Victory for Federal Employee Denied Health Care Benefits for Child’s Mental Health Residential Treatment
In August of 2016, Matthew Davis won a case for a federal employee against the United States Office of Personnel Management (OPM) under the Federal Employee Health Benefit Act (FEHBA). The FEHBA plan was administered in part by United Healthcare and its subsidiary United Behavioral Health. The employee’s child was suffering from a variety of mental health issues and his doctors and therapists decided that he needed residential treatment. The cost of the treatment should have been covered by his health insurance but the insurance company and OPM refused to pay after a very limited stay at the treatment facility.
The Court found that the insurance company cherry-picked facts from the medical records and relied on an expert whose opinion was without merit in order to deny a claim that residential treatment for the child was medically necessary. The lawsuit forced the OPM to order United Healthcare to reimburse the federal employee for the cost of the residential treatment that should have been covered by his health insurance.
$2.4 Million Judgment after St. Charles County Jury Verdict
An electrophysiologist who was driving home from his pharmaceutical research job in the Missouri Research Park in Weldon Spring was hit head on when a teenage driver crossed the double yellow line on Highway 94 in St. Charles County. Luckily, first responders from the Cottleville Fire Protection District and St. Charles County Ambulance District were just minutes away. Their efforts saved the scientist’s life. After several surgeries, months of rehab and extraordinary hard work, he was able to return to his job developing lifesaving medicines. The scientist’s Doctors and therapists testified that he was one of the hardest working and smartest patients they’ve ever treated. The teenager’s insurance company tried to use the scientist’s hard work and good recovery against him and get a discount for the harm that the teenager caused. In a weeklong trial, Tim Gallagher and Matt Davis faced four defense lawyers in a hard fought battle for justice for the injured scientist and his wife, resulting in a jury verdict in their favor. After the Jury returned their verdict, the trial Judge told the clients that it was the largest personal injury verdict that he ever had in his 26 years as a Judge.
Judgment for Employee Injured at Work
George Davis, an employee at Foundry Products, was using an industrial mixer that had been modified by Alltech Engineering, Inc. to allow the blades to continue spinning while the door was open. Mr. Davis lost digits on both hands and suffered permanent nerve damage in his hands and arms. Tim Gallagher filed the lawsuit on behalf of George and his wife, Clarice. The insurance company for George’s employer paid the $500,000 insurance policy limits. Tim pursued the case against Alltech Engineering, Inc. for modifying the blades and causing the injuries to George and received a judgment against Alltech for $1,499,998 and a judgment of $200,000 for Clarice for the suffering she experienced as a result of George’s horrific injuries.
Verdict against Transportation Commission in Tragic Accident
Trenton and Casey Mendenhall were traveling on Interstate 55 when their car ran off the road and into a steep embankment in Ste. Genevieve County. Matt Davis represented the family of Casey Mendenhall and filed suit against the Missouri Highway and Transportation Commission. The length of the guardrail on the side of the road was insufficient according to current regulations, but MHTC failed to comply, leaving the guardrail too short and failing to prevent the Mendenhalls from falling into the embankment. Matt was able to obtain a $300,000 verdict for the family of Casey Mendenhall through arbitration and $50,000 as part of an insurance settlement.
Insurance Company pays over $330,000 for Denying Accidental Death Claim
Matt Davis represented Deborah Buzzanga for the wrongful denial of accidental death coverage after her husband died tragically when his pickup went off the road in southeastern Missouri and hit a tree on December 22, 2007. Cigna originally denied the claim of Ms. Buzzanga and refused to pay under the policy. Matt filed the lawsuit in federal court in St. Louis and as successful in arguing the decision should be reversed. A judgment was awarded to Ms. Buzzanga against Cigna in the amount of $220,000, with Cigna also being responsible for prejudgment interest, attorneys, fees, costs and post judgment interest, a total $339,000 judgment.
