Attorney Portrait Information

Appealing Your Long-Term Disability Denial

| Read Time: 6 minutes

Having your long-term disability claim denied can be stressful and confusing. If this is an issue you are dealing with, you should take heart in the fact that most long-term disability claims are denied. This should not be surprising. Insurance companies make money by denying claims. What Is the Next Step? You are likely required to file an administrative appeal. Appealing a denied long-term disability claim is not easy. However, a long-term disability appeal is a lot like a redo. You get a second chance to compile and present medical and vocational evidence to try to have your claim accepted. For many, the assistance of an experienced disability insurance attorney to navigate the process is essential. ERISA Versus Non-ERISA Policies The Employee Retirement Income Security Act (“ERISA”) governs many employer benefits including disability insurance. If your disability benefits are provided by your employer, ERISA likely applies. ERISA regulates most aspects of how disability claims are processed. This includes the timeframes for making a claim determination. Under ERISA, when a claim is denied, an employee must appeal in accordance with the administrative appeals process. A policyholder cannot file a lawsuit for wrongful denial of the claim until the administrative appeals process has played out. The process of filing an administrative appeal can be time-consuming. In most cases, a policyholder will have 180 days from the date the claim has been denied to appeal. Only after the administrative appeal is denied can a policyholder file a lawsuit. Non-ERISA disability policies are governed by state contract law similar to most other insurance policies. There is no administrative appeal process. If your claim is denied, you can file a lawsuit. Steps to Making Your Disability Claim Even though you may have already received short-term disability benefits, this has little to do with whether you qualify for long-term disability benefits. For long term disability claims, your medical history and medical records are critically important. A policyholder must establish that he or she has a disabling condition. It is the policyholder’s burden to establish within a reasonable medical degree of certainty that a disabling condition exists and that the policyholder’s ability to work and earn wages has been impaired. Long-term disability policies tend to either be “own occupation” and “any occupation” policies.  Under “own occupation” policies, a policyholder is considered disabled when, due to an illness or accidental injury, he or she is unable to perform their current job. With this type of policy, the policyholder can qualify for benefits even if he or she can perform a job or occupation that is different from their “own occupation.” This differs sharply from “any occupation” policy in which an applicant is disabled when he or she is unable to work any type of job. For example, under any occupation policy, a contractor whose disability does not prevent him from working a light-duty job could not recover long-term-disability benefits. Many long-term disability claims involve significant potential recoveries and it is not uncommon for insurance companies to aggressively litigate claims. Experts often take on a significant role in disability claims. If your claim is disputed, you need a qualified team of experts to help establish that you are disabled. Establishing a Condition That is Consider Disabling Disability claims first and foremost are driven by medical opinion. A policyholder seeking benefits has the burden of establishing that he or she has a medical or psychological condition that is disabling. As a rule of thumb, the condition needs to be objectively serious. If your condition is insignificant or ill-defined, you probably will not qualify. Further, your physicians or medical experts need to help establish that your condition impacts your ability to work. This issue can be tricky depending on whether you have an “any occupation” or “own occupation” policy. Vocational evidence often comes into play in long-term disability claims. Vocational evidence is simply evidence related to your education, work experience, and ability to earn a living. In many cases, the insurance company may hire an expert to state that you can work your regular job, or, in the case of an “any occupation” policy, a different job. Similarly, an experienced disability attorney should retain a vocation expert to establish that the client is disabled within the meaning of the policy. The strength of a vocational expert’s opinion regarding disability largely depends on your objective medical evidence. If you have not been evaluated by the correct specialists to establish a disability, your claim will probably not be approved. This is why having an experienced long term disability attorney to assist you can be instrumental.   Why are claims denied? In many cases, disability claims are wrongfully delayed or denied, causing hardship and stress to the policyholder. However, sometimes claims are denied simply because the policyholder did not present enough evidence with their initial claim. It is the policyholder’s burden to establish the existence of a disabling condition. Most disability claims are denied due to a supposed lack of supporting medical or vocational evidence. For example, a policyholder may present evidence that they have been diagnosed with fibromyalgia but provide no further information as to how it impacts their ability to work. While fibromyalgia may, in reality, be a disabling condition, the fact the policyholder did not link their condition to vocational status may prevent their claim from being approved.  On the flip side, the insurance company is working hard with a team of experts to deny your claim. Most insurance companies have a list of preferred medical experts who they routinely send disability claimants to for evaluation. The insurance company’s experts will often differ sharply from your treating physicians and will almost always conclude that you are not medically disabled. While this is not fair, it is the way the disability process works. If you feel the insurance company is stacking the deck against you, you should consult with a disability insurance attorney.  What to Do After a Disability Claim is Denied? When a claim is denied, the policyholder should be provided...

