If you've been in an auto accident in Rhode Island recently, were injured, and have auto coverage for you and anyone else who may have been injured, you may wonder why you would need a personal injury attorney. If you caused the accident and injured someone else, then the required bodily injury (BI) insurance will cover that person's medical bills, lost wages, and pain and suffering. You must have the minimum BI coverage, which is $25,000 per person and $50,000 per accident, but you can always opt to purchase additional coverage. 

There's also uninsured and underinsured motorist bodily injury coverage (UM/UIM), which is required in Rhode Island. This coverage is used for your own medical expenses when the other driver who caused the accident either does not have auto insurance or does not have enough to cover the expenses of your medical needs. It can also be used in hit-and-run cases where the driver causing the accident takes off before exchanging information.

In cases where you caused the accident and injured yourself, if you have optional medical payments coverage, then your own medical bills will be covered. It can also be used to pay medical and funeral expenses of anyone else injured or killed.

With this kind of coverage required or available in Rhode Island, many people think all you have to do is file a claim and your medical expenses will magically get paid or be reimbursed. There's only one problem: the insurance company itself. Auto insurers will often employ tactics to outright deny or somehow reduce a payout to you – this is true even if it's your own insurer denying or reducing your claim.

Insurance companies prioritize profits over you, your health, and your recovery. And this is in no way better exemplified than in a current case filed on February 21, 2020, in a Kentucky federal court. 

What does a recent case in Kentucky say about insurance companies and their tactics to reduce or deny benefits to policyholders?

In Hack et al v. State Farm Fire & Casualty Insurance Company, a potential class-action lawsuit, the plaintiffs allege that a State Farm unit employed an unlawful utilization process (which is a fancy way of saying "paper review" process) to reduce or deny personal injury compensation to its policyholders who needed medical assistance after a car accident. This is a key tactic used by many insurance companies. Lawsuits for years now have claimed the same. This most recent case is merely a testament to insurance companies' persistence to maintain profits over the health of policyholders.

In Hack et al v. State Farm Fire & Casualty, the plaintiffs claim the utilization process was impermissible according to Kentucky law. State Farm Fire paid vendors to conduct these utilization reviews and then, when the third party cited findings that "the insured's medical treatment or billing was excessive or unrelated," State Farm Fire used those determinations as the primary reason to deny medical benefits. (Complaint, p. 8). According to the Motor Vehicle Reparations Act (MVRA), however, PIP benefits cannot be denied based solely on the findings of utilization reviews. 

The Complaint states that State Farm Mutual (State Farm Fire's parent company)

denied more than $6 million dollars in owed PIP benefits to Kentucky insureds due to the findings of approximately ONE THOUSAND AND SIX HUNDRED utilization reviews. (p. 6)

In other words, these policyholders required medical treatment after a car accident in Kentucky, and these policyholders expected their personal injury protection (PIP) coverage to pay for the medical expenses along with any pain and suffering or lost wages. 

Why does this case matter to auto insurance policyholders in Rhode Island?

State Farm has a huge slice of the auto insurance market in Rhode Island. If the company employs unlawful tactics in one place, it could employ unlawful tactics elsewhere, too. But not even that, it just generally highlights the lengths (lawful or not) the auto insurance company will go to deny or reduce benefits for its policyholders – the very people who pay for the protection.

If you have been injured in a car accident, having an attorney advocate your rights is the only real way you'll know someone is fighting for you and not against you. It's always wise to schedule a free consultation with a personal injury attorney in Rhode Island to make sure you are getting the benefits you signed up for.