Washington Injury Law Blog

If repeated bailouts was enough, now word comes out that AIG is systematically refusing to pay for medical treatments covered by its policy for civilian U.S. contractors injured in Iraq. Those brave men and women who take jobs in Iraq to support our troops and are then injured by the same attacks that kill our troops, have health insurance through AIG.  However, AIG refuses to pay 50% or more of the time in serious injury claims.

Aig is engaged in a pettern of deny, delay and refuse until forced by litigation to pay for those most seriously injured.  Below is TV news story, very shocking and just plain wrong.

 http://www.youtube.com/watch?v=msvlnsNCnQM

Insurance companies routinely conduct business just like AIG here in Washington. Deny, Deny, Delay, Delay are the normal tactics in far too many my clients’ and other Washington injury victims claims. It doesn’t matter if it’s a car accident, motorcycle accident, pedestrian or bicycle accident, all the insurance company cares about is keeping its money and making you prove you needed every treatment visit to your doctor or other medical care provider.  

It’s this type of bad faith conduct by insurance companies that forces injury victims to hire attorneys. Don’t let the insurance company steam roll over you.  Learn all you can about the injury claim process. A good place to start is at www.ScottMcDonaldlaw.com.

Max Meyers, Esq.

Imagine your house and everything you own is gone to a devastating fire when you return from work today. Then your insurance company says it will only pay an amount that covers 80% of what its going to cost to rebuild the house you just bought brand new 3 months ago. Your homeless, with only the clothes on your back, what do you do? So many people find themselves in this situation every year.

Wind storms, firestorms, hurricanes, tornadoes can all cause catastrophic damage to your home or even the entire loss of the home. Wind storms and firestorms have destroyed many Washington homes in the last couple years. At tragic times like these you need something to hold your life together as it crumbles around you. Homeowner’s insurance is suppose to be that safety net – where you’re put back to as good as new by your friendly neighborhood insurance company.

All too often – this is merely TV hype – and the reality is shocking and infuriating.  Insurance companies are raking in record profits this year – more money than any time in their history. How is this happening? The companies say their just having a few good years, others say their cutting coverage and low balling claims payments. I wonder if these record profits have come on the backs of Katrina victims or San Diego firestorm victims or tornado victims in the midwest?

In 2003 San Diego had a wildfire that destroyed attorney Karen Reimus’ brand new house and her entire neighborhood. “It’s what I would fathom Armageddon would look like. Because it was just every home completely down to the ground and just black and sooty and there’s smoke in the air … And it looked like maybe you were walking into hell.” Reimus said a different kind of hell soon followed – dealing with her insurance company – Liberty Mutual.

Reimus’ house was fully insured based on the recommendations and determinations made by Liberty Mutual when she purchased the insurance. However, the offer she received from Liberty Mutual after the total fire loss stunned her. The offer of things Liberty Mutual would pay for – called a scope of loss – failed to included everything necessary to rebuild the house. The offer contained no money to have blue prints draw up to rebuild the house – how do you build a house without architectural blue prints? Other areas of the offer were also missing or too low.  It quickly became clear to Reimus and her husband that the offer was not based on reality – they had been low balled!

The Reimus’ were forced to take the gloves off and go to battle with Liberty Mutual. As an attorney this choice was much easier for Mrs. Reimus, but most homeowners do not have the advantage of a legal education. What happens to them? Abuse by insurance companies happens!

Instead of managing risk, insurance companies are attempting to eliminate risk – which is crazy and counter to the whole way insurance is suppose to work. Insurance companies are suppose to collect enough payments from their customers to cover a certain amount of damage claims that they knows will occur on average per year with a little extra to make a profit. Insurance companies are not suppose to collect payments and pay no claims at all – by constantly changing the language of the policy and eliminating coverage all together. Why have insurance if the company is always trying to find ways to not pay for the protection its agent said you would have?

If you find yourself face with a low ball offer following a catastrophic loss of your house,  good first step is to file a formal complaint with the Washington State Insurance Commissioner. The second step is to contact an experience Washington insurance claims attorney to find out what rights you have given your circumstances. Getting good information early about the claims process and traps to avoid can save you headaches down the road.

A good general tip before you find yourself in the situation is to document the inside and outside of your home with good photos or a video.  It’s also a good idea to do the same with your personal belongings.  Having a complete and accurate record of all your clothes, furniture, electronics, power tools, yard tools, and all other personal belongs with as much detail as possible including purchase date and price will help fight any low ball offers from your insurance company. 

