior Court RIC 120 2396, Judge Craig Riemer, April 16, 2014.


LESSON TIPS

  Dr. Madison wisely brought in sharp MD experts: an orthopedic surgeon, to support the DC’s diagnosis.
  Most of the bills were chiropractic showing that many juries are generally sympathetic to chiropractic care.

Pre-existing disc diseases are not created by the accident; rather they are susceptible to serious exacerbations.



SHAWN IS SPEAKING AT

• CCA Districts
San Francisco 9/11/14
Riverside County 9/23/14
Alameda County 11/20/14

For questions call John at 310-697-9000 or
e-mail johntawlian@shawnsteel.com





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