Seattle Sidewalk Problems Are Up To The Homeowner

National Pedestrian Crash Report

The Top Ten Worst Insurance Companies - Washington State Insurance Commisioner

Seattle Woman Fights for her Life and Insurance Coverage l Washington Lawyer

Type: Insurance Coverage Dispute

Date: October 7, 2009, 10/07/09

Location: Seattle, WA

Outcome: Partial Coverage

Alyssa Olsen is not only battling CVID (common variable immune deficiency), a genetic disorder that leaves her extra vulnerable to bacteria and viruses, she is also battling an insurance coverage dispute with Regence Blue Shield Washington.

Olsen was given two to three years to live, unless she underwent a bone-marrow transplant that could save her life. 

The transplant costs $400,000 but Regence denied the treatment because there isn’t proof of a high rate of success.   

Olsen appealed twice to Regence and was denied both times, so she filed an appeal and through friends, contacted the media.  36 hours after the story aired on KOMO 4 News, Dr. Joseph Gifford, Regence’s Medical Director, invited Olsen to his office. 

Regence told Olsen that coverage of her transplant was approved for $200,000, but that leaves Olsen with $200,000 left to pay for her procedure, scheduled for November 10. 

Family, friends and strangers have donated $13,000 to Olsen.

We hope for a rapid recovery for Alyssa and that she continues to receive an outpouring of support from her community.

According to the Health Affairs Journal, about half of all bankruptcies filed in the U.S. are due to medical expenses.

If you have coverage disputes with your insurance company, you should speak with an experienced Seattle insurance dispute lawyer.

Insurance Dispute Resources l Washington State l Seattle Attorney

• Washington State's Insurance Fair Conduct Act
• Insurance Company "Tricks of the Trade"
• From Good Hands to Boxing Gloves: How Allstate Has Earned Billions by Shortchanging Policyholders & Claimants
• Contempt order that triggered huge fines against Allstate to be lifted
• Insurance Bad Faith: Farmers Insurance bills fire victims $420,000
• Allstate Claims Process Explained
• Health Insurer Ordered to Pay $9 Million for Illegally Terminating Benefits
• Insurance Company Alleged to Have Killed Patient for Refusing to Pay for Treatment
• Insurance Companies Seeking Ways to Mitigate the Insurance Fair Conduct Act (Referendum 67)
• Health Plan Sues Accident Victim to Recover Entire Settlement Recovery

Important Resources l Washington State Insurance Claims l Seattle Attorney

• Washington State Office of the Insurance Commissioner

  Description: The Insurance Commissioner’s Office has the responsibility of regulating the insurance business in Washington under authority granted by the insurance laws of this state.

• Americans For Insurance Reform

  Description: Americans for Insurance Reform (AIR) is a national coalition of public interest organizations that support effective insurance industry reforms to control skyrocketing insurance rates, reduced insurance coverage, arbitrary policy cancellations, mismanagement and other insurance industry abuses.

• Fight Bad-faith Insurance Companies (FBIC)

  Description: FBIC (Fight Bad-faith Insurance Companies) is a non-profit consumer advocacy organization which specializes in uncovering today's alleged fraudulent multi-billion dollar bad-faith non-payment of claims rip-offs by the powerful Insurance Industry.

• AllstateInsuranceSucks.com

  Description: Forbes picks AllstateInsuranceSucks.com as #1 Corporate Complaint Site.

• Insurance Information Institute: Auto Insurance Facts

  Description: The average cost of automobile insurance declined by 1.3 percent in 2005, according to a September 2007 report from the National Association of Insurance Commissioners (NAIC). See more interesting car insurance facts.

Washington State's Insurance Fair Conduct Act - One Year Anniversary l Seattle Personal Injury Attorney

This time last year, Washington State citizens passed Referendum 67, the pro-consumer insurance legislation.  If you recall, the insurance industry spent approximately $12 Million dollars to defeat this law.  Fortunately, the voters passed the measure by an extremely wide margin (57% to 43%).