Source:  CNBC – March 3, 2008, by Dana Ervin Miller and Scott Cohn

A Vashon Island, Washington widow, Jodi Scanlon, has been forced to file a lawsuit against her late husband’s $500,000 accidental-death life insurance policy with CIGNA Group Insurance. Her husband Michael suffered from MS and was living part time in a nursing home, where he fell and struck his head in November 2006. The fall led to a traumatic brain injury which Michael never recovered from. The autopsy report ruled Michael’s death an accident.

Jodi submitted a claim shortly after Michael’s death. The Scanlon’s had been paying Michael’s life insurance policy premiums for 10 years and were stunned to receive a rejection letter from CIGNA. A doctor hired by CIGNA had reviewed Michael’s medical records and somehow determined that the fall was caused by a pre-existing heart condition. The doctor went on to say that the pre-existing heart condition was made worse by the blood thinning aspirin he was on – which contributed to his death.

Now, I have not review the medical records or facts surrounding Michael’s fall, but this is unbelievable. This poor family pays premiums on a life insurance policy for 10 years, an autopsy rules Michael’s death an accident, and the accidental fall is the triggering event that ultimately results in his death. To you and me this seems like an open and shut case. How can CIGNA deny payment?

The answer is they most likely can’t. Washington voters recently approved R-67 (aka Fair Insurance Conduct Act), which is a new law aimed at holding insurance companies accountable for their bad faith practices in handling first party insurance claims. First party insurance claims are those that you make against insurance that you have purchased – like life insurance.

CIGNA is going to have to show that its denial is based upon sound medicine – that Michael’s heart condition caused the fall. I not sure how they can determine this based on a medical records review.  Seems to me witnesses to Michael’s fall – if there were any – would have to say something like he was grabbing his chest or arm prior to falling – thus indicating a possible heart attack. Even then the autopsy would have likely revealed damage to the heart from the heart attack – and if bad enough – the coroner would’ve ruled the death by natural causes – heart attack. I’m not a doctor by any means and this is all pure speculation by me, but CIGNA’s story doesn’t really seem to add up.

Jodi’s story strikes at the heart. Not only did she lose her husband to a tragic accident - but the loss was made much worse by CIGNA denying payment on the life insurance policy. CIGNA by forcing Jodi into litigation will cause Jodi to re-live over and over again the painful memory of her husband’s death. Situations like this is why Seattle injury attorneys like me have jobs. Big insurance companies take advantage of the little person by twisting the facts to fit their need and greed for evermore profits.

Luckily for Jodi Scanlon Washington laws are on her side. Jodi has filed her lawsuit under the Fair Insurance Conduct Act. If CIGNA is found to have acted in bad faith they could have to pay triple damages or 1.5 million to Jodi plus her attorney fees and costs of the lawsuit.

If you’re faced with this type of situation or know someone who is – please contact an experienced Washington injury attorney – and get some good advice on your rights.

Source: Seattle Times article, February 15, 2008 by Sonia Krishnan

There’s another good post by Missouri Injury Law Blog concerning Allstate’s settlement tactics. Allstate advertises that you’re in “Good Hands” with them. But ask any experienced Washington injury attorney or injury victim who has had to deal with Allstate on an injury claim and you’ll quickly hear how those hands came wrapped in boxing gloves.

Many of my clients have found dealing with Allstate on your own is like going a few rounds with Mohammad Ali. There’s a lot of jabs, some body blows and eventually you’re seeing stars wondering what happened. There are numerous stories of how Allstate adjusters have not dealt with people on a level playing field just like the story of attorney Ben Sansone’s client. 

A case in Washington had to reinforce the fact that Allstate cannot tell a Washington car accident victim they don’t need to speak with an attorney because the insurance adjuster is looking out for them and attorneys will only take money out of their pocket. When an insurance company tells someone they’re looking out for them and they don’t need an attorney to review a release of all claims form they want signed – the insurance company is giving legal advice without a license to practice law. That’s illegal – and just not right.

Although I haven’t personally had an insurance company threaten bankruptcy of the at fault driver as a way to force a low settlement — it doesn’t surprise me. An experienced Washington injury attorney should know that a bankruptcy has no effect on the available insurance. This underhanded tactic does not work on experienced injury attorneys, but if it were you — would you know the threat was hollow? I have had several cases were the at fault party went bankrupt, but the insurance coverage was still available and paid despite the bankruptcy. This is definitely a trap for the unwary and another reason you should speak with an experienced Washington injury attorney before speaking with an insurance adjuster.

Or better yet order my free book “The Guide to Washington Injury Cases” by clicking here. The book will give you some good information about the whole Washington car accident claim process before you speak with that pushy insurance adjuster.

