Another win at Ross Law PDX! Last year our client was injured in a car crash. Her insurer, USAA Casualty Insurance Company, was obligated under Oregon Law and her insurance policy to pay up to $15,000.00 of her reasonable and necessary crash related medical expenses. These are commonly referred to as PIP benefits. After a few months USAA stopped paying reasonable and necessary medical bills. USAA also ignored the law that required USAA to provide written notice of the denials to our client and our office. As a result, our client was incurring medical expenses and had no idea that USAA would refuse to pay them.
Unbeknownst to our client USAA’s vendor Auto Injury Solutions (AIS) had been recommending that USAA refuse to pay the bills. What appears to have happened was USAA’s adjuster arbitrarily set a reserve (think of this as the budget for the claim) of $5,000.00 to cover our client’s medical expenses. Once our client’s bills exceeded the $5,000 reserve, it triggered AIS to conduct further detailed review on all subsequent bills. Not surprisingly AIS told USAA’s adjuster to refuse to pay all subsequent bills. USAA did as AIS informed them to do and denied the bills without reaching out to our client’s medical providers to get further clarification on her injuries and treatment, or reaching out to our office for more information. As a result, thousands of dollars of crash related medical expenses went unpaid.
We had no choice at that point and filed a lawsuit against USAA Casualty Insurance Company on our client’s behalf. Our client did not have to worry about paying the costs and attorney fees to file the lawsuit because Oregon Law allows for the insured to recover costs in attorney fees in situations like this. We filed the lawsuit in Mulnomah County Circuit Court under case number 18CV27752.
Shortly after the lawsuit was filed USAA suddenly paid, without explanation, almost two thousand dollars of outstanding Medical bills. However, USAA refused to pay for a few visits to a chiropractor. USAA then blamed Auto Injury Solutions and our client for USAA’s failure to pay the medical expenses. Apparently USAA decided to “deny, deny, deny, and blame the other guy.” In doing so, it appeared USAA completely disregarded its’ contractual and legal obligation to pay these medical bills under the Insurance Policy and Oregon Law.
USAA then steadfastly refused to make a fair settlement offer. Instead, USAA attempted to settle the case by forcing our client to sign a confidentiality and non-disparagement agreement in exchange for payment of benefits that she was entitled to. USAA also refused to pay the full amount of the incurred costs and attorney fees. It was our belief that USAA was attempting to strip our client’s First Amendment Rights in an effort to conceal USAA’s attempts to profit from unlawfully denying active duty military, veterans, and their families insurance benefits. Our client stood firm and refused to be gagged by USAA’s corporate greed.
We then took a deposition of USAA’s corporate representative. He gave some troubling testimony. This included claiming that he received a letter from a physician hired by AIS that recommended that he deny the bills. This is called a “file review” letter or USAA calls it a “PHAD” (physician denial letter). However, USAA never sent that letter to anyone and claims it simply disappeared. USAA’s corporate representative confirmed that this has never happened before. USAA’s corporate representative also testified that he reviewed the written notices of the denials. These are commonly referred to as “Explanation of Benefits forms,” or “EOB’s.” These were the documents that USAA was required by law to send to our client or our office but failed to. Despite testifying the EOB’s existed and were reviewed, USAA refused to produce them despite our formal legal request and various follow up letters to USAA’s lawyers.
As a result of USAA’s shenanigans we filed motions with the arbitrator to compel them to produce the information they were concealing. At this point USAA had three lawyers on the case. We also filed motions for sanctions to punish USAA for their unscrupulous and shameful litigation tactics. In April 2019, on the last business day before the hearing on the motions for sanctions, USAA suddenly “tendered” the disputed amount of the medical bills. This means that we had won and USAA would send us a check to pay the amount of the remaining disputed bills.
However, that is not the end of the story. Despite USAA stating in writing and orally that it would send the check to pay the roughly $3,700.00 of wrongfully denied bills, USAA didn’t pay. USAA also took issue with the Arbitrator awarding roughly $59,000.00 in attorney fees and costs. The arbitrator stated that USAA’s conduct was “deplorable.”
USAA appealed the arbitrator’s decision and tried to bury the arbitrator’s written findings of facts which outline USAA’s shameful conduct. USAA was finally able to convince the court that USAA should only pay our client’s attorney fees of roughly $39,000.00. Both the Judge and the Arbitrator had serious issues with the way USAA was treating its insured and the way they chose to litigate this matter.
This was a big win for our client who was able to get thousands of dollars in medical debt wiped out. It was also a huge blow to USAA and their team of lawyers because it is clear that their unlawful PIP denials will cost them substantially if the right lawyer gets a hold of the case and forces them to explain why they are trying to screw their insured out of benefits.
If you, or someone you know, have been wrongfully wrongfully denied Personal Injury Protection benefits, or have been sent to an examination by your auto insurance company you should call an Oregon Insurance Lawyer at Ross Law PDX as soon as possible at 503.224.1658 to discuss your options. Jeremiah Ross is happy to represent clients in PIP denial cases on a contingency basis. As a Veteran, Jeremiah is happy to go to battle against USAA who hides behind a cloak of patriotism only to put profit over people.