A 39-year-old Washington woman paralyzed from injuries caused in a car crash sued her insurer for denying coverage for surgery doctors agree could have prevented her paralysis.
Tara Sadler, a Yakima, Wash., resident and mother of two boys, filed the suit against State Farm Mutual Automobile Insurance Co., claiming the insurer denied her neurosurgeon’s decision to repair a severe neck injury caused in an auto accident on Feb. 29, 2004.
The complaint alleges State Farm denied Sadler’s personal injury protection (PIP) claim to maximize its profits. By the time the insurance company approved Sadler’s claim, Sadler was paralyzed.
“This is the worst case of PIP insurance abuse I have ever seen,” said Karen Koehler, an attorney with the law firm Stritmatter Kessler representing the Sadlers. “We have letters from Sadler’s doctors that confirm State Farm’s delay of the surgery is the reason for her paralysis.”
According to law firm, the day of the accident, Tara Sadler and her husband Donald Sadler, were driving their 1999 Volkswagen Beetle on North First Street in Yakima. Another vehicle improperly crossed several lanes of traffic while fleeing from the police. Donald Sadler, the driver, slammed the car’s breaks to avoid a collision. Tara Sadler, sitting in the passenger seat and wearing her seat belt, was thrown forward as the car came to a sudden stop.
After the accident, Sadler had neck and shoulder pain on the right side and arm numbness with tingling and loss of use. She saw her family physician, who ordered physical therapy for eight weeks, the law firm said. According to the complaint, in the days and weeks following the accident, Sadler’s condition worsened.
Sadler decided to see a chiropractor in Yakima who stopped the physical therapy, reviewed X-rays, and made arrangements for an MRI on her neck. The MRI indicated a significant disc protrusion in her neck with spinal cord compression and her chiropractor directed her to see a surgeon.
According to the complaint, on June 11, 2004, Sadler saw an orthopedic surgeon in Seattle who agreed that the injury warranted immediate attention and referred her to a neurosurgeon, Dr. Srinivasan, who concurred that surgery would alleviate most of her neck, shoulder, and arm ailments.
Dr. Srinivasan contacted State Farm to inform them of the need for the surgery.
Sadler, who did not have health insurance, believed the remaining $18,000 of PIP coverage she purchased from State Farm would be sufficient to pay for the surgery, the complaint details.
“When I saw Dr. Srinivasan, she said the sooner I get to surgery the better the outcome would be,” said Tara Sadler.
As Sadler returned home, Dr. Srinivasan called State Farm to advise them of the need for surgery and verify the availability of funds. State Farm replied that Sadler’s PIP benefits would be suspended and were not available for the needed surgery, court documents say.
“State Farm had absolutely no basis to deny Tara’s surgeon’s conclusion,” attorney Koehler said. “State Farm decided to gamble with Sadler’s health to try to save a buck.”
One week after hearing that she needed immediate surgery, State Farm sent a letter to Sadler that benefits were being withheld pending an involuntary medical evaluation scheduled for July 19 — almost five weeks later. Meanwhile her medical condition continued to deteriorate, the suit states.
“By this point, the paralysis had now moved down her leg. People were noticing she was dragging her right leg when she walked,” Koehler said. “She was frightened and did not know where to turn.”
Tara hired Yakima attorney Scott Brumback, whose office began calling State Farm sometimes on a daily basis, the law firm said. As a result, State Farm agreed to move the involuntary medical exam up by four days to July 15, 2004. The examiner, Dr. Gorman, M.D., confirmed Dr. Srinivasan’s prognosis and pronounced Sadler’s condition a medical emergency, court documents show.
According to court documents, after Dr. Gorman examined Sadler he called State Farm to report Sadler needed immediate surgery but was told the State Farm claims manager was out of the office.
It took until July 20, 2004 — 37 days since Sadler’s surgeon urged immediate action — for the State Farm insurance adjuster to file the appropriate paperwork and approve Sadler’s surgery.
On July 29, 2004, Dr. Srinivasan performed the surgery, but it was unsuccessful in fixing the damage caused by the accident that was worsened by the delays in treatment, court documents show. Sadler is now bound to using a wheelchair.
“It is nothing new for insurance companies to unjustly put profits over people by denying PIP claims,” Koehler said. “But never have I seen this level of callous incompetence. We believe had State Farm done the right thing and stood by its promise to Tara, she would be walking today.”
The suit was filed in King County Superior Court in Seattle and seeks monetary damages.
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