Blue Cross has apparently been fishing for doctors who will report pre-existing conditions of new Blue Cross members during office visits according to a good post by California Personal Injury And Insurance Blog. Blue Cross is looking for doctors to refer new Blue Cross members with the condition that the doctor agrees to report back on these new members pre-existing conditions. You wonder why would Blue Cross do this? The answer is corporate greed and the pursuit of what else but PROFITS!! 

The post on  California Personal Injury And Insurance Blog has a link to a funny video about Blue Cross and its denials for pre-existing conditions. Check it out – it’s funny! [youtube]http://www.youtube.com/watch?v=UisM6rlhbCQ[/youtube]

Doctors should not be the ones checking up for Blue Cross or any other health insurance company. It violates doctor-patient privilege and undermines patient trust in doctors. Blue Cross has all the tools it needs to check a new members past medical records for pre-existing conditions. Blue Cross is trying to shortcut this process by having doctors do it for them. This is just not right – - and another example of what is wrong with healthcare in America. “Profits over People” seems to be the theme heard again and again!

I wonder which of the current Presidential candidates has a good idea for dealing with this health insurance problem?

As a Kirkland injury accident attorney I handle many cases involving very serious injuries. I am frequently asked questions by clients and family members about issues common in many injury accidents. I want to provide you with some good information and tips about serious injury cases in Washington, so I’ve decided to do a series of blogs on the frequently asked questions I get about injury accidents in Washington.

Q:   If an insurance adjuster calls me after my accident to ask me questions, can I talk to her?

Of course you can, but I don’t recommend it following a serious accident. The insurance adjuster is calling to get you to make statements (usually in a recorded call) about the events leading up to and including the accident. They will also ask you about your injuries and whether you went to a hospital or a doctor following the accident. They will ask how you’re doing and if you missed work. She will be looking for ways to limit your claim based on your answers.

The inherent problem with talking to an adjuster following a serious accident is that they’re probing and trying to make a record of your statement. They can then use it against you at a later time should you bring a lawsuit against the driver or owner of the other car involved in your accident. They will also use it against you even if you don’t have an attorney, they will often try to make you feel guilty for not have recovered from your injuries quickly enough or that you’re going to the doctor too much. Don’t fall for the insurance companies deceptive tactics.

If an insurance adjuster calls to talk to you, tell them you’ll be happy to speak to them, after you speak with your attorney. Or better yet order my free book “The Guide to Washington Injury Cases” by clicking here. My special report will give you some good information about handling injury accident claims before you speak with that willy insurance adjuster.

Attorney Jonathan Stein author of the California Personal Injury and Insurance Blog has an interesting recent post about Allstate. It appears that Allstate thinks a Missouri judge and the Missouri Supreme Court do not know what the law is. This seems to be Allstate’s position in a bad faith case in Missouri. The bad faith case arises from a rear-end car accident that an Allstate customer caused and Allstate refused to pay the claims its customer owed for years. 

According to Joe Lambe of the Kansis City Star Allstate was ordered in September to turn over documents that plaintiff’s attorneys allege may show that in the 1990’s Allstate set up a claims payment systems that short changed clients while earning Allstate huge profits. The MO judge set the fine for Allstae’s refusal to produce the documents at $25,000 per day. In November the MO Supreme Court agreed with the judge, yet Allstate continues to refuse to produce the documents.

This is where it gets good. Allstate’s attorney told the MO judge that Allstate had a principled difference they’re “not able to resolve until somebody says what the law is.” Everyone generally knows it’s the courts who tell us what the laws is. The courts decide what the law is and we follow what it says, it’s that simple.  Allstate’s attorney then told the judge Allstate would not turn over the 12,500 documents without protective order sealing the records from public view. You have to wonder what is Allstate fighting so hard to hide?

The judge in response told Allstate he had told them what the law was. But Allstate seems to have decided the judge was wrong, the Mo Supreme Court is wrong, and the law doesn’t apply to them. Apparently, Allstate lives by some other set of laws that only apply to them. 

As Jonathan Stein said in his post Allstate is fighting awfully hard to keep these documents secret and I’ll bet that if made public they would strike a might blow to Allstate and its image of “good hands.” We’ll have to see how this turns out.

One of my goals in this blog is to help those of you handling your own injury claim. I found a great blog post by attorney Jonathan Stein at the California Personal Injury & Insurance Blog about the various levels of insurance adjusters that may shuffle through your case. Here is his post:

Their is a hierarchy of adjusters. It goes something like this:

Step 1:         When you first report a claim, if the report comes in as property damage only and it is a clear liability case, the claim is assigned to a fast-track adjuster. These people handle claims quickly, but do not deal with injuries or arguments about fault. Some insurance companies, if not most these days, use these people to deal with any non-injury claim.

