Aunt who sued her 12-year-old nephew says insurance rules forced her hand

[jberryhill]

One thing I would suggest, whenever you see news of "that outrageous frivolous lawsuit" that some awful person filed somewhere, is to step back and to think about what else might be lurking outside of the picture that has been framed for you by the media.

Even if you have health insurance, if you suffer an injury and there is the potential that the injury occurred under circumstances where another insurer should cover the injury, you will find yourself trapped between forces beyond your control.

You might have the best health insurance in the world but if, say, you are injured in a car accident, then it's up to the auto insurance of the responsible company to deal with claims arising from your injuries. If the health insurer says the auto insurer should pay, and the auto insurer says your injuries were not caused by the accident, then the only thing that is going to resolve which insurance company ends up paying the bill, is a lawsuit which either does, or does not, assign responsibility for your injury to the auto insurance policyholder.

In this iteration of the trope, a lot of people wanted to know "why didn't she sue the insurance company" or "why didn't she sue the homeowner". The answer, quite simply, is that the named defendant has to be the covered person who caused the injury, in this instance the nephew in question.

And, as Paul Harvey used to say, the rest of the story:


http://www.washingtonpost.com/news/morning-mix/wp/2015/10/14/aunt-who-sued-12-year-old-says-insurance-claim-rules-forced-her-hand/?tid=pm_national_pop_b

Jennifer Connell, 54, said that she was forced to sue her nephew, who was 8 when the accident occurred, because it was the only way to get her homeowners insurance policy to pay for the cost of her care.

“This was meant to be a simple homeowners insurance case,” Connell told CNN. “Connecticut law is such that I was advised by counsel that this is the way a suit is meant to be worded.”

According to Connecticut law, the insurance company couldn’t be named in the lawsuit, so 12-year-old Sean Tarala was named as the defendant.

...

Connell’s insurance company offered her $1, her lawyers said. “She suffered a horrific injury,” they added. “She had two surgeries and is potentially facing a third.”

[Warren DeMontague]

1. Did they force her to complain in court about not being able to "hold the h'ors douevres plate?"

Sure, now that she's logged onto the internet and seen all the people calling her another glaring example of spoiled, out of touch manhattan asshatterry, yeah, i bet she wants to "clarify"

[jberryhill]

6. Do you think her injury is limited to hors d'oevres plates?

Or do you think that was a bad recent example she used when the media glare - prompted by the rightwing "tort reform" machine - was suddenly turned on her?

How do you suppose this case came to national media attention?

Do you suppose there are intrepid reporters from the NY Daily News et al. who lurk around the dockets of local courts in Connecticut, and read all the filings that come in?

A case like this getting the spotlight turned on it, requires a certain amount of pimping by someone who wants the story pimped.

You are being manipulated, and don't realize how. There is a media machine which wants you to believe things about civil litigation that are distorted and untrue.

But... hey... she said "hors d'oeuvres plate" ahahahahhahahahahaha....

Is her wrist injured? Was coverage denied for her injuries? Are we ever going to get comprehensive health care reform in this country, to get out of this madness?

[Hoppy]

17. Regarding your 4th question, Yes.

Reporters do hang around court houses. As a corollary, the cases on Judge Judy and so forth, come from staff who hang around court houses and question people who are filing claims.

My boss was interviewed by one of those people.

[jberryhill]

8. Lemme give you an example of this

What is more interesting to you, intellectually and/or personally:

1. A legal dispute in Connecticut over claimed $127,000 damages arising from a situation that, at most, affects three people.

2. A legal dispute over a website that cost more than $127,000 and affects your right to use the word "Cambridge" as a geographically descriptive word.

Which case did you hear about this week? Why do you suppose that is?

[Warren DeMontague]

29. none of it is all that interesting.

But this is hardly a "woman sues mcdonalds over hot coffee" type case- where someone actually had a good lawsuit that was turned into some example of something it wasn't by the media.

No, this seems like a stupid-ass move by someone particularly tone deaf, who is now trying to walk it back due to negative exposure.

I could be wrong, of course.

