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Adamscheck v. American Family Mutual Ins. – UM Coverage and Workers’ Comp

If you are injured on-the-job while driving, you may be entitled to compensation via a number of avenues. It’s important to discuss with an Orlando injury lawyer the best approach. Otherwise, you may find yourself short-changed. 

Specifically, there is an interplay between auto insurance coverage and workers’ compensation. The latter is provided to workers who are hurt in the course and scope of employment, regardless of fault. Florida is a no-fault state as far as car accidents go, but if the cost for your injuries exceed $2,000 or are quite severe, you can pursue legal action against the other driver, as opposed to merely collecting personal injury protection (PIP) benefits. Your health insurance may cover a portion of your costs as well. If the other driver doesn’t have any auto insurance, you may be able to collect uninsured motorist (UM) coverage, if you have it.

But F.S. 627.727 does not allow for double recovery under workers’ compensation law. That means if your workers’ compensation benefits cover some aspect of your injuries that is later paid out by your UM carrier, your workers’ compensation provider may be able to assert a lien on those funds. These overlapping interests can get complicated, and that’s why it’s important to make sure you’ve got representation.

The recent federal appeal of Adamscheck v. American Family Mutual Ins. deal with these issues, which were weighed by the U.S. Court of Appeals for the Tenth Circuit. 

It should be noted this was a case out of Colorado, which by law does not allow workers’ compensation benefits to be offset against UIM (underinsured motorist) coverage in that state.

According to court records, plaintiff was working as a deputy sheriff when he was rear-ended by a woman driving a private vehicle. Because plaintiff was working at the time of the car accident, he was entitled to workers’ compensation insurance benefits for his injuries.

With permission from his insurance company, he settled with the at-fault driver for $25,000, which was the limit of her liability coverage. However, he’d suffered severe injuries to his back as a result of the crash, and claimed $185,000 just in existing economic damages. Those included past medical expenses and lost wages, and it didn’t include recovery for future medical care, future wage loss, permanent disability and non-economic damages for pain and suffering.

He made a demand under his personal auto insurance policy for the full $500,000 limit of his UIM coverage. His insurer offered him $65,000. He rejected this offer and filed a lawsuit in state court. He asserted the company had violated state statute and good faith laws by issuing an unreasonable denial of benefits. The insurer removed the case to federal court.

A few months before the final pretrial conference, insurer sought a partial summary judgment arguing it couldn’t be liable for bad faith because it had property reduce the settlement offer by the amount claimant had received under workers’ compensation. Insurer argued the law did not allow for double recovery of losses and that the policy also had a limiting provision. District court denied this motion, finding workers’ compensation was “not a defense in this case.”

Insurer also argued plaintiff’s injuries were exaggerated and to the extent that he was injured at all, blamed it on a prior work injury. The company noted the officer had sustained less than $400 damages to his vehicle. The company sought to present the evidence of a biomechanical engineering expert, who would testify that the low-impact car accident couldn’t have caused plaintiff’s injuries. District court excluded this testimony.

At trial, jurors awarded plaintiff nearly $400,000 in damages, finding insurer had unreasonably denied payment to plaintiff.

On appeal, the 10th Circuit affirmed insofar as the workers’ compensation offset was concerned – defendant was not entitled to that. However, the lower court erred in excluding the biomechanical engineer’s testimony and the court could not say this error was harmless. Now, the case will have to be retried.

Call Freeman Injury Law — 1-800-561-7777 for a free appointment to discuss your rights. Now serving Orlando, West Palm Beach, Port St. Lucie and Fort Lauderdale.

Additional Resources:

Adamscheck v. American Family Mutual Ins., March 29, 2016, U.S. Court of Appeals for the Tenth Circuit

More Blog Entries:

Study: U.S. Drivers Increasingly Distracted and Dangerous, March 29, 2016, Orlando Car Accident Lawyer Blog

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