Opinion ID: 1206059
Heading Depth: 2
Heading Rank: 1

Heading: Loss-of-Earnings Claim

Text: On June 17, 1982, Filasky was injured in an automobile accident while working and while a passenger in her own automobile driven by her friend, Charles Buff. She was hospitalized for approximately two weeks during which time she was absent from work. Filasky filed a loss-of-earnings claim under the following provisions of her automobile insurance policy: Loss of Income Benefits To pay eighty-five (85) percent of loss of income resulting from bodily injury, sickness or disease, caused by accident, for the period of continuous total disability beginning the fifteenth day after the accident and terminating one year and fourteen days from the date of the accident or at death, whichever occurs first, not in excess of $750.00 per month.       Other insurance Insurance afforded under Part II [which includes Loss of Income Benefits] shall be excess insurance over any benefits the injured person has the right to receive under any Workmen's Compensation Law. On July 19, 1982, Gordon visited Filasky and had her sign two release forms. One form authorized Filasky's employer to release information; the other form authorized medical personnel to release information. Preferred Risk never exercised its authority provided by these forms until after Filasky initiated legal action in May 1983. Preferred Risk also never requested Filasky to directly furnish it with her doctors' records. At some time after July 19, 1982, Gordon learned that Filasky was receiving workers' compensation. He then requested medical information from the State Compensation Department because [i]t's usually a good source of getting the entire medical picture and faster than getting information from physicians, who, Novak testified, are notorious for being dilatory in submitting reports. At Preferred Risk's request, Filasky permitted Dr. Sidney Stovall to conduct an independent medical exam on September 17, 1982. Stovall concluded that Filasky's physical complaints were subjective in nature and was unable to demonstrate any objective evidence of any injuries being present.... I feel that the patient is physically able to return back to her normal occupation at anytime, and would not anticipate any permanent impairment resulting from the injury of 6/17/82. Preferred Risk received Stovall's report on September 27, 1982. During Novak's deposition, he said that he believed on September 27, 1982, that Filasky was entitled to some lost-income benefits. When asked why benefits had not yet been paid, he responded: Because there was the question of how much. He also admitted that he knew Filasky had not worked since the accident and was receiving workers' compensation. In a letter to Filasky dated October 1, 1982, Novak wrote: I have just been informed by our Home Office that your policy had been changed to a Standard form two days before this accident. With the change of policy form, there would be no loss of earnings benefit. If you feel there was some error made in making this change, please immediately contact both the agent and myself. The letter also summarized Stovall's conclusions which, per Novak, precluded recovery of lost income regardless of the type of policy. The letter did inform Filasky that another independent medical exam could be conducted at her request if she disagreed with Stovall's findings. Novak attached a copy of Stovall's report to a letter to the State Compensation Department dated October 1, 1982, in which he requested whatever medical records and reports that you may have so that we can have our medical consultant review them. Gordon's earlier request for medical records had gone unanswered. Filasky's attorney contacted Novak in October and informed Novak that he believed his client's policy covered lost earnings. Novak then checked with his superiors who subsequently confirmed in November or December that Filasky's policy did provide loss-of-income benefits. He informed Filasky's attorney of the mistake and said he would continue attempting to obtain medical reports from the State Compensation Department. During the summer and fall of 1982, Filasky's physician was Dr. Frederick Snyder. It was Snyder's opinion that Filasky should not return to work until October 18, 1982, and then only for five or six hours each day. She returned to work in October and worked three to five hours daily for approximately five weeks. Because she could not handle the stress load and work load, her employer terminated her when it reduced its work force. Novak made a second request for medical information from the State Compensation Department in a letter dated March 21, 1983, and a third request during a telephone conversation on May 6, 1983. He discovered during the telephone conversation that Filasky was still receiving workers' compensation. On May 16, 1983, Preferred Risk issued a check for $1200 to Filasky for lost wages from the fifteenth day following her accident through the date of Stovall's exam. Filasky commenced legal action on May 18, 1983. Only after litigation ensued did Preferred Risk seek medical records directly from Filasky's physicians  even though Preferred Risk knew as early as October 1, 1982, who her physicians were. Preferred Risk requested the medical information in July 1983 and received it during the following three months. Based on its review of the medical records, Preferred Risk issued a check for $7800 to Filasky on November 21, 1983, for the remainder of lost-income benefits due her.