[LiberalElite]

31. IMO maybe she should have been prepped better by her atty.

I did understand the complaint about it being difficult to climb the stairs to the 3rd floor apt. I've seen sardonic comments about how you don't need wrists to climb stairs. These people must not have ever lived in a walkup. I lived in a 5th floor walkup and stairs in this kind of building tend to be fairly narrow and sometimes rickety. If the bannister was on the same side as her injury it was apparently difficult for her to hold on. I always hold on to the bannister on stairs.

[Hassin Bin Sober]

2. Even liberals fall victim to the "frivolous out of control lawsuits" meme.

How many people here still think the McDonald's coffee case was somebody suing over a boo boo.

I don't think people realize how aggressive the health insurance companies have become in trying to discover other liable parties.

I don't recall, in the past, ever having to sign an affidavit stating my ER visit wasn't the result of an accident - or did it take place in someone's home. But that seems to be common now.

[PeaceNikki]

3. Amen.

To all of this.

[demmiblue]

5. +1

[riderinthestorm]

13. + another 1 nt

[Warren DeMontague]

30. No, the McDonalds coffee thing was totally different. Skin Grafts, 200 degree coffee & crotch burns

combined with willful negligence on the part of a corporation, which was the target of the suit.

That is markedly different from suing an 8 year old over a hug which screwed up a manhattan socialite's ability to hold the hors d'ouerves plate.

[riderinthestorm]

32. The analogy is that the media decides the meme

and runs away with that "story".

So the McDonalds hot coffee case was falsely turned into something frivolous.

This case was falsely turned into a money grabbing case against a child (when it was essentially a dry insurance dispute devoid of emotionality between aunt and nephew).

The lesson is to never take the MSM's story at face value when presented with sensationalist headlines. Do some research if it's too facile.

[Hassin Bin Sober]

33. So this case is about multiple surgeries, scars, pain and permanent consequences.

And the ultimate target was a corporation (the home owner's insurance company). Btw, the ultimate target of the McDonald's case was their insurance carrier.


One was a "hug" - the media driven portrayal which, from what I read, could be more accurately described as a "tackle"


The other was a "boo boo oh poor baby spilled coffee" - if you want to believe the media portrayal (I don't).

[Warren DeMontague]

34. So you do want to blame the 8 year old. Own it.

Beyond that, what the fuck is a homeowners insurance company supposed to have to do with medical bills? Isnt that what health insurance is for?

[Goblinmonger]

36. Read your homeowners policy.

It is written to cover these things. In case you are confused, check under the liability sections.

[Warren DeMontague]

37. It would appear that no matter what any of us here think, it took about 25 minutes for a jury to

Disagree.

Maybe next time she should leave out the thing about the hors d'ouevres.

[riderinthestorm]

39. No, the jury threw it back to her health insurance to pay up

I had a simple wrist fracture. It cost $57k to repair 10 yrs ago.

My wrist is still not right. Its never regained the strength and mobility as before.

I have no problem thinking her $127k is valid and her insurance company decided to try to find someone else to pay.

Now its on them to pay her bill

[jberryhill]

43. You still aren't getting it

NOW her health insurer will cover it.

The way this works is that if your health insurer can point to ANY other insurance - auto, home, whatever - that *might* have to pick up the tab, they will deny coverage.

The jury verdict only establishes which insurer has to pay.

That's why juries aren't allowed to be told this.

Juries are INTENTIONALLY kept in the dark, and made to believe they are determining who is responsible. If they realize that their time is being eaten up on behalf of the respective shareholders and underwriters, they would walk the fuck out.

Our crazy health and social services system makes us pawns in a game played between the insurance companies, and necessitates these nutty lawsuits.

[area51]

54. ^ This.

"Our crazy health and social services system makes us pawns in a game played between the insurance companies, and necessitates these nutty lawsuits."

GingrichCare keeps the current rightwing insurance cos. in charge of deciding whether to pay health care claims.

[Warren DeMontague]

55. Ah. Well, then, I guess everybody wins.

Her health insurance should have covered it from the get-go, of course.

