Woman sues nephew for $127K after she fell at his 8th-birthday pa (1 Viewer)

[Harry Manback]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

 

[Hang 10]

Where did the 127K figure come from? How much of that was medical bills and how much for pain & suffering from painful whorederves holding?

Your'e ignorant and a jackass.

Whoa, settle down there, Harry Man. You got carpal tunnels in your right wrist too?

 

[Doug B]

She was offered a dollar for her medical bills.

I'd like to know the story behind that. I know the quality of health insurance can vary wildly ... but what the heck happened that got her medical insurance company to the point where they wouldn't pay for surgery? Maybe some kind of cap? Something else entirely?

Also, would love to see video of the hug (doubt it exists, though). Was it more like an exuberant hug? Did the kid leave his feet (aunt says yes)? Was it practically a Ric Flair takedown?

 

[thecatch]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

This and Mr. Ford's posts assume there is a reasonable basis for holding a 8 year old liable in tort for jumping into his family member's arms. That causes me to raise my eyebrows but it could be that there is some sort of authority supporting that proposition, in which case I fully agree with you guys. If there's not, then we're closer to the "frivolous" side of the ledger.

 

[James Daulton]

Why didn't her medical insurance pay her medical bills like any other accident?

 

[Harry Manback]

Why didn't her medical insurance pay her medical bills like any other accident?

They thought they could go after the homeowners insurance for it since it happened at their house?

 

[Doug B]

This and Mr. Ford's posts assume there is a reasonable basis for holding a 8 year old liable in tort for jumping into his family member's arms. That causes me to raise my eyebrows but it could be that there is some sort of authority supporting that proposition, in which case I fully agree with you guys. If there's not, then we're closer to the "frivolous" side of the ledger.

Connecticut law seems to stipulate that an insurance company cannot be a party to a lawsuit (or at least, certain types of lawsuits). The suit must be between two people persons.

 

[James Daulton]

Why didn't her medical insurance pay her medical bills like any other accident?

They thought they could go after the homeowners insurance for it since it happened at their house?

But it's not like this lady would have been stuck with massive medical bills. And if I fall at my sisters house, I'm not suing her homeowners. In fact, my son was at a party at my sister's house when he was like 6, fell from running around like all the others, and we took him to the ED. My insurance covered everything.

Should I have sued?

 

[Doug B]

They thought they could go after the homeowners insurance for it since it happened at their house?

Man, you have to be right about this. Just seems like the aunt's medical insurance company should have known such a case was pretty much unwinnable. How do you make a child the defendant without prejudicing the case? Did the legal tack they took really seem like it could sway jurors?

I guess it was a Hail Mary, and if it doesn't work, oh well ... we're no worse off than if we hadn't sued.

 

[Doug B]

And if I fall at my sisters house, I'm not suing her homeowners. In fact, my son was at a party at my sister's house when he was like 6, fell from running around like all the others, and we took him to the ED. My insurance covered everything.

Should I have sued?

What the lawyers in this thread seem to be saying is that, depending on state laws ... you very well may have been within your rights to sue. For right or wrong - the filing of the lawsuit is a "morally neutral" act, legally speaking.

Now, whether that personal calculus makes sense for you, personally, is another matter.

 

[Hang 10]

Why didn't her medical insurance pay her medical bills like any other accident?

They thought they could go after the homeowners insurance for it since it happened at their house?

Whether her insurance company thought they could get money from the homeowners or not, how could they deny a legit claim for her wrist surgeries?

 

[James Daulton]

They thought they could go after the homeowners insurance for it since it happened at their house?

Man, you have to be right about this. Just seems like the aunt's medical insurance company should have known such a case was pretty much unwinnable. How do you make a child the defendant without prejudicing the case? Did the legal tack they took really seem like it could sway jurors?

I guess it was a Hail Mary, and if it doesn't work, oh well ... we're no worse off than if we hadn't sued.

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

This and Mr. Ford's posts assume there is a reasonable basis for holding a 8 year old liable in tort for jumping into his family member's arms. That causes me to raise my eyebrows but it could be that there is some sort of authority supporting that proposition, in which case I fully agree with you guys. If there's not, then we're closer to the "frivolous" side of the ledger.

