It took nine years, but a Pennsylvania man finally has resolution for a 2002 neck injury he suffered in a car crash while on duty as a police officer. He has since been unable to work, has racked up extensive medical bills, and has been stuck in litigation with an insurance company for many years.
The officer’s employer had purchased workers’ compensation insurance, which paid two-thirds of his salary. The officer also received one-third of his salary from Sugarcreek Borough and $25,000 in auto insurance coverage on the car that caused the accident. Unfortunately, the officer’s costs were significantly higher than the benefits he received.
In response to ever increasing medical costs, the officer sought to recover under an underinsured motorist policy issued to his employer by a local insurance company. According to USA Today, nearly 14 percent of drivers in America lack any insurance, much less adequate insurance, so such policies are prudent for employers whose employees drive a significant amount. In Pennsylvania, a driver is only required to have $15,000 in coverage for injuries to another person.
If successful, the officer would be entitled up to the $100,000 in coverage per incident. His claim was denied because the policy had an exclusion clause, which stated no one could recover under this policy if they were eligible for workers’ compensation benefits.
Lengthy Litigation Ensues
The officer brought his claim to court, originally winning at trial before an appellate court reversed the ruling and found in favor of the insurance company. He then appealed to the Pennsylvania Supreme Court – by this time several years had already passed.
The officer argued that the exclusion was contrary to public policy, because most claims under the policy would be brought by someone eligible for workers’ compensation benefits, thus making the coverage illusory. The Pennsylvania Supreme Court agreed, adding that the insurance company had received a windfall by charging a premium for the coverage that would almost never be applicable.
In the end the officer received the compensation he needed to cover the costs of the accident. However, similar litigation is not uncommon as many insurance policies have multiple exclusion clauses. Therefore, anyone who has been injured on the job or needs help with a workers’ compensation claim should speak with an experienced lawyer immediately to discuss their rights and legal options. It would also be wise to have your coverage reviewed by a lawyer with experience in automobile accident claims.