[jberryhill]

60. Right, but health insurance companies are hunting for denials if there is other insurance

"From the start, this was a case was about one thing: getting medical bills paid by homeowners' 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," a statement from Connell's law firm Jainchill and Beckert read in part.



That's them. There is no personal animus.

[Warren DeMontague]

62. Fair enough. I was wrong.

I'm a very insensitive man.

[jberryhill]

63. No worries - it's insidious what they do with these stories

These types of suits are popularized in a way to obscure what is actually going on in the larger picture.

Your gut reaction, and most others, is the intended one.

Watch for it when the next one comes around.

Some of the same people on DU, too:

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x4592436

4-Year-Old Can Be Sued, Judge Rules in Bike Case

Normally, nobody goes around suing small children, but if it makes a difference to whose insurance ends up paying out, then you are not even seeing a court battle among the individuals involved, but you are seeing a contest between two insurance companies which have subrogated the claims of all of the people involved.

And what I always find fascinating in these threads is that the "damn lawyers", "damn judges", or "damn whoever" take all of the heat, and not the damnable system that causes this - lack of comprehensive medical, rehabilitative and social insurance.

You just don't see this in other countries, and it is written off as "Americans like to sue each other". No we don't.

Years ago, I was at a conference in Belgium and the conference center had a concrete plaza at the entranceway, with a really badly placed uneven curb near the doors. It's hard to describe, but in a nutshell, it was a trip and fall hazard that you wouldn't really expect to see at a facility like that.

I was hanging outside with a Belgian lawyer and said, "Now there's a lawsuit looking to happen."

"What do you mean?"

"That curb. Someone could trip and hurt themselves."

"Yeah, they might if they aren't careful."

"...and then they'll sue the pants off of the owner."

"For what?"

"Medical expenses for a broken elbow, for one."

He just looked at me funny and asked, "Why would the owner have to pay someone's medical expenses?"

[Ms. Toad]

47. The jury determined the nephew was not negligent.

Without negligence, there is no legal basis for the health insurance to refuse to pay.

The whole point of the litigation was to determine whether it was an accident - or negligence on the part of someone covered by a policy other than health insurance.

[Hassin Bin Sober]

40. Oh for fuck's sake. You are usually more level headed than this.

(Meaning you you usually have a position I agree with. Lol)

I never said the kid was at fault.

I have no idea what the particulars of the case are.

But...

I will say this. I understand a homeowner's policy is not "my insurance" for any and all injuries I receive while on someone else's property. I have a friend who always jokes about suing my condo association if she falls on our back stairs. It's kind of a running joke. After I tell her, ... if she falls, I'll just drag her out to the street and say a CTA bus hit her, ... I tell her we aren't her insurance policy and there has to be some failure of our duty maintain stairs so as not to have a dangerous condition causing her to fall.

That said. The lady in the article showed up at their house and got knocked over by an eight year old and ended up with a rather serious injury and two, maybe three, surgeries. It's not like she tripped over her own shoe laces (or maybe it came out at trial and she did and that's why she lost).

Heck, it really isn't that crazy to assume that MAYBE the kid acted recklessly, even for an eight year old. Hell, I have a 6 year old nephew who is the biggest kid in his class. I can only imagine how big the bruiser will be when he is 8. And I hope, by 8, he realizes he can hurt someone. He sure didn't (I hope) know when he hit me in the cookies when he was 3. Little fucker had me in tears.

[Warren DeMontague]

57. He's eight, or he was, that's the point.

8 year olds are kind of reckless by definition.

I learned real early on not to bend over and kiss my kids on the tops of their heads- I learned this with the first one, actually- because inevitably, if I did so, my well-intentioned display of affection would be met with a perfectly timed jump, driving the hardest part of kid cranium right up and into the softest part of my nose.

Not the sort of mistake you want to make repeatedly.

Look, I don't pretend to understand the insurance industry or its weird relationship with Connecticut law. And this is hardly the DU hill I want to die on. But whatever was behind the Kabuki theater that this thing apparently was, I think it's safe to say that the kid was probably the least at fault. It sure doesn't sound like he was being malicious.

