|
When genuine disputes arise between businesses and
individuals, the parties involved rely on their adversaries
making honest attempts to fulfill their obligations
and resolve their differences. Occasionally, some parties
may make promises with no intention of keeping them;
in other words, they act in bad faith. Doing so is both
illegal and damaging to effective business practices,
as it undermines the assumptions on which our entire
system of business is based.
It can be daunting to seek resolution in such a situation,
since proving another party's bad faith can be difficult.
At Golomb & Honik, we tackle these challenging cases.
Here are some examples of our successes:
-
After a man was rendered a paraplegic in a motor vehicle
accident, he required extensive medical care on both
an in-patient and outpatient basis. At a certain point
in his recovery, he was home and receiving physical
therapy on a daily basis; his rehabilitation specialist
prescribed outpatient physical therapy at the rehabilitation
hospital where he had spent months as a patient. The
outpatient physical therapy would allow him to transfer
himself from his bed to a wheelchair and, ultimately,
teach him how to drive a specially equipped van so
that he could be self-sufficient. His insuring HMO,
while agreeing to pay for the outpatient physical
therapy, refused to pay for the transportation services
to and from that therapy, and paratransit service
was unavailable. The HMO's refusal to pay for the
transportation for outpatient services essentially
left the patient alone at home without treatment.
As a result, he suffered extensive bedsores and required
hospitalization on five separate occasions. Bad faith
litigation was instituted against the HMO by Golomb
& Honik attorneys, who overcame preliminary objections
and motions to dismiss based on various "HMO immunity"
statutes. During the course of discovery, it was clearly
determined that the HMO administrators who denied
the claim did so in bad faith by misapplying their
own policy language. Upon completion of depositions,
the case settled for $1 million.
- A surgeon who
was insured against disability suffered multiple herniated
discs resulting in multiple surgeries; he became totally
and residually disabled in 2001. Although his condition
was a serious one, he returned to work in a matter
of months but was unable to perform some strenuous
surgeries as before his injury. Once the waiting period
on his policy expired, the surgeon made a claim on
his own for residual disability benefits; the insurance
company denied his claim. Golomb & Honik instituted
suit on his behalf and included counts for breach
of contract, bad faith, and violations of the Pennsylvania
Unfair Trade Practices Act as well as other consumer
laws. Golomb & Honik lawyers were able to establish
bad faith on the part of the insurance company, including
the way in which this individual case was handled. They
also demonstrated a company-wide pattern and practice
in misinterpreting their own policy language for the
sole purpose of denying claims. The case settled shortly
before trial for nearly ten times the compensatory
claim for residual disability benefits.
- A Philadelphia lawyer who was insured against disability, suffered from a chronic disease from which he ultimately became totally disabled as a trial attorney.
The victim-lawyer, through Golomb & Honik attorneys, brought an action against the defendant international insurance iompany for a breach of contract and the bad faith handling of the attorney's claim for disability benefits.
The attorney had a medical condition known as Crohn's Disease and, although diagnosed since early adulthood, worked continuously for several decades as a trial attorney. Beginning in November, 2000, he worked at his law firm on restricted basis and as a result collected a significantly reduced salary until the end of 2003 when his firm dissolved. At that time his conditioned worsened and he was unable to continue as a trial attorney or act as a litigation attorney in any form except to refer client matters to other attorneys.
The defendant insurance company denied his claim for disability benefits on the basis that his consultations with other attorneys referring matters, constituted a "new occupation" serving as a basis for the defendant international insurance company to deny disability benefits.
Golomb & Honik attorneys filed a complaint for breach of contract, unfair trade practices and consumer protection law, breach of fiduciary duty and bad faith. After exhaustive motion practice and pretrial discovery, the case settled for an amount which essentially represents the present rate of the total benefit the victim-attorney was otherwise entitled to until his 65th birthday.
- A 60-year old physician who maintained a full obstetrical and gynecological practice injured his dominant left hand leaving him unable to perform the substantial duties of his profession (i.e., surgery and child delivery).
After his injury, the physician made a claim for benefits under his group and individual policies with the defendant insurance company. While the insurance company initially paid the physician the benefits he was entitled to, for several years he was terminated benefits based on the results of a functional capacity evaluation and defense medical examination concluding that he was able to return to work. As a result, Golomb & Honik attorneys filed suit against the defendant insurance company claiming breach of contract, breach of fiduciary duty, bad faith and violations of Pennsylvania's consumer protection law.
During the course of discovery, and with the assistance of nationally recognized experts, it was determined that given the type of injury the physician suffered leading to his disability, the functional capacity evaluation and defense medical examination were both flawed. Each examination failed to analyze whether the physician could perform the specific duties of his profession and neither examiner bothered to review the relevant medical records. In fact, during the course of discovery the defendant insurance company admitted in writing that the functional capacity evaluation performed was conducted under improper protocol. Despite this allegation, the defendant insurance company continued to refuse the physician benefits. After extensive discovery and with the assistance of eminently qualified experts, the case settled for a confidential amount which was essentially equal to the present value of 100% of the benefits that the physician was entitled to plus an amount for bad faith and counsel fees.
|