Referendum 67 is now called the Washington Insurance Fair Conduct Act (IFCA).  IFCA created a process for consumers who feel their insurance companies have not promptly and fairly settled a valid claim. The Act requires insurance companies to act "reasonably" when settling claims, or risk having to pay a policyholder triple damages if the company ends up losing the case in court.

So far, about 900 people have notified the Washington State Insurance Commissioner's office that they plan to sue their insurance companies under IFCA.  Under the Act, a policyholder is required to give the insurance company 20 days prior notice of the intent to sue.  This is supposed to give the carrier one last chance to resolve the claim. 

Washington Insurance Commissioner Mike Kreidler says, "If that's one of the outcomes of Referendum 67, that is very positive from the standpoint of consumers – that they're dealing with better-trained adjusters who are going to make the determination on their particular claim."

Although the insurance industry fought the passage of IFCA by saying the law would raise insurance rates and create more lawsuits, Kreidler says these claims don't appear to have come true.

The Insurance Commissioner's office is tracking the numbers and types of cases and will do some random follow-ups in the coming year. For now, Commissioner Kreidler says he's pleased with the Insurance Fair Conduct Act for giving consumers more clout with their insurance companies.

In my own practice, IFCA has helped tremendously, especially in the smaller claims where it was not cost-effective to litigate against the insurance company.  In those cases, it would cost much more to litigate than what the claim was worth (usually those claims which are valued at $30,000 and under).

Insurance Company "Tricks of the Trade" l Seattle Personal Injury & Insurance Claims Attorney

Frivolous Lawsuits by Car Insurance Companies

Insurance Bad Faith: Farmers Insurance bills fire victims $420,000

First a devastating fire robbed a local family of nearly everything. Then a big insurance company tried to take the rest and more, hitting the family with a bill of $420,000. Last October Chris Christoffersen and her daughter Melissa awoke to devastation. The apartment complex they lived in was engulfed in flames.

"I watched everything from throughout my life - gone. Gone in just a few seconds," she said. Things were looking up until the family got a phone call from Farmers Insurance, which insures the apartment complex.  Farmers wanted $350,000 to repair the four units damaged in the fire!

http://www.komonews.com/news/problemsolvers/19166579.html

Insurance Company Rules - Watch this Video!!

People often ask me what it's like dealing with insurance companies all day, each week, and every month.  Well, the words that come to mind are: frustrating, irritating, disheartening, disappointing, and blood-boiling, just to name a few.  Most of my clients, particular those who have had to file lawsuits, can certainly relate.

But here's a video that really captures what it's like to deal with an insurance company when it comes time to work out a settlement.  Enjoy it, I certainly did!!  Insurance Company Rules.

Health Plan Sues Accident Victim to Recover Entire Settlement Recovery l Seattle Attorney

Can you imagine recovering a settlement after being permanently injured in a car accident that wasn’t your fault, and then being sued by your own health insurance plan to recover all of your settlement funds?

That’s exactly what happened to 52-year-old Missouri resident Deborah Shank. A collision with a semi-trailer truck seven years ago left Shank permanently brain-damaged and in a wheelchair. Her husband, Jim, and three sons found a small source of solace: a $700,000 accident settlement from the trucking company involved. After legal fees and other expenses, the remaining $417,000 was put in a special trust. It was to be used for Mrs. Shank's ongoing and future medical care.

But instead of using that money for her medical treatment, it will likely all go to repay Shank’s health insurance plan. The health plan was administered through Shank’s employer at the time – Wal-Mart Stores, Inc. Wal-Mart’s health plan was created under ERISA (Employee Retirement Income Security Act of 1974). ERISA is a federal law that sets minimum standards for most voluntarily established health plans in private industry to provide protection for individuals in these plans.

But recent federal court decisions have given enormous power to ERISA plans, especially in situations where the insured received health benefits due to injuries caused by another party. In those cases, many ERISA plans argue that it is entitled to repayment from any settlement recovery for accident-related benefits received by the person insured under the plan.

