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Denial of Insurance

Occasionally, it seems obvious that you should be compensated – you were badly injured and it was clearly the fault of someone else.

However, your own insurance company denies coverage.

Improper denial of insurance benefits is also known as insurance bad faith.


ACTUAL CASE

Senai T was a 16 year old immigrant from Ethiopia who was living with his extended family in an apartment in North Seattle. While coming home from school one day, he was struck in a crosswalk by a hit and run driver a block from his home. His leg was fractured and he was not able to see the license plate of the vehicle.

Senai turned to his brother’s underinsured motorist insurance. Senai was living with his brother who was a medical student at the time. The insurance carrier denied coverage on the ground that Senai was not technically living with his brother because he sometimes slept in his brother’s apartment, and he sometimes slept in the same apartment with his own parents.

Attorney Mike Maxwell sued the insurance company asking the court to declare that Senai met the definition of “insured” under the applicable insurance policy. Mike claimed that the insurance company was not aware of large extended Ethiopian families, and in the Ethiopian culture, a 16 year old boy could be a resident of both his brother’s and his parents’ house at the same time.

After deposing witnesses, both parties moved for summary judgment. The insurance company asked the judge to throw Senai’s case out of court. Mike asked the court to declare that Senai was an “insured” within the meaning of the insurance policy. The judge agreed with Mike and Senai got the benefit of all the insurance policy. Not only that, but the insurance policy was required to pay all of Senai’s attorney fees and costs as well.

If you feel that your insurance company wrongfully denied you or a loved one benefits, please feel free to contact us. We have insurance in establishing insurance benefits even when the insurance company thinks that benefits should not be paid.

 

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