Feb 06, 2012

Case Results

DISCLAIMER: Please note that every case is different and these verdicts and settlements, while accurate, do not represent what we may obtain for you in your case.

Payment of Rehabilitation Claim

In Neurocare, Inc. and Barbara Whitmore v. Principal Life Ins. Co., 1999 U.S. Dist. LEXIS (N.D. Cal. 1999), Principal denied claims for payment of rehabilitation treatment presented by the rehabilitation facility and the patient. The basis for the denial was that the care was not medically necessary. The federal district court for the Northern District of California reversed the denial. The court held that it was an abuse of discretion for the insurer to deny the medical necessity of Whitmore's treatment without having her claim reviewed by a physician. The court also noted that Principal's failure to interpret ambiguous and undefined terms in the patient's favor was also arbitrary and capricious. You can read the decision from the court in this case by clicking on the "library" link on this site.

Awarded: Award of Over $35,000 on Rehabilitation Claim