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Attorney Portrait Information

What is a Life Insurance Interpleader Action?

| Read Time: 4 minutes

You are hanging around your house when a process server knocks on your door and serves you with a Complaint for Interpleader. You may ask: What is this? What must I do next? Will this just go away? It will not just go away. The good news, you have been named as a party because you may be owed a large sum of money. The bad news, you have to make your claim in court.  Definition of Life Insurance Interpleader Action An interpleader is a very different type of legal case. Unlike a typical lawsuit in which a plaintiff sues a defendant, an interpleader is filed by a party referred to as a stakeholder who is holding some type of property – probably money – that may be owed to multiple people. The stakeholder initiates the interpleader action because it is concerned that it may give the property or money to the wrong person. Rather than be exposed to double liability, the stakeholder will force all parties with a claim to the property into court to make their claims. That way, the stakeholder avoids the potential liability of giving the property to the wrong party.  Life insurance interpleaders arise when people have competing claims for life insurance proceeds. An insurer will often deposit the money into the registry of the court and file an interpleader action forcing the claimants to work out their claims in court. That way, it will ultimately be up to the court system to determine who is entitled to the money. In essence, the insurance company puts up the money, wipes its hands, and walks away.  What Should You Do Once You Have Been Served?  First, we recommend that you contact an experienced life insurance attorney to discuss your options. Now that you have been forced into this situation, you need to expect the other person claiming the life insurance proceeds will have competent legal counsel. If you truly believe you are entitled to the life insurance proceeds, you need to assert your claim in court or risk losing.  You Need to Act Fast If the interpleader has been filed in federal court, you have 21 days to file your response. Failure to provide a timely response could lead to default and you losing your claim without even making an appearance in the case.  Federal or State Jurisdiction  Rule 22 of the Federal Rules of Civil Procedure permits an interpleader action to be filed in federal court as long as the court has subject matter jurisdiction over the case. Subject matter jurisdiction exists either because there is a federal question, i.e. a federal law that is implicated, or because their parties have diverse citizenships.  If your life insurance policy was issued through your employment, then there will probably be federal question jurisdiction because ERISA governs employer-sponsored benefits. There are also life insurance benefit programs for federal government workers that are also subject to federal question jurisdiction.  Diversity jurisdiction applies when the claim’s value exceeds $75,000.00 and the parties are citizens of different states.   Insurance carriers tend to prefer to file interpleader actions in federal court.  How Do You Make Competing Claims?  The reason an insurer files the interpleader is that there are multiple or competing claims for life insurance proceeds or to other property. To make a claim, you will need to file an answer to the interpleader action. It is also common to file a cross-claim against other claimants named in the complaint.   It is common for the insurer that filed the interpleader to seek leave of court to be dismissed from the case. It is normally the insurer’s position that they had fulfilled their duty by depositing the funds into the registry of the court and allowing the parties’ to make their claims. Sometimes the claimants may have separate claims against the insurance company. For instance, if the insurance company knew a person is the rightful beneficiary but proceeded to file an interpleader action anyways, the insurance company may be liable for penalties and attorney’s fees under a variety of prompt payment and bad faith claim handling laws.  Once you have filed a response, you will have the opportunity to discover evidence, hire experts, take depositions, and proceed to trial to prove that you are entitled to the life insurance proceeds.  There are a number of different case types that we tend to see more often with life insurance interpleaders: One: Lack of Capacity to Change Beneficiary We see a lot of cases where the insured changed the primary beneficiary later in life when the insured arguably lacks the mental capacity to understand that he was making the change. Along the same lines, we also see situations where people close to the insured may attempt to use undue influence, force, or duress to change the beneficiary. In these types of cases, objective medical evidence that the insured lacked capacity certainly helps challenge the change. In these situations, there are often nefarious actors with past history of wrongdoing involved with the insured. We have worked on multiple cases where a former felon released from prison suddenly becomes the insured’s caretaker. These cases can be difficult to prove and often rely on a combination of medical evidence and testimony to invalidate a beneficiary change.  Second: Divorce Many states will void an ex-spouse’s interest as a life insurance beneficiary in the event of divorce. Of course, there are numerous other exceptions to this rule. For instance, sometimes a property separation agreement will stipulate that a spouse is entitled to certain insurance benefits. Other times, an insured may list or re-inscribe the ex-spouse after the divorce.  Third: ERISA Preemption While most states will invalidate an ex-spouse’s beneficiary designation, life insurance policies that are governed by ERISA – a federal statute, do not follow a similar path. Under ERISA policies, the insured must change the beneficiary. If they do not, then the ex-spouse may be entitled to life insurance benefits.  Fourth: Homicide  Most states have “slayer statutes” on the...

