Case details
Insured claimed carrier delayed in tendering policy limit
SUMMARY
$4326008
Amount
Verdict-Plaintiff
Result type
Not present
Ruling
KEYWORDS
brain injury, chronic pain, emotional distress, grossly comminuted fracture, heel bone, of the left calcaneus, permanent limp, post-traumatic arthritis
FACTS
On Aug. 11, 2008, plaintiff Michael Mazik, 27, an outdoor education teacher and AstroCamp counselor who previously sustained a brain injury, was involved in a head-on collision at 40 to 50 mph, resulting in the at-fault driver dying on impact. Mazik shattered his heel bone and was allegedly left with a heel deformity. The insurance carrier for at-fault driver tendered its $50,000 policy limits. Then, in January 2010, Mazik sought further recovery via the supplementary-underinsured-motorist provision of his own insurance policy, which was administered by Government Employees Insurance Co. (GEICO). Mazik sought to have GEICO tender his remaining available policy benefits of $50,000. However, GEICO initially offered $1,000 and then $13,800. Its highest offer was ultimately $18,887. Mazik sued Government Employees Insurance Co. (erroneously sued as GEICO General Insurance Co.), alleging that the carrier’s actions constituted bad faith. The matter proceeded to arbitration, but GEICO rejected the finding. Thus, the matter proceeded to trial. However, Judge Richard Rico ruled that the total amount of the arbitration award was not admissible and that witnesses could only testify that the arbitration award was in excess of the policy limits. Plaintiff’s counsel argued that based on the severity of the injury to a 27-year-old active man, GEICO should have paid the available policy limits of $50,000 in 2010. The plaintiff’s expert orthopedic surgeon described Mazik’s injury as “disastrous” and confirmed that the severity of the injury was detailed in the medical records that were in GEICO’s possession in January 2010. GEICO’s regional liability administrator, Lon Grothen, and the adjuster, Rick Burton, admitted that Mazik had sustained a serious injury. They also admitted that they value a claim based on the medical summaries created when reviewing the records and that the summaries GEICO creates have to be an accurate representation of the injury and the permanency of the injury in order to properly evaluate a claim. However, plaintiff’s counsel contended that with 15 to 20 records, GEICO either failed to summarize the medical records that clearly established a permanent injury or mischaracterized the records to make Mazik’s injury seem less serious. In addition, counsel contended that there was a specific pattern to GEICO’s medical summaries for each medical record provided to GEICO in Mazik’s demand package. For example, plaintiff’s counsel presented to the jury about 15 to 20 medical records and noted that GEICO’s summary stated that Mazik was “doing well,” when, in reality, the actual record said that Mazik was “doing well given the extent of the injury.” Counsel also noted that GEICO stated that Mazik’s doctor “does not recommend surgery,” when the actual records stated that Mazik had significant swelling, weakness, and stiffness, which were made worse with walking, that Mazik was taking Vicodin, and that the doctor ” cannot state if surgical intervention would be beneficial at this time; may require fusion.” Plaintiff’s counsel compared, side-by-side, the actual record versus GEICO’s allegedly summarized mischaracterization, on which GEICO relied. In addition, plaintiff’s counsel contended that GEICO delayed in performing a defense medical exam and in taking the deposition of Mazik for over a year. Counsel also contended that when reviewing the deposition transcript and defense-medical-exam report, GEICO ignored countless statements and findings that supported payment of the policy and only considered statements that supported its low offers. Counsel further contended that GEICO failed to consider new information about Mazik’s condition, even though additional records were provided to GEICO on multiple occasions throughout the claim. GEICO denied Mazik’s allegations, claiming that its medical summaries were accurate and that it was Mazik who mischaracterized the medical records. For example, defense counsel noted that the plaintiff’s treating physician wrote that he did not “anticipate” Mazik needing surgery “given the fact that he appears to be doing quite well,” and that Mazik’s physical therapist wrote, at the conclusion of treatment, that Mazik reported that he “had returned to his previous level of function.” Thus, GEICO denied that benefits were due to Mazik under the policy in 2010, and contended that any payment of underinsured-motorist benefits was reasonably in dispute throughout 2013. GEICO also contended that it properly investigated Mazik’s claim and that, based on its investigation, Mazik’s reasonable damages covered by the underinsured-motorist provisions of the policy were less than the amounts demanded by Mazik in settlement. GEICO contended that it was aware in 2010 that Mazik had suffered a fractured heel, but claimed that Mazik’s injury was fully resolved and that no additional medical treatment whatsoever was necessary. Thus, GEICO claimed that it made several prompt and reasonable settlement offers to Mazik., As a result of the 2008 collision with the underinsured driver, Mazik suffered a grossly comminuted fracture of the left calcaneus, which required three casts, total non-weight bearing for approximately four months, crutches, and extensive rehabilitation to walk again. He also claimed that he suffered a thoracic strain, a left elbow laceration, and multiple abrasions. Mazik claimed that the shattering of his heel caused a reduction of Bohler’s angle, resulting in a heel deformity and a loss of range of motion. He claimed that as a result, he is left with a permanent limp, post-traumatic arthritis, and chronic pain. Mazik alleged that his condition makes it very difficult to walk up hills or stairs, or walk on a beach. In addition, he alleged that his residual issues are permanent and that he suffered emotional distress as result of his condition and GEICO’s delay, but he did not seek any counseling. Thus, Mazik claimed that he had $19,387.86 in past medical bills and $9,400 in past loss of income. He also sought recovery of $300,000 in emotional distress damages related to the 30 months (2.5 years) delay in GEICO resolving his claim. In addition, he sought recovery of approximately $10,000 in attorney fees and costs. Defense counsel disputed the seriousness of Mazik’s alleged condition. Counsel acknowledged that Mazik had suffered a fractured heel in the 2008 collision, but argued that Mazik’s injury had fully resolved and that no additional medical treatment whatsoever was necessary. Defense counsel further argued that Mazik mischaracterized his medical records to make his condition seem more serious than it was.
COURT
Superior Court of Los Angeles County, Los Angeles, CA
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INJURIES:
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- brain
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