Accident & Injury Law in Texas

Archive for the ‘insurance’ Category

Here’s an excellent article I came across today about buying auto insurance:

http://articles.moneycentral.msn.com/Insurance/InsureYourCar/10-things-your-auto-insurer-wont-tell-you.aspx?Gt1=33004

Check it out and let me know what you think.

Andrew

Big 5 insurers’ profits up 56% in 2009

As the nation struggled last, year with rising health care costs and a recession, the five largest health insurance companies had combined profits of $12.2 billion — up 56 percent over 2008, according to a new report by liberal health care activists.

Based on company financial reports for 2009 filed with the Securities and Exchange Commission, the report said insurers WellPoint Inc., UnitedHealth Group, Cigna Corp., Aetna and Humana Inc. covered 2.7 million fewer people than they did the year before.

The report Thursday also said three of the five insurers cut the proportion of premiums they spent on their customers’ medical care, committing relatively more to salaries, administrative expenses and profits.

Prepared by Heath Care for America Now, a coalition of liberal advocacy groups and labor unions, the report was aimed at bolstering the drive by Democrats to complete work on a health care overhaul, which, insurers have vigorously opposed.

Industry representatives Thursday criticized the reports approach, pointing out that 2008 was a bad year financially across many industries, skewing the 2009 comparison.
“It is disingenuous to look at the profits at one company today compared to where it was in the depth of a recession,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry’s Washington-based lobbying arm.

The 2009 company profits are nonetheless intensifying pressure on an industry already under attack for raising premiums and denying coverage to millions of Americans.

“That’s why we need health insurance reform today in this country and why we are going to continue in the Congress to work on this until we see it through,” said Rep. Rosa DeLauro, D-Conn., a leading advocate of the health legislation being pushed by Democrats on Capitol Hill.

In California, Anthem Blue Cross, a subsidiary of WellPoint, is facing growing scrutiny over its decision to raise premiums for individual health insurance policies by as much as 39 percent this year for some consumers.

Thursday, WellPoint defended the rate increase in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius, saying that the rising rates reflect soaring medical costs and will average closer to 20 percent for most customers.

WellPoint also said Anthem’s individual business in California lost money in 2009, as the weak economy prompted many customers to switch to lower-cost options. The company did not, say how much Anthem lost.

Indianapolis-based Well-Point as a whole posted a profit, recording net income of more than $4.7 billion in 2009.

WellPoint’s profit margin, at 7.3 percent, was the highest of the five big insurers. Margins at the other four ranged from 3.4 percent for Louisville, Ky., based Humana to 7.1 percent for Philadelphia based Cigna.

The companies were achieving better results at the same time they lost customers.

WellPoint shed nearly 1.4 million customers, a 3.9 percent drop over 2008, according to its filings. And Cigna lost 5.5 percent of its customers, or 639,000 people.

Only Aetna, which also was the only company whose profits decreased from 2008, gained customers, picking up an additional 1.2 Million people, an increase of 6.9 percent.

The shrinking customer base — which reflects increasing unemployment and the growing number of companies that are dropping coverage— was offset slightly by growth in the companies’ public sector business through Medicare and Medicaid.

We’ve all seen the Geico gecko and All State’s Dennis Haysbert on TV. They say we can save money on car insurance and maybe we can. It depends.
Prices are determined by factors such as your credit score, one of the top three factors in pricing, along with where you drive, how much you drive, your age and your gender. Your driving record is among the top ten factors calculated in the price but unless it’s terrible, it’s not as important as the others.

It pays to get five or six quotes. In some cases, you could save money buying over the Internet, but allow plenty of time to fill out a lengthy application with all sorts of questions. If you are an ultimate winner in the Web application process, you could save 15 percent over the price of buying from an agent, but not always.

Internet sellers include Geico Direct, Amica, Ameriprise, USAA and 21st Century.

In addition to your credit score, the price may also be influenced by your insurance score. Reed Elsevier sells the Choice Point Attract auto insurance score. It ranges from 200 to 997 and costs $12.95.

If you have been insured by a company for five years or more, you might get a better deal because of the loyalty discount. Having a home insured by the same company brings the multiline discount. Accident-free brings a nice discount as well.

If you have a teen driver, you will pay a high price, but could get discounts for driver training and good school grades.

Service is an important matter to consider. That is, if your agent is located a short distance away, you could get faster service for a car accident than you would from an Internet insurance provider who is a thousand miles away.

State Farm Insurance was slapped on Monday with a far-reaching state order that calls on the state’s largest insurer to refund $310 million to its Texas home insurance customers for overcharges dating back to 2003.

Texas Insurance Commissioner Mike Geeslin said that State Farm, which provides coverage to 1.2 million Texans, must pay up after fighting state regulators for several years to avoid the refunds that Geeslin and consumer advocates say are owed.

State Farm officials,  who have said the company owes nothing, were not immediately available for comment. The company has 10 days to file an appeal, which could delay any refunds until the courts rule.

The refund amounts to 6.2 percent of policyholder premiums for customers insured by State Farm. Lloyds— the company’s home insurance arm – from September 2003 to August 2004. For customers insured from September 2004 to July 2008, the refund amounts to about 3.4 percent of premium for each year they were insured.

“The commissioner found State Farm Lloyds rates were excessive and is ordering State Farm Lloyds to pay refunds,” Geeslin said in a summary of his order released late Monday.

The amount that State Farm was ordered to pay was less than what the state’s public insurance counsel was seeking — about $1 billion — as Geeslin followed the recommendations of his staff for a lesser amount.

“There is evidence, there is law — and between the two, you come up with $310 million,” he said.

Alex Winslow, head of consumer group Texas Watch, called the order an insult to policyholders.

