Policy holders in Weatherford, Mineral Wells, Aledo, Azle, Springtown, Willow Park, Hudson Oaks, Millsap, Brock, and other places in Parker County need to understand important reasons for seeing an Insurance Law Attorney.
The El Paso Court of Appeals issued an opinion on April 11, 2012, that is a good illustration for the involvement of an Insurance Law Attorney. The style of the case is, Amy Warmbrod v. USAA County Mutual Insurance Company.
Here is some background:
Warmbrod sustained severe injuries in a car accident. She was treated free of charge at United States Army hospitals by virtue of her husband’s military status. Her injuries and damages were in excess of both the tortfeasor’s insurance coverage and the underinsured motorist’s (UIM) provisions of her own USAA auto insurance policy. She demanded that USAA pay her the $100,000 UIM benefits under her policy. The Army submitted a reimbursement claim to USAA for the medical care it rendered in the amount of $26,404.96 pursuant to 10 U.S.C. Section 1095 and the Federal Medical Care Recovery Act, (FMCRA) 42 U.S.C. Sections 2651 – 2653. After USAA paid the Army, Warmbrod sued USAA for violations of the Texas Deceptive Trade Practices Act and the Texas Insurance Code and other legal reasons. The heart of the complaints against USAA were that the payments to anyone besides Warmbrod were improper.
USAA filed a motion for summary judgment, asking the court to rule as a matter of law that they had committed no wrongs.
Warmbrod argued the “made whole” legal doctrine as part of her claim.
FMCRA is one of the federal statutes that gives the United States government the authority to recover medical care it provides at its own expense to covered beneficiaries.
The court discussed at length the provisions of the federal law and how it applied to this case.
They also discussed the Texas Insurance Code provisions dealing with the purposes of UIM coverage and how UIM coverage is suppose to work.
In this case, USAA prevailed. What is important about this case to insureds such as Warmbrod and to Insurance Law Attorneys is being aware of the numerous laws that exist regarding the different obligations that arise when injury claims are made against the person who caused the injury and the even against the injured person’s own coverage.
Other posts have discussed the obligations regarding hospital liens, subrogation interests, assignments, etc. This case illustrates yet another concern that has to be resolved.
It is important to bear in mind several repercussions of failing to adequately protect the various interests that can arise when these other interests are not properly protected. The insurance company that improperly pays benefits can be liable for the interests of the person or entity that is not properly protected. In addition, the injured person can be liable for those interests not being properly protected.
The liability of the injured person collecting benefits can include being financially responsible for monies improperly paid. Additional liability can include losing future benefits. Further still, in some cases a person can be criminally liable for not protecting the interests of these other entities.
The bottom line is that getting injured and settling with an insurance company (not talking about health insurance) without an experienced attorney being involved can add a nightmare on top of the nightmare that was being lived as a result of the original injury. Talk to an attorney before accepting any insurance benefits or claims.
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