Well, sure. Jumping into people's arms can cause injury. Whether or not that person is related to you doesn't actually change whether or not that person gets injured. It's negligent to launch yourself into someone else's arms without warning because of the aforementioned possibility of causing injury. Connecticut law holds that an 8-year-old can be held liable for negligence, but that there's a lower standard of care. The standard is:

"That care which an ordinary prudent child of the same capacity to appreciate and avoid danger of injury would use under similar circumstances" or "such care as may reasonably be expected of children of similar age, judgment, and experience" where judgment is considered the ability to "discretion to heed and power of self control."

So the question for the jury was twofold:

What is the capacity to appreciate and avoid danger of injury of this child based on his age, intelligence, and experience; and

Was launching himself into his 50-year-old aunt's arms consistent with that capacity?

Sounds like the jury decided. But those are complex questions, and could have come out the other way.

 

[Ookie Pringle]

So did her health insurance company decide to subrogate against the homeowners company? Can they force her hand to sue if they want to do that? If so, they did they wait so long to do it? She likely was done with her medical treatments a few years ago.

 

[Doug B]

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

I don't have a way to explain away your take. You raise superficially solid points. Medical insurance doesn't investigate things the way an auto insurance company might (not to my knowledge, anyway). I wonder if it might have been the aunt's long-term disability insurance company, rather ... and the media accounts just didn't get it straight?

LawyerGuys -- anything in the tea leaves that might indicate the aunt drove the suit, not her medical insurance company?

 

[Ookie Pringle]

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

I don't have a way to explain away your take. You raise superficially solid points. Medical insurance doesn't investigate things the way an auto insurance company might (not to my knowledge, anyway). I wonder if it might have been the aunt's long-term disability insurance company, rather ... and the media accounts just didn't get it straight?

LawyerGuys -- anything in the tea leaves that might indicate the aunt drove the suit, not her medical insurance company?

Medical insurance companies and providers do ask a lot of questions especially when it comes to workers' compensation. Providers ask right away if you were hurt at work and it is growing more prevalent because work comp is now paying more in several states due to the ACA. Health insurance companies ask because they want to know if they can subrogate.

 

[Henry Ford]

They thought they could go after the homeowners insurance for it since it happened at their house?

Man, you have to be right about this. Just seems like the aunt's medical insurance company should have known such a case was pretty much unwinnable. How do you make a child the defendant without prejudicing the case? Did the legal tack they took really seem like it could sway jurors?

I guess it was a Hail Mary, and if it doesn't work, oh well ... we're no worse off than if we hadn't sued.

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

Health care providers ask you to tell them what happened before you even see a doctor these days. One of the reasons is that your insurance won't pay for a number of things, particularly if there's what they consider to be a "primary insurance" (tortfeasor, other policy that should pay, etc.) The healthcare provider doesn't want to get stuck with the bill. And they won't see you until you work it out. Remember - this wasn't a life-threatening emergency. And even then, if they treat you, they send all your information (yes, often codes) to the insurance company. Those codes generally identify how things happened. For instance, E8120 - motor vehicle accident. Your health insurance may refuse to pay, based on it being a MVA, until liability is established. Happens a lot.

For instance - when you go see a specialist, they'll always ask you "is this a worker's comp claim?" If it is, they need to discuss it with comp before you go in.

 

[Doug B]

So the question for the jury was twofold:

What is the capacity to appreciate and avoid danger of injury of this child based on his age, intelligence, and experience; and

Was launching himself into his 50-year-old aunt's arms consistent with that capacity?

Sounds like the jury decided. But those are complex questions, and could have come out the other way.

You know what's especially bad about this instruction? The bolded part forces the jury to apply pure guesswork. The child in front of them -- who is a complete stranger to all the jurors -- is four years older than when the incident happened. So (rhetorically) on what basis are they asked to make the judgment of age, intelligence, and experience?

Hard for me to imagine a way for the aunt's lawyer to win this particular case before a jury. Unless there are unrevealed facts that are just game-changing bombshells. Or unless, for some reason or other, the jury decided to sympathize hard with the aunt.

 

[James Daulton]

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

I don't have a way to explain away your take. You raise superficially solid points. Medical insurance doesn't investigate things the way an auto insurance company might (not to my knowledge, anyway). I wonder if it might have been the aunt's long-term disability insurance company, rather ... and the media accounts just didn't get it straight?

LawyerGuys -- anything in the tea leaves that might indicate the aunt drove the suit, not her medical insurance company?

