Expert: Claims Guy - 12/5/2010

Question
Washington State Auto Claim. Claimant is at a stop light stopped when he suddenly blacked out or had a seizure and accelerated through the intersection damaging several parked and unoccupied vehicles. Claimant's insurance company denied the property damage claims because this was a solo medical event, no prior history of illness and this would be case law of negligence.  The claimant suffers from Post Traumatic Stress Disorder from Vietnam war and is seeking help for this, possibly takes meds for his PTSD. Claimant walks with a cane, and his drivers license is on a probationary status. Police report is adverse to Claimant. I do not believe Claimant Carrier can deny on law of negligence because what did the owners of the parked and unoccupied vehicles do wrong? I do not know if they can deny based on the seizure or blackout if they state there was no prior history of illness. With the claimant's PTSD and his probationary license I believe there was a history but I am not sure if arguing the history would do more harm than good. I feel that if Claimant Carrier states there is no history than a coverage denial would not apply. Can Claimant Carrier deny on case law of negligence? Is there Washington law that would allow this denial? I need to argue this denial but am not sure how.  

Answer
The insurer's duty is to defend their customer from any claims or lawsuits.  They investigate and determine whether their insured was negligent.  They attempt to determine what a judge or jury would decided if the case went to court.

They determined that he did nothing wrong and was not negligent because he had nothing in his medical history to suggest a blackout would occur while driving.  If this is correct, then they made the correct decision.  

Unfortunately, there can be cases in which property is damaged but no one is negligent.  I know you did nothing wrong.  I empathize with your situation and it must be frustrating.  But they only pay you if their customer was negligent.  The fact that you were not negligent is not really relevant under the law in every state.  It matters whether he was negligent.

However, there appears to be some question as to whether or not the PTSD could have caused the blackout.  The only way to really figure this out would be to examine his medical records and then get a medical opinion from an independent doctor.  And you'd have to file a lawsuit and get this information during Discovery.  The cost would probably outweigh your losses.

If you have insurance coverage, then either Collision or uninsured motorist coverage might pay for your losses.