 

Step 2:          Your claim involves clear liability (in other words, everyone agrees that the guy who hit the parked car is at fault) and an injury, then you get into an adjuster who handles injury claims. But, as you probably figured, there is a catch. Call them step 2A and step 2B.

              Step 2a:  2a involves clear liability claims with subjective injuries. In other words, soft tissue type claims like whiplash. There is one type of an adjuster for these cases, usually someone promoted from step 1.

              Step 2b: 2b involves clear liability claims with objective injuries. In other words, someone has a broken bone. This is usually a promotion from 2a.

 

Step 3:          Step 3 involves disputed liability claims with an injury. At this point, most insurance companies do not break claims down into subjective and objective. Disputed liability with an injury usually ends up here.

 

Step 4:          Attorney represented claims. Up until now, steps 1 through 3, the claims involved people trying to do it themselves. Once you get an attorney, you move to step 4. And you are lucky. Seriously. These are better quality adjusters with more experience who understand the system. They try to resolve most cases without lawsuits being filed.

 

Step 5:          Litigation adjusters. These are the adjusters who take step 4 claims after a lawsuit has been filed. Usually, they are the most experienced adjusters and understand how to resolve cases, and what a case is truly worth. These are, in my experience, the best adjusters.

 

Now, is this true for every insurance company? Of course not. But, it is true often enough. Now you will at least have some idea who you are dealing with and why you may be passed around like a hot potato.

In Washington the same type of adjuster switching occurs. Please remember that the insurance adjusters at all levels are trained how to speak to you and how to use your words against you. Don’t give that records statement or sign anything until you have ordered my FREE book – The Guide To Washington Injury Cases and get the basic info you need before speaking with any insurance adjuster.  

I have compiled a list of 10 things to do after you have been in an accident. The list can apply to any vehicle accident, including car accidents, motorcycle accidents, bicycle accidents, and even pedestrians hit by a car. Use the below list and your common sense as your guide in determining what to do after a vehicle accident.

1.    Stop Your Vehicle. Stop your vehicle at or close to the scene of the collision, without blocking the flow of traffic any more than is necessary. Use flares, flashlights, your car’s emergency flashers or some type of warning device to warn other drivers of the accident.

2.    Help Anyone Who is Hurt. Check the vehicle to determine if anyone has been hurt. If someone is seriously hurt call 911 for an ambulance immediately and provide all reasonable assistance you can. DO NOT ATTEMPT to provide medical care unless you are trained in first aid.

3.    Call the Police. You only have to notify the police of accidents involving injury to or death to any person, or in cases of property damage in excess of $500.00.

4.    Exchange Information. Provide to and get from the other parties name, address and vehicle registration number, and drivers’ license information. Also get names, addresses and phones of all witnesses to the accident. Make no admission and take no blame immediately after the accident. Any statements you make to the drivers of the other vehicle or anyone else can be used against you in court. Do not admit that you were at fault and keep your opinions to yourself. You may wish to consult an attorney as soon as possible before making any agreements with anyone and before making any admissions.

5.    What Else at the Scene? Most people have cameras in their cell phones. Use your cell camera or other camera to take pictures of the accident scene. Take pictures of the vehicles from all angles, position of the vehicles in roadway, traffic signs or lights, skid marks, obstructions to vision, roadway configuration, and any other important details. You should take pictures from several distances, close up, far away, and medium distance. If you don’t have a camera, write down a diagram of the accident scene including position of vehicles, traffic signs or lights, skid marks, obstructions to vision, roadway configuration, weather condition, lighting and any other detail that are important. At this point you may leave the accident scene.

6.    Injuries. If you have been injured in the collision have your doctor examine you as soon as possible after the accident. This is important because some serious injuries sustained in car accidents do not always show immediate symptoms.

7.    File an Accident Report. You are required by law to file an accident report with the Washington State Patrol within 24 hours of the accident. Accident Report Forms are available at local police stations.

8.    Notify your Insurance. Most insurance policies require you to report an accident within 24 hours of the accident. You need to notify the insurance company in order to preserve your right to later make claims for Personal Injury Protection (PIP) coverage or uninsured motorist or underinsured motorist coverage.

9.    Keep a Record. You may be entitled to be reimbursed for all expenses incurred as a result of the accident, and all time missed from work. Keep a written record of all expenses you pay and number of days missed from work.