Jury Verdict against Insurer for Uninsured Motorist Accident
In November of 2009 Terran was hit by a driver who did not stop , causing him to hit another car that was parked. The collision caused Terran to suffer injuries to his back and shoulder that caused him significant pain. He continued to have back problems for years following the accident, and a doctor testified that Terran’s injuries would be lifelong. Tim took the case to trial against Safeco Insurance Company of Illinois and a St. Louis jury awarded Terran $100,000. Terran’s case included several complicated issues and Tim filed successful motions that were pivotal to the case.
$150,000 Settlement for Woman Stopped at Traffic Light
A 26 year old woman was struck from behind as she was waiting for a green light at an intersection in Jefferson County in February of 2013. Her car was struck suddenly by a pickup truck from behind, with the initial collision causing a third car to subsequently strike the young woman’s vehicle, causing further damage. The damage to the vehicle was so severe she had to be extracted from the car by firefighters and was found to have suffered injuries to her head and back that caused her to postpone her wedding date only two months away. Tim represented the woman in the accident and was able to successfully negotiate a settlement in excess of $150,000 for her as a result of the significant injuries to her neck and back.
Man Receives $750,000 Settlement for Hit and Run by Drunk Driver
A man was seriously injured on his way to his job in July of 2012 when his motorcycle was traveling north on Interstate 170 near Delmar Boulevard. The motorcycle was struck from behind by a vehicle that was speeding before swerving into the far right lane and striking the motorcycle. The force of the collision was such that the driver’s license plate wedged in the back of the motorcycle. Police identified the driver of the vehicle and found she had been drinking and was underaged. The man had to undergo shoulder surgery as a result of the accident and missed nine months of work. Having to miss so much time off forced him to have to look for a new job. The driver of the vehicle was twenty years old and was charged with fleeing the scene of the accident. Tim filed suit against the driver in 2012 and added the Saint Louis County bar that served her alcohol that night as a Defendant five months later. Tim successfully negotiated a $500,000 settlement with the insurance carrier for the driver and was awarded a $250,000 judgment by a judge against the bar that served her in August of 2013.
Verdict for patient in claim for perforated bowel
Gary M. went to the hospital Emergency Room in the middle of the night because he could not urinate. The urologist on call initially told the ER Doctors to send Gary home to take a warm bath. Gary returned to the ER in severe pain because he could not empty his bladder. This time the on call urologist did come into the hospital and while trying to inspect Gary’s bladder with a rigid urethroscope punctured through Gary’s urethra and his bowel. Gary had to wear a colostomy bag for 5 months to give his bowel time to heal. Tim Gallagher prepared and took the case to trial and a jury in the City of St. Louis returned a verdict in favor of Gary awarding him his medical bills, lost wages and $125,000.00 for non-economic damages.
Settlement reached in fireworks explosion case
On July 2, 2003, a trailer full of fireworks exploded in Bonita Springs, FL killing 5 people. The surviving children and the mother of two brothers who died were referred to Tim Gallagher by out of state lawyers. The case was filed in Missouri because the main defendants were a fireworks manufacturer and pyrotechnic show producer located in the St. Louis area. Tim Gallagher represented the family through 3 years of complex litigation that included dozens of depositions, a variety of expert witnesses and procedurals challenges that took the case all the way to the Missouri Supreme Court. The case settled a few weeks before trial in June, 2008.
CIGNA forced to pay benefits of $498,000 plus interest and fees after Court Ruling
Before he won the largest verdict in Missouri in 2008, the same client had to go Federal Court to force CIGNA to pay him money he was owed under a Disability Policy that he had through work. CIGNA Insurance Company said that because the man had slight residual movement in his shoulders and lower limbs he had not lost complete use of his limbs within the meaning of its disability policy. CIGNA claimed that a Federal law known as ERISA gave it discretion to deny the benefits that he had paid for through payroll deductions. Matt Davis and Tim Gallagher sued CIGNA in Federal Court. In a decision that is now being used by other lawyers across the country a Federal Court Judge found that CIGNA “committed a procedural irregularity by failing to use proper judgment in reviewing (the) claim result(ing) in a total lack of faith in the integrity of the decision making process.” CIGNA didn’t even appeal the ruling, but instead paid the full amount of benefits in the amount of $498,000 plus interest and attorneys’ fees.
