Pre-existing Conditions, Total Loss – $500,000

Our client was involved in a major motor vehicle collision that ultimately produced a full-case recovery, but the claim was complicated by a substantial and questionable medical history. The insurance paid its primary limits of $30,000 early in the claim, leaving a secondary underinsured policy of $470,000 as the remaining exposure.

Negotiations began with an initial offer of $18,492.68. Through persistent advocacy and a clear presentation of the facts and medical chronology, we obtained improved offers of $175,000 and then $185,000. The adjuster then demanded ten years of prior medical records; those records were not produced. While negotiations continued, our client sustained a separate premises injury and continued treatment through the VA, where he ultimately underwent an ablation. We consistently maintained that prior records were unnecessary given the nature of the impact and the medical documentation already on file substantiated a policy-limit recovery. The continuity of VA care, together with the later production of additional records, allowed us to present a targeted supplemental demand tying the ongoing treatment and procedures to the collision and demonstrating the need for further intervention.

After the supplemental demand and submission of the additional records documenting continued care and the ablation, the carrier agreed to tender the remaining Underinsured motorist policy limits of $470,000. Combined with insurance’s $30,000, the gross policy recovery for the file totaled $500,000. The case demonstrates that even when a claimant has prior surgeries and a cluster of pre-collision falls, issues the defense will aggressively mine, persistent documentation, a clear treatment chronology, and timely supplemental demands supported by objective procedure records can materially change an insurer’s valuation and produce a full-limits recovery.