10.     Do Not Sign Any Documents. You should not sign any documents without consulting your attorney. In particular, do not sign any kind of release without consulting an attorney no matter what an insurance adjuster says. Once you sign a comprehensive release, you will not be able to obtain further financial recovery from that person or insurance company, No Matter What! Signing the release means you have settled your claim FOREVER.

Over my three part series I have explained the Top 7 Errors to Avoid When Treating your Car Accident Injuries. All 7 errors to avoid are listed below.  Car accident victims often don’t have the information they need at the time of the accident when they start receiving medical care for injuries caused by the car accident. Hopefully by reading the below list you have gained some useful insight into how to protect your injury case.

It doesn’t matter whether you ultimately hire and attorney to help you on your injury case or not, the insurance companies will always look for these errors and use them against you when they find them. Everyone deserves to be treated fairly. It’s my hope to level the playing field a little for you by providing this information.

Here are the Top 7 Errors to Avoid when Treating your Car Accident Injuries:

1. Not seeking medical treated immediately.  When you have been injured and feel pain do not delay in  seeking medical care.  Not seeking medical treatment immediately often times leads to insurance companies arguing that you must not have been hurt very badly if you were able to wait days or weeks before first seeing a doctor.  Protect your health and your case by seeking medical treatment as soon as possible.

2. Not following the doctor’s instructions.  When your doctor tells you what to do to heal your injuries you need to follow through with what your doctor recommends.  Your doctor is the expert at diagnosing and fixing injuries, and your injury case will likely depend on his expert opinions.  The insurance company will minimize the severity of your injuries because you failed to do what was recommended by your doctor.

3. Not starting or completing therapy recommended by your doctor. If your doctor instructs you to go to 12 physical therapy treatments over the next six weeks, do it! Don’t let your busy schedule dictate when you’ll get the medical care you need. Delays in starting treatment and stopping before treatment is completed allows the insurance company to argue your injuries weren’t bad or you must have been healed earlier than expected. Protect your case and promptly seek treatment that’s recommended.

4. Self-referring to other types of treatment without consulting your doctor. An injury case is very often dependant on your primary doctor’s expert opinion regarding if you were injured and the severity of that injury. If you go to a chiropractor or other health care provider without first discussing it with your primary doctor it can look like you may be seeking unnecessary care. Keeping your primary doctor in the loop and in your corner protects your case.

5. Skipping treatment appointments or letting large gaps in time pass between treatment follow-ups. When you miss appointments or stop treating for long periods it implies that you are not suffering from your injuries. If your injuries were bad and very painful we would expect you to be very motivated to seek the treatment needed to stop the pain and suffering as quickly as possible. Life can get in the way of the best-laid plans, and you can learn to live with the daily discomfort, but it does a great disservice to your injury case when this happens.

6. Failing to disclose preexisting injuries. You need to be open and honest with your doctor. Failing to tell him about a prior injury to the same body part or any other body part can lead him to incorrect conclusions and opinions. Since your case is normally very dependent on your doctor’s expert opinion, you don’t want the facts that your doctor bases those opinions (part of which is your medical history including preexisting injuries) to be based upon inaccurate information and thus open to attack by the insurance company. It’s best if everything is out in the open, that way your doctor and attorney can deal with any complicating issues appropriately. Just because you have preexisting injuries does not mean you lose, Washington law still allows for such situations as do many other states laws.

7. Not having your car insurance or health insurance pay your medical bills. When the at-fault party or you pay your medical bills you hurt your injury case. There is a financial benefit to you when your car insurance or health insurance pays your medical bills for you. Don’t hurt your case by failing to take advantage of available insurance coverage. The reason for this is complex due to subrogation issues that may vary depending on the type of insurance coverage you have available to you.

Just because you were in a car accident that someone else caused that doesn’t mean that you should be made to feel guilty or defensive about getting medical treatment you need to heal. Being injured in a car accident is serious and may only happen once in your lifetime.  Don’t hurt your case by committing the above errors in the assumption everything will work out in the end. Nobody is going to take care of you except you. 

Insurance companies are in the business of making money and will generally only do the minimum required regardless of how long you’ve been a customer. However, that doesn’t mean just because you were in a car accident that someone else caused you should be made to feel guilty or defensive about getting medical treatment you need to heal. 

Healing from injuries suffered in a car accident can be time consuming, frustrating and stressful. But if you want to receive fair compensation for the injuries caused by the car accident you need to work at getting better by being diligent in your treatment, honest with your doctor and taking advantage of available insurance coverage. Doing these things and avoiding the top 7 errors when treating your car accident injuries will in most cases establish a solid foundation for your injury case, and help you maintain the full value of your case when it comes time negotiation a settlement or file a lawsuit.