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Attorney Portrait Houston Accident News

Laredo Accident Kills One, Injures Two on Houston Street

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Laredo, TX (March 9, 2020) – A single-vehicle crash left one man dead and two passengers injured Monday morning. The accident occurred at the 200 block of Houston Street around 5:30 a.m. According to the Laredo Police Department, 21-year-old Michael Garza was driving a gray Honda Accord with two passengers when he lost control of the vehicle. When officers arrived, the Honda was flipped on its side and the two passengers were trapped. The Laredo Fire Department helped extricate the two unnamed passengers from the vehicle, but Garza died at the scene of the accident from his injuries. Initial reports indicate that none of the occupants were wearing a seatbelt at the time of the accident. The Laredo Police Department is still investigating the cause of the crash. Source: KGNS Contact an Experienced Texas Car Accident Attorney Unfortunately, auto accidents like this happen far too often in Texas. Police must investigate these crashes thoroughly to determine the cause and hold those responsible accountable. At The Johns Law Firm, we understand how devastating these accidents are for the families and friends of the victims.  If you sustain injuries or lose a loved one in an accident, please contact one of our Texas car accident attorneys or call us at 866-762-0302 to set up a free consultation. We will fight to get you the compensation you deserve. Our deepest condolences go out to the families of the victims of this horrible incident. If a family member would like the name of a person removed for any reason, please click the “Remove Post” link. REMOVE POST

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Attorney Portrait Louisiana Accident News

Suspect in Deadly Crash on O’Neal Lane Arrested, Charged with Vehicular Homicide

| Read Time: 2 minutes

Baton Rouge, LA (March 6, 2020) – A single-car accident left one person dead on Friday afternoon. The crash occurred on O’Neal Lane between George O’Neal Road and South Harrell’s Ferry Road around 4:18 p.m. According to the East Baton Rouge Sheriff’s Office, 20-year-old Carlos Daniel Ramos was driving over Jones Creek Bridge with 19-year-old Eduardo Pardo and another unidentified passenger. Ramos went off of the road and hit the side of the bridge, flipping over the vehicle. Pardo died at the scene of the accident, while Ramos and the other passenger fled on foot. Deputies found Ramos running behind a building on O’Neal Lane and arrested him under suspicion of driving while intoxicated. Police were not able to locate the other passenger who fled the scene. During the investigation, Ramos admitted to drinking alcohol before he started driving. He also admitted to not having a driver’s license. Police have charged Ramos with vehicular homicide, reckless operation of a vehicle, operating a vehicle while intoxicated, and driving without a license. Investigators are currently awaiting a toxicology report. Source: WBRZ Contact an Experienced Louisiana Car Accident Attorney Unfortunately, auto accidents like this happen far too often in Louisiana. Police must investigate these crashes thoroughly to determine the cause and hold those responsible accountable. At The Johns Law Firm, we understand how devastating these accidents are for the families and friends of the victims.  If you sustain injuries or lose a loved one in an accident, please contact one of our Louisiana car accident attorneys or call us at 866-762-0302 to set up a free consultation. We will fight to get you the compensation you deserve. Our deepest condolences go out to the families of the victims of this horrible incident. If a family member would like the name of a person removed for any reason, please click the “Remove Post” link. REMOVE POST

