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Auto insurer refuses to provide coverage for the jaws of life

Stephanie Day — Thu, 22 Jan 2009 10:26:32 GMT

Recently, State Farm refused to pay a fire department bill for the use of the "jaws of life" to extricate an injured person from an automobile collision. State Farm's basis for the coverage denial was that the extrication was a "non-medical" expense, and thus, not covered by the injured insured's medical payments coverage.

This position leaves me to wonder what we're really paying for when we buy automobile insurance coverage. I guess State Farm and other like-insurance companies expect its injured insured to be taken to the emergency room by the wrecker towing the mangled vehicle. Maybe the emergency room doctors and staff would enjoy working outside for a change.

Folks, question your insurance agent about your policy, and be sure to read your auto insurance policies carefully!

Originally posted at InjuryBoard by Stephanie Day

Insurance Companies Will Be There? For whom?

Brett Goodson — Sun, 28 Jun 2009 22:17:42 GMT

It was impossible to turn on the radio, a television or go online this weekend and not see the news. Michael Jackson, the king of pop himself, died at the age of 50. The headlines were everywhere, but so it seems, was something else. A commercial (see below) appeared on all the major news networks during what seemed to be every commercial break. It features a young Michael Jackson, during his Jackson 5 days, singing “I’ll Be There” and it’s doubtful the relation to the major story of the day was purely coincidental. If you haven’t seen it yet, the commercial is for a major insurance provider and features images of people who appear to have just suffered a devastating loss and the insurance company coming to the rescue. It also includes images of candle light vigils, soldiers returning home presumably from Iraq or Afghanistan, and cancer benefits, among other things.

Commercial

Perhaps I’m too cynical, but being familiar with the insurance industry’s unwritten policy of, “Deny, Delay, Refuse & Confuse,” I’d like to take this opportunity to suggest some new lyrics that may be a bit more appropriate for an insurance company commercial:

I’ll be there (to instruct contractors to alter damage reports and undervalue claims in Oklahoma following a tornado and in Mississippi following Hurricane Katrina so the company can refuse coverage to policy holders).

I’ll be there (to suddenly refuse coverage, after providing it for 8 years, to a boy with a crippling neurological condition that forces him to function at the level of an infant based on a report by a obstetrician/gynecologist).

Just call my name, and I’ll be there (to initially deny a claim for a liver transplant, stating it was not “appropriate,” only to approve the transplant mere hours before the teenage patient died from her illness).

Granted, the Jackson 5 version is catchier, but as far as insurance companies go, the above version may be more accurate. Insurance companies have their "good hands" out to collect your premium but put on the boxing gloves if you ever need to make a claim.

Don't allow yourself to be cheated by insurance company claims practices. You have rights which can be enforced in a court of law.

Originally posted at InjuryBoard by Brett Goodson

Ohio Judicial Campaign Contribution Conundrum

Brett Goodson — Mon, 15 Jun 2009 16:00:02 GMT

The recent Supreme Court decision in Caperton v. A.T. Massey Coal Company may have elected judges checking lists of their major campaign contributors against upcoming cases on the docket, but what will be the lasting impact? (Click Here for more information) Caperton concerned Justice Brent D. Benjamin of the West Virginia Supreme Court and his refusal to withdrawal from a case in which one of the parties, A.T. Massey, had been a major contributor in his campaign for a spot on the West Virginia Supreme Court. A.T. Massey had contributed close to $3 million in an effort to unseat the incumbent that then candidate Benjamin was opposing. After winning the election, Justice Benjamin refused to remove himself from a case involving A.T. Massey. He sided with A.T. Massey (resulting in 3-2 decisions) on two separate occasions, each time throwing out a $50 million jury verdict. Writing for the majority, US Supreme Court Justice Anthony Kennedy called the facts “extreme” and that the situation reflected poorly on the West Virginia judicial system.

Like West Virginia, Ohio conducts elections to fill the seats of its Supreme Court. And like West Virginia (as well as every other state that fills its Supreme Court via election), Ohio has its fair share of campaign contributors. Of the 7 current members of the Ohio Supreme Court, 5 count insurance companies as their top organizational contributor. These contributions ranged from $29,000 to $124,000 during the 2008 election. Perhaps more disturbing is a 2006 New York Times article which found Ohio judges rarely removed themselves from cases involving campaign contributors and on average decide in their favor 70% of the time.

A great fictional novel to read this summer is John Grisham’s, The Appeal. The book describes how easy it is for business and insurance companies to influence judicial elections which can in turn help them increase profits and obtain favorable rulings from the judges they helped elect. While this subject matter is disturbing, the book is a great read.

