Traumatic brain injuries can cause a lifetime of problems. Michigan law requires no-fault providers to pay for medical expenses related to auto accidents – no matter how long after the crash they happen. But insurance providers like to object. When that happened to Joseph Weir, Macomb Law Group was there to defend his insurance claims all the way to the Michigan Court of Appeals.
1996 Traumatic Brain Injury Leads to Decades of Medical Care
In 1996, 14-year-old Joseph Weir fell from the back of a pickup truck. His head struck the ground causing a non-depressed skull fracture, brain hemorrhages, and a closed head injury. He was in the hospital for 10 days. Joe’s family filed a personal injury protection (PIP) insurance claim and Allstate paid some benefits until 1999.
Then in 2012, Joe overdosed on Ambien and was admitted to a psychiatric hospital. Once he was released, his sister’s coworker heard her crying and asked why she was upset. Joe’s sister told her coworker that Allstate was not providing Joe and his family any help. Coincidently the coworker’s wife was a nurse case manager and the family hired her to help Joe obtain treatment for behavioral and emotional instability. He received psychiatric counseling, vocational rehabilitation, and recreational therapy. Joe’s mother, Brenda, who had been his full-time caretaker since the accident, finally had some help. Since the accident Brenda was responsible for “his daily everything”, and slept “with one eye open, one ear to the wall” to keep him from hurting someone or getting out of line. His psychiatrists said that his problems were the result of his traumatic brain injury in 1996.
Insurance Claims Denied for Ongoing Traumatic Brain Injury Treatments
But this time, when Joe and his family asked Allstate to pay his medical bills, and to pay Brenda for her work providing attendant care, the insurance claim was denied. Allstate claimed both that his mental health problems existed before the accident and that they developed because of injuries between 1999 and 2010. Joe came to Jim Spagnuolo of Macomb Law Group for help, and our auto insurance claim attorneys went to bat with the insurance company, fighting the insurance claim denial.
A Battle of Experts Over the Cause of Mental Health Problems
Joe’s case came down to the testimony of expert witnesses on both sides. Attorney Spagnuolo worked with Joe’s treating physicians to establish that his mental health problems were the result of the pickup truck injury. Physiatrist Todd Best, MD, neuropsychologist Ray Kamoo, Ph.D., and psychiatrist Eugene Rubin, MD, all provided expert testimony that in their medical opinion, Joe’s problems stemmed from the 1996 auto accident and his traumatic brain injury.
But the insurance industry has paid doctors of their own. Two of these medical examiners offered their opinion that Joe’s mental health issues and his injuries were unrelated. Instead of looking at causes, these witnesses disregarded objective testing and testified to symptoms of paranoid ideation, suspiciousness, and antisocial personality traits. One witness claimed this meant Joe suffered bipolar disorder that emerged later in Joe’s life.
Joe’s doctors won out. The jury found that Allstate should pay for Joe’s medical expenses and attendant care costs, with interest. Then Allstate chose to ignore the jury verdict and appealed to the Michigan Court of Appeals claiming, among other things, that the experts’ testimonies were flawed and inadmissible. The insurance company was able to dig up some facts that tended to show Joe wasn’t perfect before the crash, and that he had hurt himself in between 1996 and 2012.
But Macomb Law Group won again. In a recent unpublished opinion, Wier v Allstate Insurance Company, Docket Nos. 334773 and 335167 (March 13, 2018), the court found that the doctors’ testimony was properly admitted. The other evidence created an issue of credibility for the jury to decide, not admissibility. Allstate hadn’t presented any evidence to connect these unrelated facts to Joe’s mental health or the development of his injuries. The court said that evidence was insufficient to undercut the doctors’ authority, and the jury’s verdict should stand.
Read More:
- Plaintiff-Appellee Wier Brief by Macomb Law Group
- Def Appellant Allstate Brief
- Weir v Allstate Court of Appeals Decision
Defending Traumatic Brain Injury Patients’ Claims is an Ongoing Battle
When traumatic brain injury causes ongoing medical issues, it can feel like the lawsuits will never end. Jim Spagnuolo and the Macomb Law Group attorneys know what it takes to win that fight. We stand with you, from the initial insurance claim to the final court decision, even through the appeals. If you or a loved one have suffered a traumatic brain injury and are facing an insurance claim denial, contact Macomb Law Group and get our team working for you.