Medical insurance companies do ask a lot of questions especially when it comes to workers' compensation. They ask right away if you were hurt at work and it is growing more prevalent because work comp is now paying more in several states due to the ACA.

The women wasn't at work so workers comp wouldn't be involved. Medical insurance companies do not ask a lot of questions in cases where people present themselves with standard injuries like this. The women talked about how it was difficult for her to navigate Manhattan, get to her apartment, hold trays, etc. I'd bet a lot that after a year or two, the injury was still bothering her and she decided to sue then.

 

[Ookie Pringle]

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

I don't have a way to explain away your take. You raise superficially solid points. Medical insurance doesn't investigate things the way an auto insurance company might (not to my knowledge, anyway). I wonder if it might have been the aunt's long-term disability insurance company, rather ... and the media accounts just didn't get it straight?

LawyerGuys -- anything in the tea leaves that might indicate the aunt drove the suit, not her medical insurance company?

Medical insurance companies do ask a lot of questions especially when it comes to workers' compensation. They ask right away if you were hurt at work and it is growing more prevalent because work comp is now paying more in several states due to the ACA.

The women wasn't at work so workers comp wouldn't be involved. Medical insurance companies do not ask a lot of questions in cases where people present themselves with standard injuries like this. The women talked about how it was difficult for her to navigate Manhattan, get to her apartment, hold trays, etc. I'd bet a lot that after a year or two, the injury was still bothering her and she decided to sue then.

I know she wasn't at work! Health insurance companies and providers do ask a lot of questions about the nature of someone's injury. I do think she is behind the lawsuit.

 

[Ditkaless Wonders]

Insurance companies spend millions lobbying legislators to pass statutes mandating that insurers fight their insurance disputes out through the names of their insureds rather than in their own names, being fearful that their rapacious reputations may doom them in front of juries if the true litigants were known. They seek to hide their identities and purposes. Legislators, hungry for dollars to run campaigns to keep them in office so that they can tell others how to live and can have others pay for ideas they may or may not be willing to pay for themselves, gladly do the bidding of those paying for their campaigns. Rather than looking to those who have set up the system in which the lawyers operate some choose to blame the lawyers. That's fine since the lobbyist for the insurance companies are likely lawyers, and the politicians far too often are as well, but the thinking is narrowly focused. To blame lawyers and to ignore the money and power of insurance companies and the moral corruption of legislators is only viewing half of the picture.

In the end the true story here is that a woman was accidentally injured by an innocent act of a child. The woman sought medical treatment for her injuries. She had insurance as did the child's father. Having paid for insurance for just such eventualities, or so they thought, they sought to use their benefits. The insurers examined their policies for loopholes through which to deny coverage. They found sufficient reasons to do so forcing a lawsuit to explore who should pay and for how much. The suit was brought pursuant to conditions set up by the industry, conditions meant to hide the true interests and true litigants. The suit was brought in the names of the injured versus the insured. Just as the lobbyist had calculated that fact allowed folks to misinterpret the nature of the suit and to leap to conclusions. The people had been manipulated just as the money interests knew they could be. Some of those people are reveling in the fact that they were easily manipulated, they celebrate their own lack of understanding. It has happened before and will again. Human behavior may not be a mathematical calculus, but it is predictable and capable of manipulation. To me the sad thing is that the manipulation can be so ham-handed and yet still work.

 

[James Daulton]

They thought they could go after the homeowners insurance for it since it happened at their house?

Man, you have to be right about this. Just seems like the aunt's medical insurance company should have known such a case was pretty much unwinnable. How do you make a child the defendant without prejudicing the case? Did the legal tack they took really seem like it could sway jurors?

I guess it was a Hail Mary, and if it doesn't work, oh well ... we're no worse off than if we hadn't sued.

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

Health care providers ask you to tell them what happened before you even see a doctor these days. One of the reasons is that your insurance won't pay for a number of things, particularly if there's what they consider to be a "primary insurance" (tortfeasor, other policy that should pay, etc.) The healthcare provider doesn't want to get stuck with the bill. And they won't see you until you work it out. Remember - this wasn't a life-threatening emergency. And even then, if they treat you, they send all your information (yes, often codes) to the insurance company. Those codes generally identify how things happened. For instance, E8120 - motor vehicle accident. Your health insurance may refuse to pay, based on it being a MVA, until liability is established. Happens a lot.