[abelenkpe]

4. I love all the posts defending insurance companies

Lawyers and our f'd up judicial and financial industry that this story has provoked.

[jberryhill]

7. I certainly don't defend the insurance companies in this

Next time someone's civil rights are violated, call a plumber for help. Lawyers suck.

[abelenkpe]

16. Yeah sorry

I'm not saying you're defending this convoluted system. Was a more a general remark concerning those trying to explain the necessity of such a ridiculous suit without admitting that people could be and should be outraged by such a reality.

[Hassin Bin Sober]

25. The people defending the insurance companies are the people saying she.....

...... should just eat the medical bills and take one for the team.

Either way the case is decided, an insurance company is paying the bills.

Without a lawsuit, both insurance companies get to point at the other guy and not pay anything.

[abelenkpe]

41. That's what's so crazy

She had insurance. They (insurance companies) shouldn't be allowed to waste the court and people's time passing the buck. That's what's outrageous. And you're right, she shouldn't pay. The second an individual pays the bill there is little chance of being reimbursed.

[jberryhill]

42. The necessity is driven by lack of a sane health care system

Everyone complains Americans are "too litigious".

No one seems to notice that, at the heart of all these personal injury suits, are claims for medical treatment.

With sane health and social insurance systems, these lawsuits go away.

[abelenkpe]

49. That does seem like a better solution. Nt

[jberryhill]

51. It is the solution obscured by the way these cases are reported

...and the way that people react to the reports.

This trope appears at least five times a year on DU.

[former9thward]

53. Finally something you said I agree with.

They certainly sucked in this case. It was a scam for money. As in Greed.

[Ichigo Kurosaki]

9. It's up to the insurance company

to sue to recover costs usually, not the insured.
But maybe things have changed since I last made a claim a long time ago.

[PeaceNikki]

10. I assume you're a practicing attorney in Connecticut?

[jberryhill]

11. That is simply not correct

Insurance companies pay, or don't pay, based on whether underlying liability of the parties has been established.

My health insurance company is not going to sue your auto insurance company over whether my injuries were caused by your running me over with your car. In order to determine whether you caused my injuries, you and I are "indispensible parties" to an action to establish that sort of liability.

Now, a lot of times, the insurance companies will settle between each other on these kinds of things, but when they don't - as happened here - the actual parties are going to court.

[Snobblevitch]

12. Many years ago I got a fax by mistake.

It was from a law firm and intended for another law firm. The son of an NBA legend and hall of famer was suing his mother. It was a long fax and I only glanced at it because I did not want to get mixed up in their business. I called the law firm that sent the fax and told them what happened. I put the fax into an envelope and mailed it back to them. The odd thing is, several years earlier, I had met both the NBA player and his son at a local function. (Hint, the player was a former Laker and helped them win several NBA titles.)

[muriel_volestrangler]

14. So she wanted her own homeowners insurance company to cover an accident at another home?

No wonder they won.

Why is her health covered by her homeowners insurance, and not her health insurance?

[jberryhill]

20. No

Her health insurance company wanted the homeowners insurance company to pay for injuries sustained at a home other than her own.

Your homeowners insurance policy covers what happens to other people, not you.

[muriel_volestrangler]

22. Your OP: " it was the only way to get her homeowners insurance policy to pay"

so this is about her homeowners insurance policy covering what happened to her. There's no health insurance company mentioned in the article.

[jberryhill]

23. Jesus

That is quoted text from the article. The article contains an error which you have discovered.

There is a long previous thread on this lawsuit, and this article is a follow up with additional details not hashed out previously.

If this country has a sane approach to health coverage, none of this class of lawsuits - of which this one is typical - would be needed.

[muriel_volestrangler]

24. There are previous threads, which have to assume there were multiple insurance companies involved

because there seems to be some form of omerta that says "you cannot admit this is a dispute between insurance companies; instead, you must pretend the catspaws are the actual people bringing the ridiculous lawsuit". It's not just the health coverage that's bad, it's the legal system. So you are still having to guess there's a health insurance company involved in this.