The Caperton case should not be read as a broad sweeping indictment on the practice of electing state Supreme Court justices. Even Justice Kennedy made sure to point that not every contribution to a campaign should be viewed as a potential source of bias. However this decision should be used as a starting point for a larger discussion on the place of elections and campaign contributions in the judicial system. In an encouraging sign, Ohio Supreme Court Chief Justice Thomas Moyer is calling for a new judicial ethics policy at the state's highest court in response to the US Supreme Court’s holding in Capterton.

Originally posted at InjuryBoard by Brett Goodson

Construction Worker Killed in Crane Accident

Chrissie Cole — Mon, 02 Jul 2007 02:07:57 GMT

A worker was crushed to death, Monday, in a construction accident when an 8-ton weight from a construction crane fell on him, police said.

The worker, 51, of Fremont, employed by Mosser Construction Inc. for 18-years was helping other workers to dismantle the crane when one of the counterweights came loose and struck him. The worker was declared dead at the scene.

He was supposed to drive one of three tractor trailers that were taking away sections of the 80-ton crane that was being used to build a new pump station at the city wastewater treatment plant.

Representatives from the Occupational Safety and Health Administration were on-site Monday conducting interviews and gathering further information about the accident.

Originally posted at InjuryBoard by Chrissie Cole

Who Does Tort or Medical Malpractice Reform Really Benefit?

Alison De Villiers — Tue, 15 Sep 2009 10:24:17 GMT

We have been told repeatedly over the years that medical malpractice claims are destroying the business of healthcare. Various groups have advanced this claim at various times, but the usual suspects are insurance companies, doctors, and conservative politicians. Today, let’s take a look at the insurance industry and see if we can’t sort out some of their claims. Perhaps we can take a look at the other groups a bit later.

Insurance companies claim that medical malpractice claims are the primary driver behind the high prices doctors pay for insurance. This seems reasonable, if the cost of being a doctor goes up, either doctors will stop being doctors, change to less risky fields, or pass the costs along to the consumers of healthcare. It is true that malpractice insurance premiums have drastically increased over the last 25 years. Are these price increases being driven by lawsuits? For this charge to be true, either the overall number of claims must have increased or the awards for individual judgments must have increased massively. If increases in damage awards were responsible, then one would expect to see lower payouts and lower premiums in states that have statutorily capped such damage awards. So, when we do the research, do we see such an explosion, of either claims or payouts? The short answer is no, we do not.

A study of malpractice claims in Texas 1988-2002 found after controlling for inflation and population growth that there had been a decline in the number of small claims (under $25,000) and that the number of large claims had remained roughly constant. In addition, the amounts of those paid claims only rose 0.8-1.2 percent per year. As for the effects of capped non-economic damages, one national study found that while payouts did decline in the nineteen states that then had caps, premiums in capped states rose far faster than those in uncapped states. In states with statutory caps, the median annual premium increased 48.2%, while those states without caps saw a median increase of only 35.9%. This suggests that while something is driving premiums higher, it isn’t malpractice claims. A slightly more recent bit of research shows that nationwide the number of claims declined by four percent between 1995 and 2000. (pages 24-25). Declining numbers of lawsuits doesn’t sound like a crisis.

So, from the perspective of the insurance companies, what is driving up the cost of insuring doctors? According to Martin Weiss, an analyst with Weiss Ratings, Inc., there are several factors, including: increases in the cost of medicine generally, the cyclical nature of the insurance market, a need to shore up capital reserves for policies already in force, and a decline in investment incomes due to poor investment choices. (pages 9-11). These are all real forces, and it is utterly rational for the insurance industry to raise its prices in response to them. What is wrong is for the industry to hide those increases behind a smokescreen of some phantom ‘crisis’ of lawsuits.

The tort system as we know it has existed for centuries. Its goal is to ensure that when a person is injured through no fault of their own, that the person responsible for the injury restore them to health. A secondary goal is to discourage negligence in general. It is difficult to argue with the morality of either of these goals. We want a society in which people are personally responsible for their behavior. Tort reform is about severing responsibility for causing an injury from the person who caused it. Insurance companies would have us do this as a mere convenience, so that they need not explain why they are raising their prices. This is an unacceptable reason for fundamentally altering a massive chunk of our legal system, one that has long served us well.

Perhaps the best way to end this is to ask who tort or medical malpractice reform doesn’t benefit? The answer to that is simple: consumers.

