Insurance Companies and Claim Denial

William E. Johnson
February 11, 2014

Katherine Shea

                  Katherine Shea was an 83-year-old widow-- active, vibrant and in excellent health-- who lived independently in Missouri. She lived in her own home, drove wherever she needed to go, and did her own shopping, cooking, and cleaning. In 2011, her life would change when she was driving down the street in her Ford Taurus, and a 17-year-old swerved his SUV into her lane, smashing her vehicle head-on. “I really don’t remember anything but a big bang,” remarked Ms. Shea. This would be the start of a very long journey. 

 

 

Medical Bills and Pain and Suffering

            The crash caused extensive trauma to Ms. Shea, requiring multiple surgeries in an attempt to repair her body, as well as her brain. She spent over 5 months in medical facilities, accumulating more than $800,000 in medical bills. Besides very short walks using a walker, she is now confined to a wheelchair. She needs assistance dressing, showering, and using the bathroom. She can no longer prepare her own meals. Even very elementary tasks, such as getting herself a drink of water, require assistance. Because of all of this, Ms. Shea was forced to move to another state to receive full-time care from relatives. "She has her moments of complete despair, which is very hard to watch because it's not who she is," said Dan Shea, her nephew

Negotiating with Insurance Companies

            Because of this, her nephew attempted to negotiate a settlement with Farmers Insurance. First, they wouldn’t negotiate with the Sheas at all. Finally, the insurance company attempted to appease them by offering a low-ball figure, which would have essentially left Ms. Shea penniless. Like many others who are “insured,” she was forced to file suit in hopes of getting what she was owed. Even though the 17-year-old driver never denied fault and was well-insured, the insurance company decided to fight the claim in trial. But they lost. The jury sided with Ms. Shea and awarded her what she needed to pay for her injuries and medical care. In the words of her attorneys:

 

On October 3, 2013, after four days of trial and four hours of deliberation, a Franklin County jury returned a verdict of $2,162,000 in favor of Katherine. In addition, Katherine is entitled to pre-judgment interest in the amount of $100,335. The jury heard evidence that Katherine's paid medical bills totaled $185,000 and that the amount billed by providers totaled $800,000. The present value of Katherine's care requirements, as presented by plaintiff's expert, was approximately $2 million.

 

            You may think that this should have been the end. It wasn’t. The insurance companies are still fighting the verdict and won’t pay a dime. "They're just delaying, delaying, threatening appeals, asking judge for a new trial," said Dan. A local San Diego station reported on the story last weekend:

 

Craig McClellan appears in the documentary as the Shea family's advising attorney:

"One of the reasons the insurance company delays is because it can make more money and its money by keeping it and using it, than if it pays out a large sum to a seriously injured person."

For Dan, his crusade is not about the money, but rather regaining his aunt's dignity and educating others on what he says is a growing problem.

"Before you have an accident, make sure you understand your coverage because believe me they're looking for ways out," explained Dan.

Kay, meanwhile, is still fighting to be the vibrant woman she once was. She just hopes she'll still be around when and if her case finally settles.

"And, you know, I've always been determined to make it. I'm afraid I might die if I don't," she said.

 

West Palm Beach Injury Attorney

            Insurance companies have an inherent self-interest in shielding their profits and denying claims to policyholders. Under Florida law, an insurance company has violated the implied covenant of good faith and fair dealing if it did not act fairly and honestly toward its policyholder in response to a claim. If you live in Florida and believe that you are being treated unfairly by your insurance company, please do not hesitate to contact an experienced West Palm Beach insurance dispute attorney at William E. Johnson, P.A