For instance - when you go see a specialist, they'll always ask you "is this a worker's comp claim?" If it is, they need to discuss it with comp before you go in.

Car accidents are different. If this woman went to the ED, the insurance company would not have any idea how the accident happened. This was not workers comp so that is not an issue here. Insurance companies only get codes on UBs. Medical records only get sent to the insurance company is the insurance company asks for them.

 

[Henry Ford]

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

I don't have a way to explain away your take. You raise superficially solid points. Medical insurance doesn't investigate things the way an auto insurance company might (not to my knowledge, anyway). I wonder if it might have been the aunt's long-term disability insurance company, rather ... and the media accounts just didn't get it straight?

LawyerGuys -- anything in the tea leaves that might indicate the aunt drove the suit, not her medical insurance company?

Biggest way is to check the lawyers. Hard to tell with these guys, though. DUI/Criminal Defense/Plaintiff and Defendant PI law/Insurance coverage... could very well have been hired by an insurance company. Could very well have taken the case with just her.

 

[James Daulton]

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

I don't have a way to explain away your take. You raise superficially solid points. Medical insurance doesn't investigate things the way an auto insurance company might (not to my knowledge, anyway). I wonder if it might have been the aunt's long-term disability insurance company, rather ... and the media accounts just didn't get it straight?

LawyerGuys -- anything in the tea leaves that might indicate the aunt drove the suit, not her medical insurance company?

Medical insurance companies do ask a lot of questions especially when it comes to workers' compensation. They ask right away if you were hurt at work and it is growing more prevalent because work comp is now paying more in several states due to the ACA.

The women wasn't at work so workers comp wouldn't be involved. Medical insurance companies do not ask a lot of questions in cases where people present themselves with standard injuries like this. The women talked about how it was difficult for her to navigate Manhattan, get to her apartment, hold trays, etc. I'd bet a lot that after a year or two, the injury was still bothering her and she decided to sue then.

I know she wasn't at work! Health insurance companies and providers do ask a lot of questions about the nature of someone's injury.

I work in hospital finance and know exactly how medical insurance works and what information they get. While providers may ask about the injury, that info is not passed on to the insurance company unless the insurance company asks for it later. Only various codes are sent on the claims to the insurance company.

Just think of all the millions and millions of medical claims submitted to insurance companies every year. It's not even practical to think the insurance companies review medical records for each claim submitted.

 

[Doug B]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

 

[James Daulton]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Yea, a brief google search yields basically no details beyond the accident itself and the verdict.

 

[Henry Ford]

They thought they could go after the homeowners insurance for it since it happened at their house?

Man, you have to be right about this. Just seems like the aunt's medical insurance company should have known such a case was pretty much unwinnable. How do you make a child the defendant without prejudicing the case? Did the legal tack they took really seem like it could sway jurors?

I guess it was a Hail Mary, and if it doesn't work, oh well ... we're no worse off than if we hadn't sued.

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

Health care providers ask you to tell them what happened before you even see a doctor these days. One of the reasons is that your insurance won't pay for a number of things, particularly if there's what they consider to be a "primary insurance" (tortfeasor, other policy that should pay, etc.) The healthcare provider doesn't want to get stuck with the bill. And they won't see you until you work it out. Remember - this wasn't a life-threatening emergency. And even then, if they treat you, they send all your information (yes, often codes) to the insurance company. Those codes generally identify how things happened. For instance, E8120 - motor vehicle accident. Your health insurance may refuse to pay, based on it being a MVA, until liability is established. Happens a lot.

For instance - when you go see a specialist, they'll always ask you "is this a worker's comp claim?" If it is, they need to discuss it with comp before you go in.

Car accidents are different. If this woman went to the ED, the insurance company would not have any idea how the accident happened. This was not workers comp so that is not an issue here. Insurance companies only get codes on UBs. Medical records only get sent to the insurance company is the insurance company asks for them.

UB Occurrence Code 03. Assuming she told them what happened, a UB code would be entered that there was an accident with potential tort liability.

 

[thecatch]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

This and Mr. Ford's posts assume there is a reasonable basis for holding a 8 year old liable in tort for jumping into his family member's arms. That causes me to raise my eyebrows but it could be that there is some sort of authority supporting that proposition, in which case I fully agree with you guys. If there's not, then we're closer to the "frivolous" side of the ledger.