Originally posted at InjuryBoard by Alison De Villiers

What Jurors Probably Don't Know About Defense Medical Experts

Alison De Villiers — Mon, 22 Jun 2009 12:35:30 GMT

When a Plaintiff is injured due to the negligence of another, the Plaintiff must rely on her doctors to testify as to the nature and extent of her injuries. In most states, like Ohio, the attorney for the Defendant/insurance company is then allowed to hire a doctor to examine the Plaintiff and render an opinion on the nature and extent of the Plaintiff's injuries. In the Cincinnati area, my clients are repeatedly sent to the same few doctors to be examined. It is extremely rare that one of these doctors will agree with the Plaintiff's treating physicians regarding the extent of the Plaintiff's injuries.

To the typical juror, the defense medical experts may seem to be on equal footing as the Plaintiff's treating physicians. The attorney for the Plaintiff can do her best to show how much the defense medical expert is being paid for his time and how much that equals out to per year. But, it seems to have little effect on jurors. The defense attorneys often argue: Why would this doctor risk his medical reputation by sticking his neck out for me or my firm in this case?

What the jurors do not know is that if the defense medical doctors start agreeing with the Plaintiff's doctors, the attorney for Allstate or State Farm will not be as inclined hire them to do defense medical exams. Lose one insurance company and that could equal hundreds of thousands of dollars per year in lost income.

Although this article written for doctors about serving as an expert witness in cases was written in 2003, the information remains relevant. It emphasizes the high ethical obligations of medical expert witnesses, both for the Plaintiffs and the Defendants. It points out that one of the main problems in the legal system in regards to expert testimony is the lack of accountability for statements made by expert witnesses under oath. The article suggests peer review of expert witness testimony to ensure that it is medically sound. Another suggestion is to have court appointed defense medical examiners.

Originally posted at InjuryBoard by Alison De Villiers

Number of Lawsuits Not on the Rise

Alison De Villiers — Mon, 16 Feb 2009 11:13:00 GMT

Despite myths generated about the "lawsuit crisis" in America, the numbers show that the number of lawsuits filed in the country are actually declining.

According to the Justice Department under George W. Bush, the number of personal injury cases in U.S. District Courts from 1985-2003 fell by 79%. Lawsuits in state courts are declining as well, showing a 31% decrease from 1992-2001, according to Bureau of Justice Statics.

The numbers tell the true story and show that the myths about a "lawsuit crisis" are merely a vehicle for big businesses and insurance companies to insulate themselves from laws meant to protect Americans.

For more information on the decreasing number of lawsuits in America and other myths about purpetuated about lawsuits in America, click here.

Originally posted at InjuryBoard by Alison De Villiers

How Much Auto Insurance Should I Carry?

Brett Goodson — Tue, 26 May 2009 14:48:29 GMT

Deciding how much auto insurance to carry presents some difficult issues. The most obvious reason to carry auto insurance is to protect yourself if you cause injury or property damage to another due to your negligence. None of us expect to cause an accident, but they do happen. It can be as minor as a fender-bender backing out of a parking space to as serious as causing the death of another because you briefly took your eyes off the road.

Ohio law requires you to carry at least $12,500 in liability coverage. This isn’t nearly enough to cover most accidents. Liability coverage protects you up to your policy limits for damages caused by your negligence. So what should your policy limits be? They should far exceed any assets you have to protect. If you own a house, car, and have money in the bank, the only way to protect it is by adequate insurance coverage.

The other aspect to auto coverage is uninsured motorist coverage. This protects you to some extent if the person who injures you in an accident is either uninsured or underinsured. In Ohio you can’t buy uninsured/underinsured motorist limits higher than your liability limits so you need adequate liability limits to get adequate uninsured/underinsured motorist limits.

Probably, the best and most economical way to protect your assets and loved ones is to buy an umbrella policy over your liability limits. Make sure the umbrella coverage includes uninsured/underinsured motorist coverage. For most people I would recommend a $1,000,000 umbrella over your auto liability coverage, uninsured/underinsured motorist coverage, and homeowner’s coverage.

Originally posted at InjuryBoard by Brett Goodson

The Impact of Negligence Laws in Ohio on Personal Injury Verdicts

Alison De Villiers — Mon, 03 Aug 2009 09:07:55 GMT

Every industry has its jargon, its inside jokes, its own language, if you will. We see this in medicine, philosophy, even plumbing contracting. The law is no exception to this. What often looks, to a layperson, like confusion for the sake of confusion, is generally the result of efforts to gain technical precision. Sometimes this results in the creation of words that normally only lawyers use, like the word ‘tort.’ Sometimes it results in lawyers using common place words in a completely different or more specific way, as with the word negligence.

