Insurance For Injuries

Young athletes in Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, Irving, Cleburne, Mesquite, Garland, Weatherford, and other places in Texas, usually have some sort of insurance coverage in case they get injured when involved in school sporting events. But exactly what does this coverage provide?
A student athlete in Clark County School District in Nevada, is finding the answer to be “not enough.” This is in an article published by the Las Vegas Sun and written by Steve Green. The article, titled, “High School Football Injury Sparks Lawsuit Over Insurance Coverage” was published on December 1, 2010. The athlete is LaQuan Phillips, who was a Green Valley High School football player who got injured in a game on September 5, 2008. Phillips suffered a spinal injury and has incurred more than $195,000 in medical expenses, which does not include future medical expenses and rehabilitation recommended by his medical providers. This figure also does not include compensation for Phillips pain and suffering and/or lost quality of life.
The insurance policy at issue in this case was issued by National Union Fire Insurance Company of Pittsburg, Pa. The policy is issued to the school district and is suppose to cover student athletes, cheerleaders and students in non-sports extracurricular activities and provides up to $2.5 million in coverage.
According to the article, attorneys for Phillips filed suit against National Union and the school district after a demand was made for the policy limits of $2.5 million.
The lawsuit alleges breach of contract and the implied covenant of good faith and fair dealing. It also charges a violation of the state Unfair Claims Practices Act, saying “defendant violated (a) fiduciary duty to plaintiff by seeking and interpreting medical evaluations of the plaintiff’s condition in a manner best calculated to deny benefits, and failing to look to facts and interpretations which would enable a finding of coverage.”
The school district was hit by a claim of negligence for allegedly failing to ensure that a policy purchased for providing catastrophic coverage was structured to cover injuries other than – or less than – total paralysis of a limb or limbs.
Both defendants were also accused of “unconscionability” for knowing that students and parents would have no advance knowledge of the policy’s coverages, exclusions and deductibles, but nonetheless defined terms in the policy in “impermissable and unconscionably narrow and restricted ways, resulting in premiums being paid for insurance which would pay no benefit for injuries reasonably understood to be paralyzing or ‘catastrophic’, thereby creating an illusion of coverage where none existed.”
As a side note, in Texas, the Texas Business & Commerce Code, Section 17.45(5) defines “Unconscionable action and course of action” as “means an act or practice which, to a consumer’s detriment, takes advantage of the lack of knowledge, ability, experience, or capacity of the consumer to a grossly unfair degree.”
The case described in the Las Vegas Sun article deals with Nevada law.
The insurance company lawyers are currently concentrating on getting the case moved to Federal Court.
The school district says that Phillips is trying to impose a duty on the school district that the law does not impute to them.
The essence of what is to be drawn from this case is this. A person has got to understand what protections are provided by them in any insurance policy they have or that another, such as the school district has, that may provide coverage for them. A copy is usually easy to get and if it is not easy to read then an experienced Insurance Law Attorney should be consulted. It is hard to say what the outcome of this case may be and of course it is Nevada law, not Texas law, that will be applicable to the case.