Farmers Insurance forced to pay attorney's fees for unreasonable denial of PIP benefitsDolphus Tinnin is a mildly retarded 57-year old who lived with his mother. He was struck by a car and suffered a mild head injury and a fractured femur. Farmers was responsible to pay his No Fault Personal Injury Protection benefits, which included all related medical and attendant care. After two years of paying, the adjuster refused to pay for his visits to a rehabilitation doctor and also stopped paying the mother for attendant care. Eventually, Dolphus' attorneys filed suit for both expenses. The parties attended several mediation and settlement procedures and adjourned trial on several occasions, however, Farmers refused to offer any compromise. The case then went to trial.
At trial, the adjuster acknowledged that she should not have discontinued the rehab doctor's visits because even her Independent Medical Evaluation doctor had conceded those visits were appropriate. The jury concluded that those benefits should be paid, but denied any payment to Dolphus' mother for attendant care. The trial judge suggested that the jury's decision, right or wrong, was based on mom's testimony that she provided the same services to her disabled son before the injury "as a mother," but provided them to him after the injury, "as a necessity."
The trial judge then awarded attorneys' fees to Dolphus for the full amount of the time expended to try the case, despite the jury's decision that attendant care benefits were not payable. He noted that the physician visits were clearly payable, unreasonably denied, and an integral part of the entire "head injury" trial. Since the proofs for attendant care, i.e., the fact of the head injury, the deficits, the complications and the basis for Farmers' denial, were essentially identical to the proofs for the rehabilitation doctor's consultations, the judge found no basis for awarding only partial fees. Further, he expressed concern about punishing Dolphus and his attorneys for asserting their statutory right to be paid attorneys fees where it is necessary to sue to secure "unreasonably denied" benefits.
The Court of Appeals unanimously agreed with the lower court's decision and upheld the award of attorneys fees and costs against Farmers.