If you’ve just been in an accident, or been injured by someone, you might be wondering whether or not you should hire a lawyer.  If your injuries are very minor, such as a bruise or a little embarrassment, you might not need a lawyer, but it doesn’t hurt to contact one just in case you have a bigger legal claim than you think! 

If you’ve suffered moderate to severe injuries, you should definitely consult an attorney for assistance.  Did you know that in most cases a good attorney can help you get compensation for your injuries without even having to go to court? Most personal injury lawsuits are based on good fact-finding and steadfast negotiation more so than on black-and-white laws. Attorneys know these rules and the tricks other lawyers use to try to get around them.  For instance, do you know which questions the other side can, and can’t, ask you?  Probably not…  But lawyers are trained on these matters and can raise appropriate objections when necessary to prevent you from having to respond when you don’t need to.  While this sounds simple enough, many a case has been won or lost on simple facts.  

Also, when it comes to negotiating a settlement on your own, you will almost always fare worse than if you had a lawyer’s help.  Experienced attorneys know the average settlement range for similar injuries in the courts in your area.  Also, they know how the laws would be treated in your particular case and how such circumstances would either entitle you to more or less than the average award. 

Finally – let the pros handle the process.  Lawyers know the legal process like the backs of their hands.  Usually, you don’t.   So going it alone would be like going from your neighborhood kickboxing class to the boxing championships…    While there certainly isn’t anything wrong with being an amateur, when your legal rights are at stake your odds of prevailing are best protected if you go heavyweight-t0-heavyweight. 

At the end of the day, talk to an attorney in the beginning to figure out how best to protect your legal rights. So schedule an initial consultation – most times they’re free. 

Learn more about accidents and injuries in LawInfo’s Free Legal Resource Center.

After a New York attorney general’s office launched an investigation based upon hundreds of complaints against UnitedHealth Group, a settlement reached on Tuesday ordered the health insurance company to pay $50 million dollars for overcharging millions of Americans for health care.

New York Attorney General Andrew Cuomo says Ingenix, a research firm owned by UnitedHealth Group, has been manipulating claim numbers so insurance companies pay less. “Americans have been under-reimbursed to the tune of at least hundreds of millions of dollars,” he says. Other major insurers also use Ingenix, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield.

“This is a huge scam that affected hundreds of millions of Americans (who were) ripped off by their health insurance companies,” says Cuomo. “This was unethical, and it robbed vulnerable patients of insurance reimbursements they deserved.”

In a statement, UnitedHealth Group told TODAY: “We respectfully disagree with the New York Attorney General’s findings that we manipulated data or that our ownership of Ingenix was a conflict of interest. We agreed to his settlement because it was an effective way to address any perceived conflict of interest.”

Cuomo says he’s now investigating other health insurance companies. In addition, some patients plan to bring a class action lawsuit against UnitedHealth Group.

A class action is a case brought against a company whose actions have damaged a group of people in a similar way. A single person who has been injured may bring a class action on behalf of everyone who has been harmed. However, after the action has been started, other injured people can join the class action lawsuit (become class members).

Do you feel you have a claim as part of a class action? An experienced Lead Counsel class action attorney can advise you on whether filing a class action or an individual lawsuit is best for your case, as well as advise you on what steps you need to take.

Are you facing a legal issue?  Have you been sued, or are you wondering about foreclosure?  Did you just have a medical procedure that didn’t turn out as you expected?  Is bankruptcy looming?  What about your family life – are you and your spouse considering divorce?  Do you need to update your will?  Has someone you love been arrested for a DUI? 

These are examples of only some of the most common legal issues.  The fact is we actually deal with the law more than most people think.  More importantly, when we face a legal issue, many of us might not know where to turn for answers.  The legal system can certainly be overwhelming – especially because the consequences are often so grave. 

Since 1994, LawInfo has been providing the public with quality legal resources they can count on.  The idea for the company even came out of the founder’s own legal needs!  How do you find the right attorney?  How do you know the attorneys you contact are in good standing with the state bar association?  What if you want to learn about a legal issue before you talk to a lawyer?  Well, these are the reasons LawInfo was established!  LawInfo has a whole library of information about the most common legal issues including answers to frequently asked questions, articles, legal guides, legal forms, and other information – ALL FREE TO THE PUBLIC!  The really great thing is this – you can also easily find an attorney who will understand your legal needs.  It’s all designed to help the public – help someone find answers they need and find an attorney who can help them. 