[jberryhill]

69. "It's not just the health coverage that's bad, it's the legal system"

With universal health coverage, and paid medical leave, the legal system wouldn't have anything to do with the vast majority of these types of cases.

[pugetres]

15. "because it was the only way

to get her homeowners insurance policy to pay..."

That confuses the heck out of me. Why would she file an insurance claim on her personal homeowner's policy rather than with her health insurance provider?

[jberryhill]

21. That is an error in the article

It should say "the" homeowners insurance policy.

[Warren DeMontague]

35. Okay, same diff.

Why not a health insurance company? Isnt everyone supposed to have health insurance, now, under the ACA?

[jberryhill]

38. Health insurance does not pay if primary insurance is elsewhere

I am coming to realize that there are basic principles not widely known.

I have auto insurance. You have health insurance. If I hit you with my car and break your leg, who ultimately pays your medical bill?

(A) your health insurance

(B) my auto insurance

Please choose A or B.

[Whiskeytide]

45. You're right. Most people don't really...

... understand how this works. In Alabama, your health ins will usually pay for your treatment and then seek its subrogation interest through your claim against the responsible party. They have teeth. If I settle a case and don't resolve the subrogation lien from the settlement proceeds, my firm can be liable for it.

But what I'm seeing A LOT of now is medical practices refusing to accept your health ins (which pays them a greatly discounted amount) if they think they can get full payment from a responsible party's liability coverage. They usually back off when I send them a nasty letter, but I wonder how many accident victims don't hire a lawyer, settle themselves, get a check from a negligent driver's carrier and then just assume they have to use it to pay a radiology group $2,500 for an MRI that their health carrier could get for $700.

[jberryhill]

48. Meanwhile...

...people don't seem to notice that personal injury suits, like baseball, are not as popular a sport in Europe, and don't know why.

[Warren DeMontague]

58. No, I get it.

Obviously, though, you agree that there's a difference between me hitting you with my car and my house hitting you with my kid's hug.

[closeupready]

18. I believe it. A friend of mine had an almost identical experience.

But I didn't speak up before (in the other thread) because I've learned on this board that many here enjoy being outraged and scapegoating those who the corporate media wish to paint as the REAL villains corrupting our society, rather than see how people adapt to a crooked system, not so as to feed the corruption but rather to SURVIVE.

Interesting side discussion.

Anyone here ever seen "Claudine"? PERFECT example of a woman who felt forced to contrive a life which met the minimum standards of qualifying for welfare even when those standards demanded that receipients, basically, live in very broken homes.

[irisblue]

50. my mom & us were on welfare(Aid to Dependant Children & Families) in the early 70s

that movie was true to life

[closeupready]

61. Really? It was the kind of film that, while on the surface a romantic comedy-drama,

really spoke to life at the time in minority America. If you feel like it, could you share a typical example of how you survived on welfare then? I'd be very interested to read. Thanks, irisblue.

[Atman]

19. Thank you for a level-headed response.

The moment I read this story I knew I was only reading half of it.

I live in Connecticut, The Insurance State, and this happened in one of this wealthy state's wealthiest communities. Something didn't add up. But you're absolutely correct. I find it highly doubtful that Aunty would actually sue her own nephew just because it hurt when she carried a tray of canapes.

No insurance company wants to pay out if they don't have to. That is what the gamble is all about. Cutting/eliminating losses. So she got her medical care, filed her claim, and her insurance company saw the deep pockets of the New York City/Southwestern CT suburbanites and said "Why do we have to pay for this?" So they went after the people who could.

To be fair, I saw the pictures of the homes of the people involved. No one looks very "rich," at least by Greenwich standards. But still, the actuaries have their tables and their maps and their financials...their job is to prevent The Company from actually having to pay out on the claims which are filed.

I don't really believe this woman maliciously went after her nephew in court. More than likely her hand was forced (so to speak). We all love to hate on people who seem nasty (the drunk UCONN bacon mac & cheese kid added on top of this hasn't helped our state's image), but this looks more like a case of Giant Mega Insurance Co. not wanting to take a loss.

Of course, I could be wrong.

