December 27, 2006
Persistence Yields $200,000 in Found Money for a Massachusetts Insurer
IRG recently obtained a $200,000 recovery for an insurer on a Massachusetts second injury fund claim that had not been pursued by either the claims adjuster or defense counsel.
The claim involved an employee who suffered a fatal heart attack during the course of his employment and over $500,000 was paid to the widow by the insurer.
The insurer was eligible to recover $220,000 from the state second injury fund if it could be established that the employee's death had been caused in part by a pre-existing condition and that this pre-existing condition was known to the employer prior to the death. At the time of settlement of the claim, neither the claims adjuster nor defense counsel had identified nor pursued the recovery opportunity.
As part of a regular, free, on-site file review, IRG identified the recovery opportunity. Success was contingent on proving that prior to the employee's death, at least one person with managerial authority had been aware of a prior heart condition. Among the obstacles to proving this were the facts that the company owner was deceased and the widow was less than cooperative. Undeterred, IRG contacted one of the employee's former co-workers who supplied the name of the employee's foreman. After tracking and finding this foreman through the local Electrical Workers Union, IRG learned that he was unaware of the employee's previous heart condition. However, this foreman was able to provide the name of a superintendent who provided a sworn affidavit indicating that he had been aware of the employee's heart condition prior to his death.
After obtaining the required expert medical opinion, and organizing a detailed proof of the claim, IRG was able to negotiate a recovery of $200,000, an outstanding resolution that was essentially "found money" for this insurer.
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