Learn more about LawInfo’s Free Legal Resource Center and Find the Right Attorney in your area today!

The Los Angeles Personal injury attorneys of The Marks Law Firm specialize in Representing Those Experiencing Insurance Company Bad Faith Problems. Mr. Marks has achieved superior results in serious personal injury cases and is a particularly effective insurance bad faith attorney.

There are a number of key decisions and an Insurance Code statute which govern this specialized area of law and can be of great assistance to the policyholder. This covers item #3 of Mr. Mark’s lecture:

3. The Applicant For Insurance Has a Duty to Disclose Only that Which the applicant in Good Faith Believes is Material to Their Health.

Our Supreme Court has repeatedly held that questions on an insurance application concerning illness or disease are deemed under the law to be construed as referring to serious ailments that undermine the applicant’s general health. Hence failure to disclose Aminor indispositions@ on an insurance policy are not deemed to be material misrepresentations as a matter of law. Ransom v. Penn Mut. Life Ins. Co. (1954) 43 Cal.2d 420, 427; Thompson v. Occidental Life Ins. Co. (1973) 9 Cal.3d 904, 916.

As such, an applicant need only those disclose conditions that he or she, acting in good faith, believes material to his or her health. This is a subjective test. Whether a hypothetical reasonable person would recognize their importance is not the test:
“(I)f the applicant for insurance had no present knowledge of the facts sought or failed to appreciate the significance of information related to him, his incorrect or incomplete responses would not constitute grounds for rescission.”(emphasis added)

The rationale behind these exceptions is simple and straight-forward. It would be “patently unfair to allow the insurer to avoid its obligations under the policy on the basis of information that the applicant did not know, or alternatively, did not fully understand.@ Miller v. Republic Nat’l Life Ins. Co. (9th Cir. 1986) 789 F.2d 1336, 1340 (applying Calif. law)

See also, Telford vs. New York Life Insurance Company (1937) 9 Cal. 2d 903: The failure of an applicant to disclose physical conditions of which he or she is ignorant of, does not provide a ground for a carrier to rescind the policy. Cohen vs. Penn. Mutual Life Insurance Company (1957) 48 Cal. 2d 720; Pierre vs. Metropolitan Life Insurance Company (1937) 22 Cal. App. 2nd 346.

See also, Section 332. Required disclosures. Each party to a contract of insurance shall communicate to the other, in good faith, all facts within his knowledge which are or which he believes to be material to the contract and as to which he makes no warranty, and which the other has not the means of ascertaining. [emphasis added].

In Jefferson Standard Life Ins. Co. v. Anderson (1965) 236 CA2d 905, 909 the applicant for a life insurance policy denied any history of heart disease. After the policy was in force for a little over a year, he died of arteriosclerosis. During its investigation the carrier discovered that its policyholder had consulted with a physician five years earlier for an unrelated condition, facial paralysis, but the physician diagnosed the condition as temporary and the symptoms went away. The facial paralysis was a symptom of arteriosclerosis. However, there was no evidence that the policyholder was aware of the connection between facial paralysis and this specific heart condition. In determining that the carrier’s recission was unlawful, the Court held, Even assuming [the Insured] was suffering from (arteriosclerosis] at the time he answered the questions in the application he had no knowledge thereof. [Emphasis added].

Query: Although never clearly answered in the case law, it would appear that an applicant who has innocently forgotten they suffer from a medical condition and hence fails to discloses that condition on the application, may rely upon that lack of present knowledge@ as a defense in a recission case.

There are a number of key decisions and an Insurance Code statute which govern this specialized area of law and can be of great assistance to the policyholder. This covers key decision #1 of Mr. Mark’s lecture:

1. Prohibition of Post-Claims Underwriting in Disability CasesSection 10834 states in its entirety):

Postclaims underwriting
No insurer issuing or providing any policy of disability insurance covering hospital, medical, or surgical expenses shall engage in the practice of postclaims underwriting. For purposes of this section, “postclaims underwriting” means the rescinding, canceling, or limiting of a policy or certificate due to the insurer’s failure to complete medical underwriting and resolve all reasonable questions arising from written information submitted on or with an application before issuing the policy or certificate.

It is important to note there is a nearly identical provision in California’s Health and Safety Code which prohibits postclaims underwriting of health care plans. Health and Safety Code Section 1389.3 states: Postclaims underwriting-No health care service plan shall engage in the practice of postclaims underwriting. For purposes of this section, “postclaims underwriting” means the rescinding, canceling, or limiting of a plan contract due to the insurer’s failure to complete medical underwriting and resolve all reasonable questions arising from written information submitted on or with an application before issuing the plan contract. This section shall not limit a plan’s remedies upon a showing of willful misrepresentation.