Since many of us will at some point in our lives be involved with the legal system, as a plaintiff, defendant, or member of a jury in a civil trial, let’s try to unpack some of these terms and see if we can’t clear the air a bit. This will be a sketch of the broad outlines of negligence. Specific details may vary widely from between jurisdictions and if you are actually injured you should always consult a personal injury attorney familiar with the laws of your jurisdiction.

Let’s begin with a very brief thumbnail sketch of tort law. I won’t delve into specific cases, though if you are interested in truly bizarre injuries throughout history, you will find tort law fascinating.

A tort is simply an injury (it was originally a Latin word which entered English via French during the Middle Ages) that doesn’t arise out of a contractual or criminal matter. The most common tort today is negligence. Negligence, in a legal sense, has four parts: a duty of care, a breach of that duty, the breach must not be too remote a cause of an injury, and the breach must in fact do harm to someone.

Under the common law, if an injured party (a plaintiff) bore any responsibility, even one percent, for his or her injuries, there could be no recovery. This theory of negligence is known as contributory negligence (CN). If a cyclist continues to ride a bicycle despite knowing that the brakes do not work and accidentally rides into the street and is injured by a driver who is speeding, the cyclist was traditionally barred from recovering any damages from the negligent driver. Most people today find this system fundamentally unfair, and it has grown increasingly unpopular, with only four states and the District of Columbia still using it in its purest form.

At the opposite end of the spectrum is what is called the “pure comparative fault rule” (PCF). What this means is that you, the plaintiff, can always recover, even if 99% at fault, but that your recovery will be reduced according to your degree of fault. If a jury finds that $10,000 worth of damage has been done, with Andy 40% at fault and Elaine 60% at fault, Elaine can still recover damages, but her judgment will be reduced by 60%, for a net recovery of $4000. Thirteen states use this rule.

The remaining 33 states use some form of the “modified comparative fault rule” (MCF), which is a middle way between the pure comparative fault and contributory negligence standards. In these states, any damage award will be reduced by the plaintiff’s degree of fault, just as in a PCF system. However, if the plaintiff’s fault exceeds a certain threshold, all recovery is barred. This threshold varies by state, but is generally either fifty or fifty-one percent.

Common law is generally controlling, unless superseded by statute, so most states have enacted statutes choosing one of the above theories. In the case of Ohio, the legislature has chosen to adopt a modified comparative fault rule, with a fifty-one percent threshold. A potential difficulty with the sort of damage rule Ohio uses is that a jury can attempt to take matters into their own hands.

In theory a jury should award the same amount of damages regardless of the assigned percentages of fault. The plaintiff’s recovery will then be reduced by the court. Often however, in cases where the plaintiff bears a relatively large amount of responsibility for injuries, juries may mistakenly want to preemptively reduce the total amount of an award before the court has a chance to. This is a misinterpretation of Ohio law, and it is something of which a good attorney will be mindful.

Originally posted at InjuryBoard by Alison De Villiers

Auto Insurance Coverage In Ohio

Brett Goodson — Thu, 02 Apr 2009 09:04:28 GMT

It is hard to believe that Ohio only requires proof of $12,500 in liability insurance coverage to be able to drive a car in Ohio. This minimum insurance requirement was passed in the early 1970’s, and has not been increased one penny in over 30 years. At that time a gallon of gas cost 30¢, a new car could be purchased for $3,000, and a dented fender could be fixed for $25. It is time to increase the minimum insurance limits to at least $100,000.

While medical expenses have soared, and incomes have increased with inflation during the last 30 years, minimum insurance coverage has remained stagnant. Here is how the problem affects all of us. If you are injured in an accident caused by another driver, that person is responsible to pay for your medical expenses, lost wages, and permanent injury. If your injury causes you to go to the emergency room, your family doctor, and physical therapy, your bills could exceed $12,500. That means the party causing the accident gets off without paying for all the damages. If your costs exceed $12,500, either your own insurance has to pay (underinsured motorist insurance), or your health insurance will pay, or you will pay out of pocket. These are all bad choices. The only way to protect yourself is to purchase uninsured/underinsured motorist coverage. Don’t carry less than $250,000. A one million dollar umbrella is recommended. Just be sure your agent includes uninsured/underinsured motorist coverage with the umbrella. There are a lot of bad drivers out there and most have state minimums for their insurance coverage.

Contact your state senator or state representative and tell them to raise the minimum liability coverage in Ohio to at least $100,000. There are bills pending in the legislature now to increase the required coverage. You can do something about this problem.

Originally posted at InjuryBoard by Brett Goodson