Vancouver Personal Injury Lawyer

Health Insurance and Auto Accidents

Don Jacobs — Thu, 01 May 2008 20:35:30 GMT

Although many consumers carry personal injury protection (PIP) coverage on their auto, the minimal limits sold in Oregon and Washington are $15,000 and $10,000 respectively. If you require hospitalization after an accident, these benefits can be exhausted pretty quickly. When this happens, some are fortunate enough to have purchased individual health insurance or have it available through an employer. Although deductibles, co-pays and 80/20 percentages may apply depending on the particular coverage, most of these plans have high ceilings and cover medical bills up to a million dollars or more lifetime. Unfortunately, an alarming trend seems to have taken hold in the last several years with these plans. Provisions are being placed in the plans denying coverage for any medical care caused by an auto accident unless the consumer agrees to reimburse the plan out of any settlement or court award received. Referred to as "subrogation clauses" these provisions have long been in the fine print of most plans. The thinking is that when a consumer recovers the medical bills as part of a settlement or court award, they should rightfully reimburse their medical insurance company. When challenged, the courts have upheld these clauses as long as the consumer was fully compensated on their claim. If the guilty driver didn't have enough insurance to cover the whole claim, the consumer had no obligation to repay his insurance company. The courts have referred to this as the "made whole" doctrine, curtailing any reimbursement right of an insurance company unless the victim receives full compensation first. Unfortunately, medical insurance companies may have found a way around this rule by forcing the consumer to sign documents waiving this right before they provide any coverage. They reason if it wasn't really covered in the first place, it really isn't subject to the made "whole rule" rule. The end result? The insurance company gets paid first. Which means perhaps your entire settlement or jury verdict goes to the insurance company and you recover nothing. Makes you wonder why you bought insurance in the first place.

"Sue to collect" uninsured motorist coverage

Don Jacobs — Wed, 23 Apr 2008 20:06:00 GMT

Many people carry uninsured motorist coverage on their auto policy. This way when an uninsured driver hits your car and causes an injury, you can look to your own company for payment of your damages. If you've purchased this coverage your company has a duty to investigate the accident, evaluate your injury claim and pay benefits in a timely manner. Many times however, consumers find themselves in a dispute with their own insurance company. In uninsured motorist claims, disputes can arise over how bad you were injured or whether or not all of your injuries were caused by the accident. Sometimes companies exercise their right to have you see a doctor of their choice. The experience of most people subjected to an exam of this nature is negative. For some reason, most insurance doctors tend to disagree with the doctor in charge of providing care. So what happens when you get into a friendly dispute with your own company? For many years, insurance policies contained provisions that allowed you to resolve the dispute without going to court. A private arbitration hearing was held. Private arbitration is a great way to resolve many disputes. It's quick and inexpensive. Court cases can drag on for years, create a great deal of stress and eat up a lot of your money in court costs. Although Oregon has for the most part retained the arbitration system, many Washington insurance companies are now putting provisions in your policy requiring you go to court if you disagree with their decision. Called "sue to collect" clauses, these provisions means you have to file a lawsuit at the county courthouse against your own company. It also means you have to spend a lot more of your time and money to get your insurance benefits. Many people faced with this prospect throw up their hands and just accept what the insurance company gives them. So who do these new clauses benefit? I wonder.