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Attorney Portrait Houston Accident News

Car Accident in Southeast Houston Leaves One Dead, One Injured

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Houston, TX (March 6, 2020) – A man died after running into a truck in Southeast Houston on Friday night. The accident occurred at the 6100 block of Griggs Road around 5:02 p.m. According to the Houston Police Department, an unidentified male was turning left on Griggs Road in his Toyota Yaris when he drove into the path of a truck. The truck, carrying an unidentified father and son, hit the Yaris, causing both vehicles to hit a nearby food truck. The man driving the car was transported to the hospital but later died of his injuries. The father in the truck was not injured, but his son suffered minor injuries.  The Houston Police Department is still investigating the cause of the accident. Source: ABC13 Contact an Experienced Houston Car Accident Attorney Unfortunately, auto accidents like this happen far too often in Texas. Police must investigate these crashes thoroughly to determine the cause and hold those responsible accountable. At The Johns Law Firm, we understand how devastating these accidents are for the families and friends of the victims.  If you sustain injuries or lose a loved one in an accident, please contact one of our Houston car accident attorneys or call us at 866-762-0302 to set up a free consultation. We will fight to get you the compensation you deserve. Our deepest condolences go out to the families of the victims of this horrible incident. If a family member would like the name of a person removed for any reason, please click the “Remove Post” link. REMOVE POST

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Attorney Portrait Information

Examination Under Oath

| Read Time: 9 minutes

Most insurance policies allow the insurance company to require a policyholder to answer questions under oath and to produce documents and other information so the insurance company can investigate an insurance claim. This formal legal proceeding is called an examination under oath. The examination part of this process is requiring the policyholder to answer questions that are asked by a representative of the insurance company. In most cases, the insurance company’s representative is an attorney who has been hired to investigate the policyholder and provide the insurance company with advice about how to handle the claim. The examination normally takes place at a court reporter or attorney’s office. In most cases, an examination will last for at least a few hours and will be recorded by a court reporter. Under oath means the policyholder must swear to answer the questions truthfully. For many, an examination under oath can be highly stressful. To be completely upfront, an examination under oath is not common. They are often requested when the insurance company suspects the policyholder has done something wrong or has attempted to deceive the insurance company. Other times, the insurance believes there is a reason it can deny the insurance claim. Regardless, an examination under oath is an important event in an insurance claim that a policyholder needs to take seriously. Preparation is key to a successful outcome. In addition, refusing or failing to submit to an examination under oath can result in the denial of your insurance claim. Why Does an Insurance Company Want to Take My Examination Under Oath? Below are some common issues insurance companies often want to investigate during an examination under oath: The policyholder misrepresented the cause of the damage. The policyholder made misrepresentations in the policy application. The policyholder committed a crime related to the insurance policy. The policyholder committed fraud. The policyholder is seeking significantly more money than what the insurance company believes is owed. The policyholder has not answered the insurance company’s requests for information about the claim. The policyholder has hired a contractor, adjuster, or other experts who have a bad history with the insurance company or has a history of red flags. The insurance company believes the policy does not cover the claim. The insurance company believes there is a policy exclusion that applies.   These are not small or insignificant issues. However, it is important to remember that the mere fact that an insurance company wants to conduct an in-depth investigation of an insured does not mean it has a reasonable basis to deny an insurance claim. On the contrary, insurance policies are interpreted broadly by courts in favor of expanding insurance coverage as much as possible. Still, it is important for an insured who has had an examination requested to consult with an experienced insurance attorney to ensure he or she is adequately prepared for the examination. What Does Your Insurance Policy Require You to Do? Insurance companies tend to treat policyholders in a very abrasive and demanding manner when requesting an examination. This is especially the case when the policyholder is not represented by its own attorney. It is not uncommon for the insurance company to out of the blue give a policyholder a day and time to appear at a location to be questioned under oath. These demands normally include an extensive list of documents the insurance company insists that are brought to the examination or produced ahead of time. The insurance company may even claim that if the policyholder does not comply, he or she may be in violation of its duty to cooperate with the investigation.  For one, a policyholder does not have to appear for an examination on the day or time demanded by an insurance company. Policyholders have lives – jobs, children, and responsibilities. The most important thing a policyholder should do is stay in active communications with the insurance company. When it comes to scheduling the examination, we recommend first retaining an attorney to walk you through the specifics of your claim and communicate with the insurance company on your behalf. However, at a minimum, you should schedule your examination well enough into the future to gather the documents requested by the insurance company and review everything you need to be familiar with the claim. I’m often asked why does an insurance company gets to take an examination under oath? The right to take an examination under oath stems from the language in an insurance policy, which is a binding contract. Courts have repeatedly upheld an insurance company’s right to take an examination under oath as a contractual right that the policyholder agreed-to. The terms and conditions in the insurance policy must govern the relations between the insurer and the insured. Because an examination under oath is based on a contractual obligation, courts have ruled that the U.S. Constitution’s Fifth Amendment right against self-incrimination does not apply and that an insured must respond to questions that may implicate the insured in criminal activity. If the insured refuses to answer questions, the insurance claim may be denied. Most insurance policies contain a provision stating that an insurance company can take the examination under oath of the policyholder to investigate a claim. Some policies may require the insured to have others with knowledge of the claim to also submit to an examination. Examples of others who may have knowledge of a claim contractor, public adjusters, and residents. From the insurance company’s standpoint, these individuals may have knowledge about certain aspects of the claim. However, the policyholder ultimately can’t force someone else to sit for an examination and many insurance companies use this as a tactic to intimidate policyholders. Indeed, many insurers think the policyholder will cave in if the insurance company begins a wide-reaching investigation. It is very much likely that the insurance company is investigating the claim so aggressively because the case has tremendous value and this is how the insurance company can leverage you into taking a lowball settlement. Courts have struggled...