Like most company health plans, Wal-Mart's ERISA plan reserved the right to recoup the medical expenses it paid for someone's treatment if the person also collects damages in an injury suit. But until recently, many employers didn't vigilantly enforce the provision, and some states and federal courts didn't think the claim held water. But as the cost of covering workers continues to escalate, employers and health plans are getting more aggressive about going after the money. A Supreme Court ruling last year also has given them a stronger legal position to sue employees. And the employers have been winning.

In insurance circles, the recovery practice is called "subrogation." Employers and insurers say it's necessary to ensure that medical expenses aren't paid twice. By recovering those costs from someone who's been compensated elsewhere, they argue, they're saving money for everyone on the plan.

That’s exactly what happened in Shank’s case. Her Wal-Mart ERISA health plan sued Shank to recover the $470,000 it spent on Shank’s healthcare. It did not matter that Shank only had $417,000 left over after payment of lawyer fees and litigation costs. In fact, Shank’s lawyer anticipated Wal-Mart’s lawsuit and tried to protect these funds by depositing them in a “special needs” trust. But the federal district court ruled that this special trust offered no protection, and it could not defeat the claim asserted by Shank’s ERISA plan.

A spokeswoman for Wal-Mart said the company was obliged to act in the interest of the health benefits of its employees as a whole. "While the case involves a tragic situation, our responsibility is to follow the provisions of the [company health] plan which governs the health benefits of our associates," said Wal-Mart spokesperson Sharon Weber.

What does mean for other accident victims? If you receive health insurance benefits under an ERISA health plan, you may be forced to repay 100% of these benefits back out of the settlement recovery. It’s as if your health plan benefits are really a “loan” instead of insurance. It does not matter that the employee has often paid for these benefits through payroll deductions and other payments.

Clearly, Congress needs to act on this unjust result. The ERISA regulation should be amended to permit the innocent accident victim to keep the benefits in certain cases, or at least force the health plan to share in the legal costs incurred by the victim by having to hire an attorney and incur costs to recover a settlement. If this problem is not fixed, accident victims like Shank will continue to suffer such an unjust result.

To learn more about Deborah Shank’s case, click here.

Insurance Companies Seeking Ways to Mitigate the Insurance Fair Conduct Act (Referendum 67)

The Insurance Fair Conduct Act (formerly Referendum 67) was recently passed by Washington State voters last November.  This new law became effective Dec. 6, 2007.  And insurance companies are seeking ways to mitigate it's impact.  One attorney who represents insurance companies is giving advice to them on his own "insurance law blog." 

All claims brought under the Insurance Fair Conduct Act must be preceded by a 20-day notice of the claim to the insurance company and the insurance commissioner. (The Office of the Insurance Commissioner has created a cover sheet for the notice.)

An action may be brought only if the insurance company fails to resolve the basis for the action.  One defense to the claim is if the carrier relies on a "written opinion" from an "authorized agency" that the claim is still being investigated or that the claim is fraudulent.  If the carrier does not resolve the claim within the required 20 day period, a lawsuit may be initiated.

The Insurance Fair Conduct Act prohibits conduct by the carrier during the claims handling process that is considered "unreasonable."  Presumably, a violation of the claims handling regulations found at WAC 284-30 et seq. would be considered unreasonable and therefore provide a basis under the Act.  If the insured person prevails, the judge may triple the amount of damages.  The judge's decision to triple the damages is discretionary.  Another advantage of the Act is that it provides attorney fees to the successful claimant.  This will allow persons with smaller claims to bring a claim under the Act.  Without such an attorney fee provision, most people could not afford to incur the legal expenses necessary to go after the insurance company for a violation of the Act.

If you believe that you have been treated unfairly and unreasonably by the insurance company, please contact or call Davis Law Group for a free consultation about your rights.  No fee will be assessed to discuss your case.

Insurance Company Alleged to Have Killed Patient for Refusing to Pay for Treatment

Here's a sad and tragic story about a 17-year-old girl who died when her insurance company failed to pay for a necessary liver transplant.  The company, CIGNA Healthcare, reversed its decision to deny payment hours after the girl died.