Rough tactics in uninsured motorist coverage

Don Jacobs — Mon, 21 Apr 2008 16:17:00 GMT

Many of us carry uninsured motorist coverage on our auto policy. Always a good idea, this coverage is the only safeguard you have if hit by an uninsured driver. With so many uninsured drivers on the road, lawyers who represent injured consumers almost universally recommend purchasing this extra coverage. If you purchase this extra coverage and are hit by an uninsured driver, your insurance company is obligated to do several things. First, they have a duty to investigate the accident and your injuries. Next, they have a duty as professionals to do a good faith evaluation of what the claim is worth. Many consumers have no idea how to evaluate an injury claim. They have to rely on their insurance company as professionals in the business to perform a fair evaluation and advise them of the results. This is essentially your insurance company telling you what they feel you are owed in benefits under the policy. When an insurance company comes to a decision as to what they feel the claim is worth, they have a duty to advise you of the amount and pay it in a prompt manner. This is what you pay your insurance company for. Well what if you have an honest disagreement with your insurance company over value? Maybe you've done your own research and came up with a different number. Maybe you consulted an attorney who advised you the figure should be higher. What's supposed to happen at this point is for your company to pay what they admit they owe. They then should provide you some sort of mechanism to appeal their decision if you want to try for more. Every insurance policy contains a provision as to your rights of appeal. But the bottom line is they should pay what they admit is due under the policy. Unfortunately, many companies manipulate the system with hardball tactics. They tell you what they feel the claim is worth, but refuse to pay unless you agree waive your right to try for more. This puts many consumers in a dilemma. If you have been injured in an accident and the other driver is uninsured, you often find yourself behind the eight ball financially. You may find yourself with unpaid medical bills or lost time from work. Maybe you put some of the unexpected bills on a credit card with high interest rates. You find you really can't afford to go much further unless you get some money coming in. Your insurance company knows this. They know you are under pressure and can't afford to wait them out. Because of this, many consumers end up agreeing to waive their rights and just accept the insurance company's figure. If your company treats you this way, consult an attorney. You may have other options. And when the case is over, give your business to another company.

Oregon Court Rules against Farmers Insurance

Don Jacobs — Wed, 16 Apr 2008 20:56:36 GMT

On April 16, 2008 the Oregon Court of Appeals handed down the case of Farmers Insurance Company v. David Conner. The case is important as it sets a new precedent allowing consumers to get the full value of their insurance coverage. The facts involve a simple auto accident. Mr. Connor was injured. Another driver caused the accident. Unfortunately, the other driver carried a low liability policy of $25,000. Mr. Connor's medical bills were over $30,000. Fortunately, Mr. Connor had uninsured motorist coverage on his policy just in case he was hit by a driver without insurance or without enough insurance to cover his claim. He also carried medical coverage. All of his medical bills were paid by Farmers while he was waiting to settle. When the other driver's insurance company learned how bad he was hurt, they paid up the $25,000 in liability coverage. Mr. Connor then asked Farmers to make up the difference between what his case was worth and how much he received from the negligent driver's insurance company. The combined amount of the bad driver's policy and his own medical and uninsured motorist coverage still wasn't enough to cover what his case was worth. The case went to arbitration and an arbitrator ruled just that. Farmers agreed to pay the value set on the case by the arbitrator, but wanted to subtract from the award the amount of money they paid to cover his medical bills, essentially shorting Mr. Connor on his claim. The Court stopped Farmers from doing so. The ruling held that making sure the injured person is paid out of his policy trumps the insurance company's right to offset one coverage against another. The result, Mr. Connor actually got to receive the insurance benefits he purchased. Imagine that.

Medicine mix-ups hurt many children

Don Jacobs — Sun, 13 Apr 2008 15:43:00 GMT

The above headline highlighted an article in the Vancouver Washington paper this week. The article went on to say 1 in 15 children admitted to hospitals were harmed by drug mix-ups or accidental overdoses. Readers may recall the nightmare actor Dennis Quaid and his wife went through last November. His newborn twins were negligently given a large overdose of the blood thinner heparin. The overdose was life threatening. Fortunately the twins survived, but the actor called it "the most frightening time of my life". His advice to any parent with a child in the hospital? "Every time a caregiver comes into the room, I would check and ask the nurse what they are giving them and why," Quaid said. The 1 in 15 children harmed figure came from the first scientific test of a new detection method. The number of mistakes found was much higher than people in the industry predicted. A doctor from the National Initiative for Children's Healthcare Quality, who helped put together the detection tool used to conduct the study was quoted as saying, "These data and the Dennis Quaid episode are telling us that . these kinds of errors and experiencing harm as a result of your health care is much more common than people believe. It's very concerning". Very concerning is an understatement. When you have a one in fifteen chance of your child being injured as a result of hospital negligence just from medicine mix-ups or overdoses, it's more than concerning. It's frightening. When you take your child to a hospital you have to trust they know what they're doing and will take care of your child. You have to believe your son or daughter will be safe there and get help for whatever ails them. With the outcome of this study, that trust appears misplaced.