[Texasgal]

26. My husband was once involved

in a pretty serious car accident that required knee surgery. He was not at fault. We had to sue the insurance company for payment for injuries. We were not looking for anything else but. We had to go to court and had a jury trial. It looked horrible that we were suing a little old lady that had just recently lost her husband to cancer! The jurors were not allowed to know that we were suing her insurance company for medical bills only.

We won the case, but it looked really bad. I hated every minute of it.

[jberryhill]

27. Yep

The insurance companies are like thunderdome spectators.

[kcr]

28. Or maybe not

http://www.newstimes.com/news/article/Boy-gets-his-cake-and-can-eat-it-too-6571044.php

But a number of local lawyers questioned why Connell hadn’t simply named the boy’s father as a defendant and claimed she was hurt in his Westport yard, making him eligible to collect on insurance. After all, when Connell went to Norwalk Hospital shortly after the March 18, 2011, incident, she told doctors and nurses she had fallen and injured her wrist — with no mention of the boy’s alleged participation.
“It is odd,” Bridgeport lawyer Frank Riccio II said about naming a minor as sole defendant in a civil case. “I’ve never seen it done before. Normally you would sue the homeowner.”

Seems fishy to me.

[peapodsss]

44. meh

still a petty move

[jberryhill]

46. You have tens of thousands on hand for orthopedic surgery?

That's cool.

Most people don't.

[pnwmom]

52. I still don't understand. The accident occurred at the nephew's house.

So why would she ever expect HER homeowners policy to cover it?

From your link:

Jennifer Connell, 54, said that she was forced to sue her nephew, who was 8 when the accident occurred, because it was the only way to get her homeowners insurance policy to pay for the cost of her care.

[jberryhill]

59. It is an error in the article

They used an incorrect pronoun.

[pnwmom]

67. Pronouns matter, as any lawyer knows. That pronoun mistake changed

the meaning of the sentence entirely.

It might have been worth correcting the error in your OP, since apparently you were aware of it all along.

[jberryhill]

68. I don't change what someone else wrote

News copy is a shit show these days.

I had read right over that error since the facts of where it happened, and thus whose insurance company is being a dick, are obvious.

[jberryhill]

64. You didn't understand it five years ago, either

It was explained several times in the "tricycle runs down old lady" lawsuit thread, back in 2010

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x4592436

It's common for insurance companies to be subrogated to the rights of their insured, and to "step into the shoes" of the insured for purposes of pursuing litigation. Here's how it works.

Suppose the elderly lady had insurance which covered her medical care which resulted from the accident. Let's say they paid out $150,000 for her resultant care. To the extent they make such payments, they likely own the right to stand in her shoes for purposes of seeking recompense of those dollars. They first make demand upon the insurer for the little girl's parents, and when that is turned down, they file suit in the lady's name, but they are the real party at interest. The elderly woman's health insurer could be pursuing this claim in her name, but for their benefit.

Or, suppose the real party at interest is the hospital. Imagine the hospital bill is huge, and her estate cannot pay. The estate makes a deal with the hospital whereby it assigns the rights of the estate to the hospital, and agrees to cooperate with the prosecution of the civil claim for damages against the child and her parents (and their insurer).

The result is a lawsuit in which the named parties are the little girl and the elderly lady, when in reality, it is a fight between two insurance companies over which side will pay the loss.

Insurance subrogation cases are common. Most of the time, no one except those involved in the suit know this about the case. It is typically forbidden to disclose to the jury such arrangements, because insurers want the jury thinking about the little girl or the elderly woman, not Allstate versus State Farm (names picked only for their high recognition and market penetration).

It's all driven by our crazy health care system.

[pnwmom]

65. No, that error was specific to this article and has nothing to do with the old case. n't

[jberryhill]

66. Okay, but

When you see the next "crazy lawsuit" thread, bear in mind that there are usually two insurance companies lurking in the shadows.

That explains 99% of the "OMG crazy lawsuit" news articles.

[alexeus]

56. Sad but true

This is how things work. Insurance companies do all it can to not pay. The sad part is that normal people suffer and have to fight for what they should normally get without any conflicts or problems.