Mr. Marks has achieved superior results in serious personal injury cases and is a particularly effective insurance bad faith attorney. The Firm has assists residents throughout Southern California including Los Angeles, West Los Angeles, Encino, Woodland Hills, Sherman Oaks, Tarzana, Santa Monica, Reseda. For more information, call 888-638-2693 today!

The Los Angeles Personal injury lawyers of The Marks Law Firm Specialize in Representing Those Experiencing Insurance Company Bad Faith Problems. Mr. Marks has achieved superior results in serious personal injury cases and is a particularly effective insurance bad faith attorney. The Firm has assists residents throughout Southern California including Los Angeles, West Los Angeles, Encino, Woodland Hills, Sherman Oaks, Tarzana, Santa Monica, Reseda

A Plaintiff Perspective on Successfully Litigating
Life and Disability Recission Cases

Rescission is the method whereby an insurance company completely extinguishes the contractual rights of its insured and places the party to the same position he or she had prior to the policy being issued. If a representation is false in a material point the injured party is entitled to rescind the contract from the time the representation becomes false. A representation is false when the facts fail to correspond with its assertions or stipulations.

To justify rescission the insurer must prove the insured made a material “false representation” or “concealment” in the application or other materials submitted with the application for insurance. The burden of proof is on the insurer to establish such concealment or misrepresentation. The materiality of questions and answers in an insurance application is determined “solely by the probable and reasonable influence” which truthful answers would have had upon that insurer.

This is a subjective test. Thus, information is material if it would have caused this particular insurer’s underwriter to reject the application or to charge a higher premium for the policy or amend the policy terms. However, it is important to note that the insurance company’s testimony that it would not have issued the policy, or issued the policy with a greater premium, if the true facts were known, does not rise to the level of an evidentiary presumption: “The trier of fact is not required to believe the ‘post mortem’ (post loss) testimony of an insurer’s agents that insurance would have been refused had the true facts been disclosed.” Thompson, supra, 9 Cal.3d at 916 [emphasis added]; See Also, Imperial Cas, supra, 198 Cal.App.3d at 181.

It must be noted that in cases whereby the insurance company rescinds a policy because of a fraudulent claim, as distinguished from misrepresentations in the insurance application, an objective test is utilized: The materiality of the statement will be determined by the objective standard of its effect upon a reasonable insurer.

It is not necessary that the insured’s misrepresentation at the time of the taking of the application relates, or is otherwise connected to, the loss suffered by the insured after the policy is issued. The issue is whether the insurer would have issued the policy had it known the true facts at the time of the application.

The Los Angeles personal injury lawyers of The Marks Law Firm Specialize in Representing Those Experiencing Insurance Company Bad Faith Problems. Mr. Marks has achieved superior results in serious personal injury cases and is a particularly effective insurance bad faith attorney. The Firm has assists residents throughout Southern California including Los Angeles, West Los Angeles, Encino, Woodland Hills, Sherman Oaks, Tarzana, Santa Monica, Reseda

There are a number of key decisions and an Insurance Code statute which govern this specialized area of law and can be of great assistance to the policyholder. This covers key decision #2 of Mr. Mark’s lecture:
2. Disclosures of Material Conditions to an Insurance Agent, Which Due to the Negligence or Mistake of the Agent, Fails to be Included in the Application

Estops the Carrier from Rescinding the Policy
As explained by our Supreme Court over 70 years ago:

From an examination of the cases the following propositions may be regarded as established by the weight of authority: Where the insured, in good faith, makes truthful answers to the questions contained in the application, but his answers, owing to the fraud, mistake, or negligence of the agent filling out the application, are incorrectly transcribed, the company is estopped to assert their falsity as a defense to the policy. The acts of the agent, whether he is a general agent with power to issue policies, a soliciting agent, or merely medical examiner for the company, are in this respect the acts of the company, and he cannot be regarded as the agent of the insured, though it is so stipulated in the application or policy.’ (Citation Omitted).

