Georgia Supreme Court Holds Insurers Feet to the Fire for Trying to Avoid Coverage   Leave a comment

Have you notified all potential insurance carriers of your claim? If you’re unsure, then watch out! They may use that as a basis for denying your claim. A competent attorney can assist you in not only promptly notifying an insurance carrier of your claim but also of identifying all of the insurers that may be responsible for the injuries and losses you sustained. The following case serves as an example of how far an insurance company may go to try to avoid paying a claim:

In October 2004, a work supervisor asked Mr. Hoover, to deliver a ladder to a job site where a contractor was making roof repairs. Once there, Mr. Hoover courteously agreed to climb onto the roof and assist the contractor with his work. Tragically, after Mr. Hooper helped finish the work and was climbing off the roof, he fell to the ground and sustained a serious brain injury. Mr. Hoover’s brain injury led to a long hospitalization and expensive medical bills. As a result, Mr. Hoover obtained an attorney and filled suit against his employer and his employer’s insurance company in an effort to recover for his medical bills, lost wages, and pain and suffering.

The insurance company that was supposed to cover Mr. Hoover’s employer denied coverage and refused to defend the employer. The insurance company claimed that a certain exclusion listed in the policy allowed it to avoid paying the claim. At the same time, the insurance company tried to argue that there might also be additional exclusions that would allow it to avoid paying the claim if a court were to find that it’s first exclusion wasn’t legitimate.

Not to be discouraged, Mr. Hoover and his attorney proceeded to trial on their claim and were awarded $16.5 million in damages! To collect Mr. Hoover’s verdict, Mr. Hoover and his attorney appealed the decision of the trial court and Georgia Court of Appeals, which both held that the insurance company wasn’t liable. However, thankfully for Mr. Hoover, and injured victims across the state, the Georgia Supreme Court held that the insurance company was liable. Specifically, the Court held that the insurance company could not both (1) deny the claim and (2) try to reserve the right to argue other defenses later if its first reason for denying the claim was proven to be untrue. In other words, the insurance company had to take one position from the very start and then stick to it. Mr. Hoover’s case certainly goes a great way in illustrating an insurance company’s efforts to avoid paying a claim. Fortunately, in this case, the Court required the insurance company to actually provide insurance and pay for Mr. Hoover’s injuries.


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