Allstate Insurance Loses Right to Sell Auto Insurance

Don Jacobs — Thu, 10 Apr 2008 12:04:36 GMT

On Friday, April 4, 2008, the District Court of Appeals in the State of Florida decided to uphold the Florida Insurance Commissioner's suspension of Allstate from selling insurance in the State of Florida. The Insurance Commissioner had suspended Allstate several weeks earlier for refusing to release documents about their claims handling process. The documents were sought in a court case where a judge found Allstate guilty of improperly reducing payments to policyholders with bodily injury claim by up to 20%. The Court of Appeals also ruled that Allstate was engaged in ongoing criminal activity by failing to cooperate with the Office of Insurance Regulation's investigation of a crime, and that this constituted a danger to the public health, safety or welfare of Florida citizens. As a result of the ruling, Allstate finally relented and released the requested documents. Guess what they showed? How a company deliberately abused people with injury claims. Thousands of consumers who were Allstate policyholders were forced to accept less for their claims. Thousands of people who were injured by drivers insured by Allstate also suffered. Lawyers who handle injury cases have suspected this for years. Even more reprehensible, the documents showed how the company did things to worsen the public's perception of lawyers and injured people. Allstate wanted to get the public to distrust lawyers. They also wanted people to distrust injured people. They figured this would make anyone who served on a jury more likely to reject someone with an injury claim. The whole thing stinks. Just think, an insurance company engaging in massive nationwide abuse of injured people. At the same time, going across the nation telling state legislators the tort system is broken and we need tort reform to limit the rights of injured people to sue. A large company trying to essentially tamper with juries by making the public distrust lawyers more than they already do and to be suspicious of anyone who claims an injury. All in a very successful effort to make more money for the corporation. Allstate recently reported the largest profits of its 77-year history. It had a record profit of $4.9 billion in 2006 and 4.6 billion in 2007.

Full Coverage

Don Jacobs — Fri, 04 Apr 2008 20:14:11 GMT

Lawyers who practice injury law are used to hearing clients say, "I'm fully covered", or "I've got full coverage". Most really have no idea what this means. If you're "fully covered" you'd think you have every possible add on and extra endorsement the company sells, including collision, comprehensive, PIP, towing and rental coverage. It also implies you've purchased the highest possible coverage limit on each. Actually, "full coverage" means just the opposite of what it implies. All it really means is you've purchased a policy that fully complies with the state law on how much liability insurance you have to carry to drive. In Oregon and Washington, that means as little as $25,000. This isn't much if you injure someone seriously. Your personal assets, such as your home and savings, can be at risk. It also doesn't necessarily mean you have uninsured motorist coverage. This coverage protects you if you are injured by another driver who carries little or no insurance. Your company then acts like they insure the other driver and pay you what you would have received had the other driver been insured. For some reason, the people who don't carry insurance or who purchase "full coverage" policies seem to cause more than their share of accidents. This fact makes uninsured motorist coverage a must. Pull out your auto policy (something you really should do once in a while) and look at your coverage. Hopefully you'll notice you carry uninsured motorist coverage. If you don't, call up your agent. Purchase as much as you can afford. This is insurance you really can't afford to leave out of your policy.