Accord: Byrd v. Mutual Benefit Health & Acc. Ass’n (1946) 73 Cal.App.2d 457, 463: “Where the insured, in good faith, makes truthful answers to the questions, but his answers, owing to the fraud, mistake or negligence of the agent filling out the application, are incorrectly transcribed, the company is estopped to assert their falsity as a defense to the policy.@; Rutherford v. Prudential Ins. Co. (1965) 234 Cal.App.2d 719, 726 [same]; Boggio v. California Western States Life Ins. Co., (1966) 108 Cal.App.2d 588, 598 [same].

The estoppel rule applies even when the applicant receives a copy of his or her application, when some action by the agent leads the applicant to believe the misstated or omitted answers were immaterial. Rutherford v. Prudential Ins. Co. (1965) 234 Cal.App.2d 719, 726.

In Rutherford, the applicant mentioned preexisting health conditions to the physician hired by insurance company to conduct a medical examination. The physician led the insured to believe such information was not essential and that further written responses to the health questionnaire was unnecessary. The insurer could not rely on a misrepresentation defense.

This estoppel rule applies even where there is an express limitation of the authority of the agent to bind the company. Byrd v. Mutual Benefit H. & A. Assn. (1946) 73 Cal.App.2d 457, 463. This is true as knowledge of insurance company’s agent, obtained while acting within the scope of his authority, is imputed to the insurer as a matter of law. Beach vs. United States Fidelity & Guaranty Company (1962) 205 Cal. App. 409.

For more information on Insurance Company Bad Faith Problems, please visit Scott A. Mark’s website or call 1-888-638-2693.

The Los Angeles personal injury lawyers of The Marks Law Firm Specialize in Representing Those Experiencing Insurance Company Bad Faith Problems. Mr. Marks has achieved superior results in serious personal injury cases and is a particularly effective insurance bad faith attorney. The Firm has assists residents throughout Southern California including Los Angeles, West Los Angeles, Encino, Woodland Hills, Sherman Oaks, Tarzana, Santa Monica, Reseda

Uninsured/Underinsured Bad Faith
By Scott A. Marks
Los Angeles Insurance Bad Faith Lawyer

EMOTIONAL DISTRESS DAMAGES CAN BE QUITE SIGNIFICANT

IN BAD FAITH CASES

Emotional distress damages can be quite significant in bad faith cases. See Clayton v. United Services Automobile Association, supra, 54 Cal.App.4th at 1160, 1162 [$400,000 award as compensation for emotional distress upheld by the appellate court as reasonable based upon the insurer’s bad faith attempt to settle the underinsured motorist claim for a fraction of the policy limits, even though the insured did not suffer any financial hardship from the delay in payment of the claim]; Jarchow v. Transamerica Title Insurance Company (1975) 49 Cal.App.3d 917 [$200,000 award as compensation for emotional distress caused by the insurer’s conduct in forcing plaintiff to institute judicial proceedings against the insurer in order to obtain benefits due and owing to her.

In addition to these compensatory damages, in cases where the insurer has acted with malice, fraud and/or oppression, the insured may recover punitive damages. The same acts which constitute a breach of the implied covenant may also be shown to demonstrate liability for punitive damages when such acts occur within the context of malice, fraud and/or oppression.

Where an insurer handles a first party claim in a manner designed to minimize, or completely deny, benefits due and owing under a policy, it not only breaches the implied covenant but also subjects itself to punitive damage liability. For instance, evidence that an insurer ignored facts in its file which supported the claim while focusing on the facts justifying denial constituted a breach of the implied covenant and supported an award of over $3,000,000 in punitive damages. Similarly, a bad faith judgment awarding plaintiff $100,000 in compensatory damages and $5,000,000 in punitive damages was upheld, in part, by evidence that a claims adjuster testified that he was instructed by his supervisor that the purpose of the claims department was not to find ways to pay claims, but rather to find ways to deny claims.

Likewise, the appellate court held that an insurer’s defacto policy of minimizing payment of claims, as inferred through the testimony of its claims adjusters and policy manuals, not only constituted a breach of the implied covenant, but supported an award of punitive damages as well. The Court specifically held that the nominal amount of compensatory damages awarded $146.71, combined with a modest amount of general damages for emotional distress, $5,000, and supported a punitive damage award of $200,000. The Court of Appeal specifically rejected the defendant insurer’s argument that the amount of the punitive damage award was excessive based upon evidence that its net annual profit exceeded $200 million.

Finally the appellate court upheld an award of $429,310 in compensatory damages and $3,900,000 in punitive damages, based upon an insurer’s misconduct in attempting to settle an underinsured motorist claim for a fraction of the available policy limits.