In the case, the carrier had paid PIP benefits for over 16 months to the claimant. At that point the carrier had reviewed the claim in its entirety including medical records, forms, as well as opinions from independent medical doctors who verified that the claimant’s motor vehicle related injuries had resolved long ago. Based on this the carrier denied the claimant’s continued benefits and suit was filed against the carrier.
At trial Plaintiff was seeking roughly $400,000 dollars based her claims for wage loss, attendant care, replacement services and interest. There were several defenses that were put forth during the trial which included the fact that the claimant’s injuries had resolved long ago and therefore their continued pursuit of benefits did not arise from the automobile accident and were therefore not reasonable or necessary. Also included in the defense was the fact that the attendant care forms that had been filled out by Plaintiff and her service provider significantly inflated the amount of attendant care benefits sought. Based on the significant inflation of benefits sought the defense asked that the jury return a verdict of no cause in the carrier’s favor, based on the fraud committed.
The jury agreed with the defense that the attendant care forms were significantly inflated and returned a verdict of no cause in favor of the defense.