Insurance Settlements and Health Care Bills

Don Jacobs — Tue, 01 Apr 2008 18:37:04 GMT

Read the fine print. Who hasn't heard that advice. Let's say you are injured in a collision. The other driver is at fault. Fortunately, they have insurance. You'd think the company would step up from the very beginning and offer to pay your medical bills as they are incurred. Wouldn't that be the right thing to do? Wouldn't you want your insurance company to do this if you injured someone? I'm not saying this never happens, but in over twenty five years of doing accident law I've seen it occur twice. This makes it almost as rare as a Trail Blazer Championship. So how do you keep the doctors off your back while you're waiting to settle? Most people turn to the PIP coverage on their auto policy. This is great coverage, but many people make the mistake of buying the lowest coverage available, $15,000 in Oregon. This amount can get eaten up pretty quick if you are hospitalized, especially if expensive tests are run. Then what? To whom do you turn? What about your health insurance? You may have a deductible and some co-pays, but at least the bulk of the bill will be paid. However, just about every health insurance policy these days has a provision saying they get paid back when you settle. Some consumers wonder why they have to pay this back, since they've been paying for years to maintain the coverage. The short answer is it's in the policy. You didn't have much choice about the terms when your company went with this health insurer. Well that's fine you figure, after all the settlement should cover all my health care bills and usually a bigger amount for pain and suffering. But what if it doesn't? What if the other driver purchased the lowest coverage allowed by law? What if the coverage isn't enough to cover all of your bills? Who gets paid first, you or your health insurance company? Well gosh you were the person who was injured. You were the person who paid for the health insurance coverage out of your check every month. Clearly it must be you, right? Think again. Read the fine print. Many health insurance policies now have provisions giving them the right to be paid first. Many are now actually contacting the other driver's insurance before the case settles, demanding they be paid in full before you get a dime. Liens are threatened unless they are paid directly, sometimes leaving you with nothing. What about all those co-pays and deductibles you had to pay? What about your lost wages? Shouldn't they be paid first? Before your insurance company gets any money? Seems reasonable. But insurance companies carry much more clout than the average consumer. They get to write the contracts. There are a few protections in the law limiting your health insurer from taking all the money. But don't expect them to tell you when they apply. After all, who is more important here, you or the insurance company?

PIP insurance. Why do I have to pay it back?

Don Jacobs — Fri, 28 Mar 2008 21:00:39 GMT

If you live in Oregon, you automatically carry PIP insurance on your auto policy. Washington doesn't require it yet, but does require your agent have you sign off on a form if you decide to reject it. PIP insurance is a good thing to have. If you are in an accident and someone injures you, PIP pays for your medical bills and a portion of your wages while you are trying to recover. Some people think the other driver's insurance should be paying instead. A nice wish. However, the other driver's insurance won't typically pay a dime until they can write one check to settle the whole claim. Without PIP insurance, it can be tough for people to get by with no income and medical bills stacking up. Many doctors will not wait until the claim settles to get paid. Collection agencies start to rear their heads. PIP is good insurance. Doctors love it. There is no deductible, no co-pay and no pre-approval for care. As long as the treatment is related to the accident it should be paid. PIP is provided for a fee of course. Look at your insurance bill next time it comes in and see what you pay for this coverage. What surprises many people is the rule they have to pay this coverage back when they settle. "Why do I have to pay this back? " or, "I thought I paid for this coverage?" are common questions heard by attorneys in this area. The simple answer is because the policy says so. Read the fine print. Clients who hear this often ask, "Do I get my premiums back?" Wouldn't that be nice. Unfortunately, no. Often times your insurance company gets paid before you do on these cases. Washington does have some case law that limits what you have to pay and Oregon has a somewhat weak statutory scheme that reduces payback on infrequent occasions, but both states allow this to happen. So what can you do? Fight city hall? No, but you can at least look into whether or not one of the legal exceptions applies in your case. Don't expect your insurance company to tell you if it does. After all, you did pay for this coverage. If an exception exists to the payback rule you want to take advantage of it.

PIP insurance. Why do I have to pay it back?(2)

Don Jacobs — Fri, 28 Mar 2008 21:00:39 GMT