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Attorney Portrait Louisiana Accident News

Fiery Tanker Truck Crash on Airline Highway Leaves One Dead

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Baton Rouge, LA (March 3, 2020) — An 18-wheeler crashed in Baton Rouge late Monday night, killing its driver. The accident occurred around 10:00 p.m. near the intersection of Airline Highway and South Choctaw Drive. Investigators say that the unnamed truck driver was hauling small amounts of petroleum on Airline Highway. They then had a medical emergency that caused them to crash. The crash ruptured the fuel tank and started a large fire. Firefighters found the driver while trying to extinguish the fire. Despite CPR and other life-saving efforts, the driver died on the scene.  The Baton Rouge Fire Department is still investigating the scene and the cause of the accident. Source: WBRZ

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Attorney Portrait Houston Accident News

Wrong-Way Crash on US 290 Kills Two People in Houston

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Houston, TX (February 29, 2020) — A wrong-way crash in northwest Houston left two people dead on Saturday morning. The accident occurred on the Northwest Freeway near West Tidwell Road around 2:20 a.m. According to the Houston Police Department, someone reported that a truck was driving the wrong way on the Northwest Freeway. Officers were in the area searching for the truck when they responded to the crash. A Toyota Corolla was driving west on the freeway when the reported truck collided with it head-on. The driver of the Corolla, whose name has not been released, died on the scene. Emergency responders transported the unidentified truck driver to the hospital with critical injuries. He later died at the hospital. All westbound lanes of the Northwest Freeway closed while the Houston Police Department investigated the crash. The main lanes of the road reopened late Saturday morning. Source: Click 2 Houston Contact an Experienced Houston Personal Injury Attorney Unfortunately, auto accidents like this happen far too often in Houston. Police must investigate these crashes thoroughly to determine the cause and hold those responsible accountable. At The Johns Law Firm, we understand how devastating these accidents are for the families and friends of the victims.  If you sustain injuries or lose a loved one in an accident, please contact one of our Houston car accident attorneys or call us at 866-762-0302 to set up a free consultation. We will fight to get you the compensation you deserve. Our deepest condolences go out to the families of the victims of this horrible incident. If a family member would like the name of a person removed for any reason, please click the “Remove Post” link. REMOVE POST