Well, sure. Jumping into people's arms can cause injury. Whether or not that person is related to you doesn't actually change whether or not that person gets injured. It's negligent to launch yourself into someone else's arms without warning because of the aforementioned possibility of causing injury. Connecticut law holds that an 8-year-old can be held liable for negligence, but that there's a lower standard of care. The standard is:"That care which an ordinary prudent child of the same capacity to appreciate and avoid danger of injury would use under similar circumstances" or "such care as may reasonably be expected of children of similar age, judgment, and experience" where judgment is considered the ability to "discretion to heed and power of self control."

So the question for the jury was twofold:

What is the capacity to appreciate and avoid danger of injury of this child based on his age, intelligence, and experience; and

Was launching himself into his 50-year-old aunt's arms consistent with that capacity?

Sounds like the jury decided. But those are complex questions, and could have come out the other way.

Ok, so I mean, they *could* have come out the other way, but given the facts was it reasonable to believe they could have? Is there precedent for that kind of finding under similar circumstances? These questions go to the wisdom of the suit more so than whether it was frivolous, so I probably shouldn't have even used that word tangentially. It just strikes me as a very questionable decision to bring the suit in the first place because the odds of finding an 8 year old negligence on the reported facts seem silly, and open up your client to the kind of online scorn she's apparently receiving.

 

[Henry Ford]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Right. And if she gets found out doing that, she's guilty of insurance fraud.

 

[Ookie Pringle]

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

I don't have a way to explain away your take. You raise superficially solid points. Medical insurance doesn't investigate things the way an auto insurance company might (not to my knowledge, anyway). I wonder if it might have been the aunt's long-term disability insurance company, rather ... and the media accounts just didn't get it straight?

LawyerGuys -- anything in the tea leaves that might indicate the aunt drove the suit, not her medical insurance company?

Medical insurance companies do ask a lot of questions especially when it comes to workers' compensation. They ask right away if you were hurt at work and it is growing more prevalent because work comp is now paying more in several states due to the ACA.

The women wasn't at work so workers comp wouldn't be involved. Medical insurance companies do not ask a lot of questions in cases where people present themselves with standard injuries like this. The women talked about how it was difficult for her to navigate Manhattan, get to her apartment, hold trays, etc. I'd bet a lot that after a year or two, the injury was still bothering her and she decided to sue then.

I know she wasn't at work! Health insurance companies and providers do ask a lot of questions about the nature of someone's injury.

I work in hospital finance and know exactly how medical insurance works and what information they get. While providers may ask about the injury, that info is not passed on to the insurance company unless the insurance company asks for it later. Only various codes are sent on the claims.

Why do health insurance companies send out questionnaires to people they treated asking questions about the injury and whether or not they got hurt at work? Also, these insurance companies want to find out what they can in case they can subrogate.

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

This and Mr. Ford's posts assume there is a reasonable basis for holding a 8 year old liable in tort for jumping into his family member's arms. That causes me to raise my eyebrows but it could be that there is some sort of authority supporting that proposition, in which case I fully agree with you guys. If there's not, then we're closer to the "frivolous" side of the ledger.

Well, sure. Jumping into people's arms can cause injury. Whether or not that person is related to you doesn't actually change whether or not that person gets injured. It's negligent to launch yourself into someone else's arms without warning because of the aforementioned possibility of causing injury. Connecticut law holds that an 8-year-old can be held liable for negligence, but that there's a lower standard of care. The standard is:"That care which an ordinary prudent child of the same capacity to appreciate and avoid danger of injury would use under similar circumstances" or "such care as may reasonably be expected of children of similar age, judgment, and experience" where judgment is considered the ability to "discretion to heed and power of self control."

So the question for the jury was twofold:

What is the capacity to appreciate and avoid danger of injury of this child based on his age, intelligence, and experience; and

Was launching himself into his 50-year-old aunt's arms consistent with that capacity?

Sounds like the jury decided. But those are complex questions, and could have come out the other way.

Ok, so I mean, they *could* have come out the other way, but given the facts was it reasonable to believe they could have? Is there precedent for that kind of finding under similar circumstances? These questions go to the wisdom of the suit more so than whether it was frivolous, so I probably shouldn't have even used that word tangentially. It just strikes me as a very questionable decision to bring the suit in the first place because the odds of finding an 8 year old negligence on the reported facts seem silly, and open up your client to the kind of online scorn she's apparently receiving.