Largest personal injury verdict in Saint Louis County History
Tim Gallagher and Matt Davis, along with Co-counsel Robert M.N. Palmer of Springfield, MO, represented a 48 year old man and his wife in a trial against a motorist who caused a crash in Wentzville, MO in December, 2004, that left the man a quadriplegic. On May 9, 2008, after a week long trial, a St. Louis County jury returned a verdict for the plaintiffs in the amount of 21 Million Dollars. After the trial the Judge assessed pre judgment interest on the verdict to bring the total judgment to just under 25 Million Dollars. The Missouri Lawyers Weekly reported the verdict as both the largest personal injury verdict in the history of St. Louis County and the largest verdict in a personal injury case in the State of Missouri in 2008.
Settlement for former pitcher for St. Louis Cardinals
In September of 1994 Joe Magrane and his wife Renee were driving on Wild Horse Creek Road, returning home from dinner when their car fell into a ditch on the roadway. The developer of a subdivision and its excavation contractor were in the process of creating an entrance way to a new subdivision and had cut 8 inches into the asphalt roadway. The tires on the right side of Joe’s car drove into the 6 inch deep ditch. When Joe reacted he pulled his car back across the roadway and into a tree. The airbag on his steering wheel deployed and sent his left elbow crashing through the driver’s side window. Joe sustained a laceration a tendon in his left elbow. Not a major injury unless you are a Major League pitcher. Joe’s career was not the same after the accident. He did not play in the Major League in 1995 and made a brief comeback with the Chicago White Sox in 1996. Tim Gallagher represented Joe and Renee in a personal injury lawsuit filed in St. Louis County. Tim aggressively pursued the case and achieved a favorable settlement the week before trial.
Case that reversed 150 years of legal precedence
As a young lawyer, Tim Gallagher, defended a cardiologist in the St. Louis area who admitted to having an affair with one of his patients. The husband of the patient sued the doctor for alienation of affections and criminal conversation. The case went to trial in December, 1992 after the Doctor had left the country to return to his native Pakistan. At trial Tim convinced the jury that his client was not responsible for alienating the affections of the wife, but the jury found for the husband on his claim for criminal conversation and awarded one dollar in damages. Criminal conversation is an ancient claim for damages that could be asserted by a husband for the trespass on his wife’s body against any one who had sexual intercourse with her.
Initially the husband appealed his loss on the alienation of affections claim to the Missouri Court of Appeals. On behalf of his client Tim cross – appealed the $1 verdict for the husband and convinced the Missouri Supreme Court to invoke a seldom used rule to hear the case for the purpose of reexamining the existing law before an opinion of the Court of Appeals. The Supreme Court agreed with Tim’s position and changed the law in the State of Missouri. Thomas v. Siddiqui, 869 S.W.2d 740 (Mo. 1994)
Largest personal injury verdict in Saint Charles County History
Unfortunately this verdict came when Tim Gallagher was representing the defendant. Tim represented a local Fraternity at Southwest Missouri State University in a claim bought by a young lady who was a guest at their spring dance. Following the dance the young lady dove into the shallow end of a pool and sustained a catastrophic injury that left her a quadriplegic. She claimed that the members of the fraternity served her beer in violation of the National Fraternity’s policies. The jury agreed and awarded the plaintiff $7.65 Million in actual and punitive damages. Tim represented the local chapter of the fraternity through the appeal, and following a successful oral argument the case was settled for $200,000, which was the amount Tim offered before trial. Though the amount of the verdict was not collected, it is believed to be largest personal injury verdict in the history of Saint Charles County.