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Attorney Portrait Houston Accident News

Accident on Eastex Freeway in Beaumont Kills 55-Year-Old Man

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Beaumont, TX (February 29, 2020) – A two-car accident early Saturday morning left one man dead in Beaumont. The crash occurred at the 3800 block of Eastex Freeway around 5:08 a.m. According to Sgt. Cody Guerdy of the Beaumont Police Department, 55-year-old John Christopher Garcia-Paredez was driving his green Nissan Altima on Eastex Freeway when he rear-ended a Tan GMC Yukon. It is unclear what happened to the Ultima after the initial collision. When police arrived, Garcia-Paredez was pronounced dead at the scene. The driver of the Yukon is currently cooperating with Beaumont police and the cause of the accident is still under investigation. Source: 12 News, Beaumont Enterprise Contact an Experienced Texas Personal Injury Attorney Unfortunately, auto accidents like this happen far too often in Texas. Police must investigate these crashes thoroughly to determine the cause and hold those responsible accountable. At The Johns Law Firm, we understand how devastating these accidents are for the families and friends of the victims.  If you sustain injuries or lose a loved one in an accident, please contact one of our Texas car accident attorneys or call us at 866-762-0302 to set up a free consultation. We will fight to get you the compensation you deserve. Our deepest condolences go out to the families of the victims of this horrible incident. If a family member would like the name of a person removed for any reason, please click the “Remove Post” link. REMOVE POST

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Attorney Portrait Louisiana Accident News

City Cancels Tandem Mardi Gras Floats After Second Person is Killed

| Read Time: 2 minutes

New Orleans, LA (2/22/2020) — A second person was run over and killed by a tandem float during Mardi Gras celebrations in New Orleans Saturday night. The accident occurred during the Krewe of Endymion parade around 6:55 p.m. According to the New Orleans Police Department, an adult male, whose name and age have not been released, died after getting caught between two floats at the intersection of Canal Street and South Galvez Street. It is not immediately clear whether he was pushed into the opening by the crowd or fell while trying to catch some throws.  The victim was hit by float 14, Captain S.S. Eddie, which is the same float that killed a rider in 2008. Police rushed to the scene and performed CPR, but the victim died on the scene.  Every float after float 14 was canceled Saturday night. The City of New Orleans had a press conference shortly after the accident and decided to ban tandem floats for the remainder of Mardi Gras this year. The Krewe of Bacchus released a statement saying they would abide by this ruling for their upcoming parade.  Source: WWLTV UPDATE 2/23/2020 – A man that was run over by a Mardi Gras parade float on Saturday night in New Orleans has been identified by family members. The accident occurred around 7:00 p.m. at the intersection of Galvez Street and Canal Street. The 58-year-old victim, Joe Sampson, was caught between two parts of a tandem float called the Captain S.S. Eddie in the Krewe of Endymion parade. The same float struck and killed one of its riders in 2008. Sampson is the second person to die during a Mardi Gras parade this year in New Orleans. Last Wednesday, 58-year-old Geraldine Carmouche was also caught between tandem floats during the Krewe of Nyx parade and was run over. In response to these deaths, the City of New Orleans has banned all tandem floats for the rest of the 2020 Mardi Gras season.  Source: Fox 13 Contact an Experienced New Orleans Personal Injury Attorney Unfortunately, personal injury cases like this happen far too often in New Orleans. Police must investigate them thoroughly to determine the cause and hold those responsible accountable. At The Johns Law Firm, we understand how devastating these accidents are for the families and friends of the victims, especially during celebrations like Mardi Gras. If you sustain injuries or lose a loved one to a wrongful death accident like this, please contact one of our New Orleans personal injury attorneys at 866-762-0302 to set up a free consultation. We will fight to get you the compensation you deserve.  Our deepest condolences go out to the families of the victims of this horrible incident. If a family member would like the name of a person removed for any reason, please click the “Remove Post” link. REMOVE POST

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