If it could have, it's reasonable to believe it could have.

 

[Doug B]

LawyerGuys -- do you have the impression that:

a ) aunt's lawyer flubbed an easily winnable case

b ) aunt's lawyer took on a 50-50 case, and could have won with a better strategy

c ) aunt's lawyer had an uphill battle, and likely used as good a strategy as was available

d ) aunt's lawyer took on a dog of a case and had no shot

 

[Henry Ford]

LawyerGuys -- do you have the impression that:

a ) aunt's lawyer flubbed an easily winnable case

b ) aunt's lawyer took on a 50-50 case, and could have won with a better strategy

c ) aunt's lawyer had an uphill battle, and likely used as good a strategy as was available

d ) aunt's lawyer took on a dog of a case and had no shot

There's something between b, c, and d. I'm there. I think he took on an uphill battle, potentially a dog depending on the actual facts, and possibly could have won with a better strategy depending on the facts.

 

[Doug B]

UB Occurrence Code 03. Assuming she told them what happened, a UB code would be entered that there was an accident with potential tort liability.

Hmmm ... I wonder how limited a patient's right to withhold this information is? I guess the insurance company could refuse to pay without the info, though.

Aunt: "I fell out of bed."

 

[thecatch]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

This and Mr. Ford's posts assume there is a reasonable basis for holding a 8 year old liable in tort for jumping into his family member's arms. That causes me to raise my eyebrows but it could be that there is some sort of authority supporting that proposition, in which case I fully agree with you guys. If there's not, then we're closer to the "frivolous" side of the ledger.

Well, sure. Jumping into people's arms can cause injury. Whether or not that person is related to you doesn't actually change whether or not that person gets injured. It's negligent to launch yourself into someone else's arms without warning because of the aforementioned possibility of causing injury. Connecticut law holds that an 8-year-old can be held liable for negligence, but that there's a lower standard of care. The standard is:"That care which an ordinary prudent child of the same capacity to appreciate and avoid danger of injury would use under similar circumstances" or "such care as may reasonably be expected of children of similar age, judgment, and experience" where judgment is considered the ability to "discretion to heed and power of self control."

So the question for the jury was twofold:

What is the capacity to appreciate and avoid danger of injury of this child based on his age, intelligence, and experience; and

Was launching himself into his 50-year-old aunt's arms consistent with that capacity?

Sounds like the jury decided. But those are complex questions, and could have come out the other way.

Ok, so I mean, they *could* have come out the other way, but given the facts was it reasonable to believe they could have? Is there precedent for that kind of finding under similar circumstances? These questions go to the wisdom of the suit more so than whether it was frivolous, so I probably shouldn't have even used that word tangentially. It just strikes me as a very questionable decision to bring the suit in the first place because the odds of finding an 8 year old negligence on the reported facts seem silly, and open up your client to the kind of online scorn she's apparently receiving.

If it could have, it's reasonable to believe it could have.

What the jury could done as a technical matter /= reasonable expectation, IMO.

 

[Henry Ford]

UB Occurrence Code 03. Assuming she told them what happened, a UB code would be entered that there was an accident with potential tort liability.

Hmmm ... I wonder how limited a patient's right to withhold this information is? I guess the insurance company could refuse to pay without the info, though.

Aunt: "I fell out of bed."

Congratulations. You've induced an insurance company to pay a claim based on a fraudulent misrepresentation. How does a few years in prison sound?

 

[Doug B]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Right. And if she gets found out doing that, she's guilty of insurance fraud.

Who's going to turn her in? Remember, she didn't let on at the party she hurt her wrist.

I guess I've just been lucky not to have been hurt at work and not to have been admitted to a hospital after an accidental injury ... but I've gone to doctors plenty, and no one has ever probed about why I am there.

 

[Ditkaless Wonders]

LawyerGuys -- do you have the impression that:

a ) aunt's lawyer flubbed an easily winnable case

b ) aunt's lawyer took on a 50-50 case, and could have won with a better strategy

c ) aunt's lawyer had an uphill battle, and likely used as good a strategy as was available

d ) aunt's lawyer took on a dog of a case and had no shot

Without knowing the terms of all potentially applicable insurance policies I don't know how anyone could opine. Most litigators though will have experience implying to the jury the true nature of the parties actually in interest in cases such as this. They may not state the matter, but they can lead jurors to understand it nonetheless. That hurdle cleared cases such as this are really quite routine. Persons finding them frivolous or unusual, or even comment worthy are persons unfamiliar with the system.