Nataline Sarkisyan died last month at the University of California, Los Angeles Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.  The family hired celebrity defense attorney Mark Geragos who said he plans to ask the district attorney to press murder or manslaughter charges against Cigna HealthCare in the case. The insurer “maliciously killed her” because it did not want to bear the expense of her transplant and aftercare, Geragos said.

CIGNA argued that there was a "lack of medical evidence" that the transplant would actually help the young woman live.  After many healthcare professional expressed outrage, CIGNA then reversed its decision hours after the girl's death because it decided to make an "exception" in this case.  You can read more about the story here.

Unfortunately, Mr. Geragos has a very steep hill to climb.  It's highly doubtful that the prosecutor will take such a case.  Instead, Mr. Geragos will get more publicity to help his law practice more so than the girl's grieving family.

The real problem here is the federal legislation known as the Employee Retirement Income Security Act of 1974 (ERISA). The ERISA laws have been significantly changed and modified by corporation and business lobbyists who were able to inject language to encompass, not only pension plans, but any sort of employer plans to benefit employees. The law gives insurance companies the wide discretion to decide on their own what treatment is considered reasonable, necessary and non-experimental.  Essentially, the health plan administrator decides what benefits to pay. 

Over the years the federal judiciary enforced ERISA to allow the health plan to serve as the judge and jury on all issues related to whether benefits should be paid. The public does not understand that if they are in a dispute with a health insurance company that is governed by ERISA, as most plans are, the insurance company itself gets to decide whether it should have to pay for health insurance benefits. The federal court will not intervene to help these unfortunate employees and their families who desperately need health insurance benefits.

Unfortunately, the CIGNA health plan covering Natline and her family was subject to ERISA.  The federal courts will only reverse the insurance companies if the courts find that the insurance companies have "abused its' discretion" in denying benefits. In layman's terms, what this means is if there is any evidence whatsoever to support an insurance company's denial of benefits, the federal judges will turn their head and ignore this injustice.

Many people fail to realize that virtually all insurance companies have an army of lackeys, usually retired doctors, or doctors who are otherwise incompetent that they can not make a living in the real world, who are willing to place their stamp of approval on the denial of any claim. I call these people "rubber stamp doctors" and they are hired guns to give the insurance company the decision they need to deny benefits.

The only way to correct this injustice is to elect congressmen or congresswomen who have the courage and character to change ERISA.  I doubt that the federal judiciary, who serve judge terms for life, and are answerable to virtually no one, will ever correct this injustice.

Health Insurer Ordered to Pay $9 Million for Illegally Terminating Benefits

A woman who had her medical coverage canceled as she was undergoing treatment for breast cancer has been awarded more than $9 million in a case against one of California's largest health insurers.  Patsy Bates, 52, a hairdresser from Lakewood, had been left with more than $129,000 in unpaid medical bills when Health Net Inc. canceled her policy in 2004.  On Friday, arbitration judge Sam Cianchetti ordered Health Net to repay that amount while providing $8.4 million in punitive damages and $750,000 for emotional distress.

The next day, the Los Angeles city attorney sued Health Net, claiming it illegally canceled the coverage of about 1,600 other patients. City Attorney Rocky Delgadillo also said the company illegally ran an incentive program in which it paid bonuses to an administrator for meeting targets of policy cancellations.  Health Net acknowledged that such a program existed in 2002 and 2003 but was subsequently scrapped.

Bates was fortunate because she was allowed to complete her cancer treatment through a state-funded program.  But what about others who were victims to health insurance company’s illegal efforts to terminate medical benefits when they are needed most?  I’m sure there are many others that didn’t have the means or strength to file suit against the insurance company and pursue costly and time-consuming litigation.  What Health Net did was a travesty and the award appears justified.

Allstate Claims Process Explained l Davis Law Group Seattle

New Malingerer Pyschological Test Used and Challenged in Personal-Injury Cases

I consider malingering to be fraud and I will not be a party to it.  For more information on malingering visit our firm library. 

