Personal Injury, Insurance Appeals, and Long-term Disability Case Results

A Federal Court jury in Alexandria, Virginia awarded one of BenGlassLaw's clients nearly four million dollars against a local urologist. The case, Williams v. Schwartz, represents one of the largest medical malpractice verdicts in Virginia.

In that case the plaintiff had gone to the doctor for implantation of a penile prosthesis. The plaintiff had been impotent due to vascular insufficiency and diabetes. Mr. Williams alleged that the doctor, in addition to performing the implant surgery, attempted to do a penile lengthening procedure on him without ever telling him! It turned out that this was the first penile lengthening procedure the doctor had ever done. The plaintiff alleged that the lengthening procedure lead to further diminution of blood supply to the penis and eventual loss of the penis in its entirety.

What the patient did not know at the time that he saw the doctor was that he had a history of malpractice claims and verdicts and that his license had previously been revoked by the Commonwealth of Virginia and that his privileges at area hospitals were either non-existent or limited. Further, the doctor had no insurance to cover the claim!

Our firm, together with my friend, Rob Jenner of Jenner Law, of Baltimore, Maryland represented the family of a 74-year-old man killed when he drove his car into the back of a tow truck that had stopped in the "fast lane" of southbound 495 in Prince George's County, Maryland.

The decedent was survived by a wife of almost 50 years and three adult children.

The case was filed in the Circuit Court of Fairfax County but, because it occurred in Maryland, it involved the application of Maryland law. The Virginia court ruled, however, that Maryland's "cap" on pain and suffering damages did not apply to this case.

Rob Jenner and his associate, John Cord, are to be commended for taking the laboring oar in this case which settled on the third day of trial for an all-cash payment of $2,000,000.

BenGlassLaw settled a very important case involving a 32-year old woman who developed fibromyalgia following an automobile accident. She was injured in an accident at Tyson's Corner, Virginia.

She was seen and released in the emergency department and then followed up with a chiropractor, an osteopath and an orthopedist. She never got better and eventually saw over 23 doctors and other health care providers, including at least five rheumatologists.

Each of the rheumatologists diagnosed her as suffering from fibromyalgia. She developed severe "all body" pain and ultimately needed a wheelchair to travel outside of the house. The defense experts were of the opinion that this was "only a strain" and that she needed no additional treatment.

Although the defendant had only $50,000 in insurance, our client was well protected by "underinsured" automobile insurance and we were able to settle her case on the morning before trial.

In August 2011, the defendant, who had been licensed for several weeks, was allowed by her parents to drive from Maryland to Williamsburg, where the family was vacationing. This was the longest solo trip ever undertaken by the inexperienced driver and she was not familiar with the route.

Once she reached Williamsburg she failed to observe a stop sign that was open and obvious and she struck the plaintiff's car broadside at high speed, causing it to overturn. The plaintiff, who was a elderly front seat passenger who had been belted in by his family, was ejected from the vehicle as it rolled.

He suffered numerous injuries, including multiple injuries to his hand and an amputated finger. After urgent surgery he was in a rehabilitation center for a month. He died about 90 days after accident due to unrelated causes.

The defendant had $100,000 in insurance coverage. The car that the plaintiff was traveling in had abundant uninsured motorist coverage. The case was settled after an all day mediation.

Our client worked in a sedentary occupation and had been paid benefits by Aetna life insurance company for just over two years. In October, 2013 Aetna terminated the benefits based largely on the results of a functional capacity exam (FCE). Once benefits were terminated the client had 180 days to appeal the denial. She retained us.

Once we obtained Aetna's entire claim file we discovered that after it had obtained the FCE it had hurriedly asked the client's treating physicians to comment. When we traced back the dates that letters were actually mailed and received (as opposed to when the insurance company said letters were mailed and received) he discovered that Aetna had given the treating physicians very little time to respond before issuing its final denial letter.

Aetna had also advised our client that she must apply for Social Security disability benefits. Even though those benefits were approved (paying her $2500 per month) Aetna said, in essence, "we are not bound by the Social Security Administration decision." Aetna however required that our client pay it back a huge sum of money based upon her receipt of "double benefits." (This is a normal process in group long-term disability claims.)

When we examined what actually occurred during the functional capacity exam and contrasted it with Aetna's conclusion about what happened we were able to point out dramatic differences. We researched the physical therapist who had conducted the functional capacity exam for Aetna and pointed out that he was literally brand-new to the profession having only been in business for three years.

We pointed out that previous experts that Aetna had hired had all agreed that our client was disabled. We argued that there was no material change in her condition which should have caused Aetna to terminate her benefits. We did an in-depth study of her entire record.

We then obtained additional new medical information and comments from others who had been able to witness the level of activity that our client was capable of engaging in. We also prepared a detailed study of the medications are client had to take because of her chronic pain and their effect on her capacity to be employed.

Finally, we pointed out that Aetna cannot arbitrarily ignore the comments and conclusions of the treating physicians.

Because of the reversal of Aetna's termination of benefits our client will receive approximately $500,000, payable monthly, to age 65.