 

[Ookie Pringle]

I'd like to hear from someone in the insurance industry in that state. Insurance companies have attorneys on staff and ones they work closely with for subrogation. They must hate this system in CT.

 

[James Daulton]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Right. And if she gets found out doing that, she's guilty of insurance fraud.

How is that insurance fraud? Did I commit fraud when I took my son to the emergency dept and used my insurance?

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

This and Mr. Ford's posts assume there is a reasonable basis for holding a 8 year old liable in tort for jumping into his family member's arms. That causes me to raise my eyebrows but it could be that there is some sort of authority supporting that proposition, in which case I fully agree with you guys. If there's not, then we're closer to the "frivolous" side of the ledger.

Well, sure. Jumping into people's arms can cause injury. Whether or not that person is related to you doesn't actually change whether or not that person gets injured. It's negligent to launch yourself into someone else's arms without warning because of the aforementioned possibility of causing injury. Connecticut law holds that an 8-year-old can be held liable for negligence, but that there's a lower standard of care. The standard is:"That care which an ordinary prudent child of the same capacity to appreciate and avoid danger of injury would use under similar circumstances" or "such care as may reasonably be expected of children of similar age, judgment, and experience" where judgment is considered the ability to "discretion to heed and power of self control."

So the question for the jury was twofold:

What is the capacity to appreciate and avoid danger of injury of this child based on his age, intelligence, and experience; and

Was launching himself into his 50-year-old aunt's arms consistent with that capacity?

Sounds like the jury decided. But those are complex questions, and could have come out the other way.

Ok, so I mean, they *could* have come out the other way, but given the facts was it reasonable to believe they could have? Is there precedent for that kind of finding under similar circumstances? These questions go to the wisdom of the suit more so than whether it was frivolous, so I probably shouldn't have even used that word tangentially. It just strikes me as a very questionable decision to bring the suit in the first place because the odds of finding an 8 year old negligence on the reported facts seem silly, and open up your client to the kind of online scorn she's apparently receiving.

If it could have, it's reasonable to believe it could have.

What the jury could done as a technical matter /= reasonable expectation, IMO.

So you're wondering about a reasonable expectation or belief that the jury would come out on her side? A reasonable expectation of success is a very high bar to set for frivolous lawsuits. Ridiculously high.

 

[Henry Ford]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Right. And if she gets found out doing that, she's guilty of insurance fraud.

How is that insurance fraud? Did I commit fraud when I took my son to the emergency dept and used my insurance?

Because she lied about what happened in order to induce her insurance company to pay benefits. How is that not insurance fraud?

 

[Doug B]

It just strikes me as a very questionable decision to bring the suit in the first place because the odds of finding an 8 year old negligence on the reported facts seem silly, and open up your client to the kind of online scorn she's apparently receiving.

I think the outcome was readily knowable in advance, given the facts we know. The case as a Hail Mary? OK. But counting on this judgment coming through as if it were money in the bank? Oof.

 

[matttyl]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

 

[Henry Ford]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Right. And if she gets found out doing that, she's guilty of insurance fraud.

Who's going to turn her in? Remember, she didn't let on at the party she hurt her wrist.

I guess I've just been lucky not to have been hurt at work and not to have been admitted to a hospital after an accidental injury ... but I've gone to doctors plenty, and no one has ever probed about why I am there.

Right. Lawyers are the scumbags, but she should have lied in order to get her insurance company to pay, because there was very little chance she would get caught.

 

[CletiusMaximus]

Its interesting how quickly people advocate insurance fraud as a solution to a difficult situation.

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

 

[Henry Ford]

Its interesting how quickly people advocate insurance fraud as a solution to a difficult situation.

An error occurredYou have reached your quota of positive votes for the day

 

[B-Deep]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

well

she did have a choice, pay her own medical bills rather than sue her nephew

 

[James Daulton]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Right. And if she gets found out doing that, she's guilty of insurance fraud.

How is that insurance fraud? Did I commit fraud when I took my son to the emergency dept and used my insurance?

Because she lied about what happened in order to induce her insurance company to pay benefits. How is that not insurance fraud?

If she said she fell and broke her wrist, that's insurance fraud?