AAA loses PIP dispute arising out of "pre-existing condition."
Beth Baker, the mother of David Baker, sought no fault medical benefits on behalf of her son and ward, David Baker. She claimed that a motor vehicle-related closed head injury rendered David's hospitalization necessary in response to self harm and attempted suicide. AAA argued that because David had severe pre-existing mental problems, his closed head injury was not a cause of the need for hospitalization.
The Trial Judge ruled in favor of the Bakers, finding that the head injury was a "significant contributing factor" in David's self-destructive behavior, despite the fact that it exacerbated a significant pre-existing condition. AAA argued that a prior workers compensation hearing which held that the pre-existing condition made Baker ineligible for workers compensation also constituted a binding legal determination that Baker's hospitalization did not arise, in part, from the use of a motor vehicle.On appeal the Court of Appeals majority noted that the legal standards for workers compensation and no fault are different and that the comp magistrate's ruling did not preclude a finding of causation with respect to a motor vehicle injury. Nevertheless, the two judges in the majority did overturn the award of attorneys fees and costs to the Bakers--not a surprising decision for Judge Christopher Murray who virtually always rules in favor of insurers. The dissenting judge pointed out that the court routinely examines the "unreasonableness" of an insurer's conduct post-verdict in determining whether attorneys fees are owed. That procedure could have been and should have been applied in the instant case, in order to "cure" the trial judge's failure to identify the basis for his fee award..