I just read an interesting article in the Wall Street Journal -- Malingerer Test Roils Personal-Injury Law: 'Fake Bad Scale' Bars Real Victims, Its Critics Contend, by David Armstrong.  Here's an excerpt:

A test designed to expose fakers is roiling the field of personal-injury law, distressing plaintiffs and strengthening the hand of employers and insurers.Proponents hail the true-or-false test as a valid way to identify people feigning pain, psychological symptoms or other ills to collect a payout. In hundreds of cases, expert witnesses have testified that the test provided evidence that plaintiffs were lying about their injuries, just as suggested by the test's colorful name: the Fake Bad Scale.

Use of the scale surged last year after publishers of one of the world's most venerable personality tests, the Minnesota Multiphasic Personality Inventory, endorsed the Fake Bad Scale and made it an official subset of the MMPI. According to a survey by St. Louis University, the Fake Bad Scale has been used by 75% of neuropsychologists, who regularly appear in court as expert witnesses.

But now some psychologists say the test is branding as liars too many people who have genuine symptoms. Some say it discriminates against women, too. In May, an American Psychological Association panel said there appeared to be a lack of good research supporting the test.

Contempt order that triggered huge fines against Allstate to be lifted

From Good Hands to Boxing Gloves: How Allstate Has Earned Billions by Shortchanging Policyholders & Claimants

The book From Good Hands to Boxing Gloves: The Dark Side of Insurance (2008) by David J. Berardinelli, discusses how Allstate revolutionized the claims handling process by implementing policies to deliberately reduce benefits and claim payouts by intentionally paying out less than the true value of the claim. 

Mr. Berardinelli states that our insurance system is founded on two key rules: the indemnity principle and the fiduciary principle. Together these principles are intended to level the playing field between the insurance company and the policyholder. These principles balance the insurer’s legitimate goal of being profitable while allowing the insured policyholders to get prompt and fair payment for covered losses.

Mr. Berardinelli states that casualty insurance is a unique insurance product. It’s different from other kinds of insurance like life insurance. Life insurance pays a set benefit when you die regardless of the cause or consequences of your death. But casualty insurance is indemnity coverage. It doesn’t pay a set benefit. It pays as much as the policyholder needs, up to the policy’s limit, "to restore an insured to the same financial position after the loss that he or she was in prior to the loss."  To indemnify someone means to make them whole again. That means the insured doesn’t get paid more than the actual loss. It also means the insured shouldn’t get paid less than what it takes to make the insured whole again. The insurance company's duty is to pay the full amount the policy holder needs to be put back in the same position he or she was in before the loss.  This is called the indemnity principle.

Mr. Bernadelli states that Allstate implemented a program to intentionally pay out less than the true value of claims.  Essentially, Allstate intentionally violated the indemnity principle, leaving policyholders and claimants much less than the insurance coverage they were entitled to receive.

How did Allstate accomplish this?  Well Allstate often deliberately delays paying legitimate claims by asking for useless information or demanding more proof than it really needs. It would delay payment or force policyholders to jump through needless hoops, in hopes they’ll give up or take less than the full and fair amount of the benefits they’re owed under the policy. Allstate paid for studies which showed that nearly 85% of claimants would accept whatever lowball offer Allstate made, and not bother with the hassle.  When you are talking about hundreds of thousands of claims, this adds up to hundreds of millions saved for Allstate.

Another tactic Allstate uses is to pressure policyholders who are in a financial bind into accepting a quick payment that’s far less than what they need to make them whole. It forces policyholders to file needless, expensive, and time consuming lawsuits as the only way to get what they need to fully restore them to where they were before the loss. Again, Allstate found that most people will not bother to go through the hassle of hiring a lawyer and filing a lawsuit.  More money saved for Allstate.

Mr. Bernadelli found that Allstate repeatedly violated the important principles which are necessary to protect people who purchase insurance.  Yet Allstate continues to get away with its tactics.  Allstate continues to put its own financial interests ahead of their insured’s needs, and now the system is no longer fair. The playing field is no longer level and an insured either accepts less than they receive or seeks legal counsel to level the field.