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Pennsylvania Superior Court Allows Disabled Coal-Miner to Pursue Suit Against Insurance Companies

A disabled coal miner was recently allowed the opportunity to pursue damages against an insurance company that provided policies for life and disability insurance as an extension of an auto loan and home mortgage.  The policies defined “total disability” as the inability to perform work during the initial 12-month period of any disability covered by the policy. The coal miner suffered a back injury in a traffic accident a year after he purchased the policies. 

The auto policy sent payments after receiving some verification of the continued disability, and it eventually discontinued the need for verification.  The payments lasted two years before the company attempted to contact the injured coal miner.  A letter was sent to the treating physician, inquiring about the current status of the coal miner and his ability to perform work.  The injured coal miner relayed that he had been diagnosed with a rheumatic disease that worsened his back injury and that he was receiving disability from the Social Security Administration.

The coal miner’s treating physician also provided documents that relayed the injured’s condition as unchanged and unlikely to improve.   The doctor stated that he was unable to do any heavy lifting or bending on the first round of inquiries.  With the second inquiries, the doctor confirmed that the coal miner may be able to perform light work, but that being able to sit or stand as needed was essential.  The doctor suggested a trial period of employment at any new occupation to avoid further injury.

Several years of intense litigation ensued over many issues of law.  In this case, the question for the trial court was whether or not the original insurance company acted in bad faith.  The Bad Faith Trial Court, in its bench trial, determined that while the insurance company made an incorrect conclusion, they were reasonably thorough and sufficient in their investigation to conclude the coal miner was not “totally disabled” under the policy certificates.  The coal miner appealed this decision, asking the superior court to award interest on the amount of the claim from the date the claim was made, issue punitive damages against the insurer, and assess court costs and attorney fees agains the insurer.

The Superior Court reviewed bad faith case law, which established a two part test:  1) that the insurer did not have a reasonable basis for denying benefits, and 2) that the insurer knew or recklessly disregarded its lack of reasonable basis in denying the claim.  The Superior Court felt that the trial court erred in its determination as a matter of law, pointing back to the answers provided by the coal miner’s treating physician.  The court felt that the physician’s suggestions that the coal miner could try different types of employment did not lend itself to the conclusion that he should not have benefits.  The court also felt that the definition of “Total Disability” provided in the policies did not limit the award of benefits if there was the possibility to work.  The court pointed out the long history of case law that allows an award of disability benefits, even if the injured worker is able to perform “basic functions.”  The dismissal was vacated and the case was remanded for a new trial. 

When you have been injured, it is vital to receive all the benefits you are entitled to in order to pay for medical costs and household bills.  The Pennsylvania personal injury attorneys at Needle Law Firm have the experience you need to fully litigate your case.  Call today at 570-344-1266 for a free, confidential consultation. 

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