“This is a joke. There is no doubt this refund is a pennies on the dollar settlement,” he said, adding that he wouldn’t be surprised to see the case drag on another six years if State Farm appeals.

The decision is being closely watched in part because insurance could become a pivotal issue in next year governor’s race: U.S. Sen. Kay Bailey Hutchison has indicated she will make insurance rates a major part of her campaign to unseat Gov. Rick Perry.

The rate dispute, dating back to 2003, began when the insurance department ordered State Farm Lloyds and several other insurers to reduce their premiums because they were deemed excessive.

The order stemmed from an insurance reform law passed by the Texas Legislature that year that put home insurance rates under state control after a period of record premium increases.

State Farm, which was told to cut its rates by 12 percent, responded by suing the state.

In the most recent ruling, Geesling was told to convene a hearing on the overcharge allegations and listen to evidence from State Farm, the insurance department and the state’s consumer advocate.

State Farm attorneys had said during hearings this year that a refund totaling hundreds of millions of dollars could be “crippling” for the company.

The attorneys also noted that the insurer is still paying off a $1 billion loan made by its parent company six years ago to stave off bankruptcy.

Patients who lack health insurance are more likely to die from car wrecks and other traumatic injuries than people who belong to a health plan, even though emergency rooms are required to care for all patients. regardless of ability to pay, according to a study to be published today.

An analysis of 687,091 patients who visited trauma centers nationwide between 2002 and 2006 found that the odds of dying after an accidental injury were nearly twice as high for the uninsured than for patients with private insurance, researchers reported in Archives of Surgery.

Trauma physicians said they were surprised by the findings, even though a slew of studies had previously documented the ill effects of going without health coverage. Uninsured patients are less likely to be screened for certain cancers or be admitted to specialty hospitals for procedures such as heart bypass surgery.

They also often wait longer to see doctors in ERs.

And patients without insurance may have higher rates of untreated underlying conditions that make it harder to recover from trauma injuries, the research team from Harvard University and Brigham and Women’s Hospital in Boston said. They also may be more passive with doctors and nurses because they don’t interact with them as often.

Overall, about 18,000 deaths each year have been traced to a lack of health insurance.

About a month ago, I had to take the deposition of a driver that had caused an accident.  I really ticked off his attorney when I asked him the following questions:

Q: Are you aware that, after the accident, my client had blood in his urine for a few days?

A:    No.

Q: Are you aware that, as a result of the accident, my client missed several weeks of work?

A: No.

Q: Are you aware that my client is claiming medical bills of approximately $7,500?

A: No.

Q: Are you aware that my client is claiming lost wages of about $3,000?

A: No.

Q: Based on my math, my client is claiming $10,500 just for his lost wages and medical bills, not including the weeks of pain he had to endure.  Are you aware that your insurance company has only offered my client $8,000 to settle his claim?

A: What can I do about that?

Of course, I am paraphrasing and omitting the interruptions by the other attorney who was objecting, instructing his client not to answer, and my discussion with him about why his client should answer (which he eventually allowed, after making many more objections).

First, I should tell you that I genuinely liked his client and felt that, when he took full responsibility for the accident in his deposition, he was trying to do the right thing.  But why then, was he being sued?  True, he had made a mistake and hurt my client.  But he had insurance to cover that and we tried to settle the claim for his medicals, lost wages, and what we believed a jury would agree to be his pain and suffering for the type of injuries he incurred.

The answer lies with who is in the driver’s seat.  At least, who is driving his defense.  What is obvious from the exchange above is that the defendant did not know my client’s injuries or his demands.  But it’s his case.  It’s his name as the defendant in the law suit.  It’s his credit that will be dinged by a judgment.  It’s his life that’s interrupted by this lawsuit.  But the insurance company and their lawyers don’t really care about that.  The lawyer is supposed to have a duty to the client, but there is an inherent conflict when the company you work for is paying your bills.  Sure, the other lawyer is supposed to represent his client, but if his client wants to settle but the people paying his check do not, who does he choose?  The ethics guidelines say it should be his client’s choice, but how can the client choose what he isn’t even aware of?

Unfortunately, almost all defendants in a car accident have the same involvement—almost none.  If you are ever a defendant, read your policy (it may allow you to choose your lawyer) and stay involved.

Every month, 24,070 Texans lose their health care coverage, according to a report released Wednesday by an advocacy group.

The report by Families USA, which is an advocate for quality, affordable health coverage for all Americans, comes as Congress is weighing, health care reforms pushed by President Barack Obama.

The report says that between January 2008 and December 2010, 6.9 million Americans lost or will have lost health coverage, including 866,580 Texans. Only California was projected to have had mare people lose coverage. “The longer Congress waits to act, the more families will lose coverage,” Families USA Executive Director Ron Pollack said.

Though the economy is a factor, the rising cost of premiums, Pollack said. Between 1999 and 2008, the average annual family, premium more than doubled from $5,791 to $12,680, the report said.

Arlene Wohlgemuth, a senior fellow at the Texas Public Policy Foundation, which is an advocate for limited government, said the health reform proposal that cleared a Senate panel Wednesday would amount to a “government takeover of our health care system.”

Texas has the nation’s highest rate of uninsured people: 25 percent.

State official to determine if insurer overcharged customers, by how much

Pick a dollar amount between zero and 1 billion. Depending on whom you ask, that’s what State Farm Insurance owes its Texas customers for overcharging on homeowner policies dating to 2003.

The Office of Public Insurance Counsel, the state’s consumer advocate for insurance, says in documents filed this month that Texas’ largest property insurer owes policyholders $785 million plus interest or nearly $1 billion. State Farm has 1.2 million customers in Texas.

The Texas Department of Insurance calculates the overcharges at about $251 million, plus nearly $100 million in interest.

State Farm says it owes customers nothing, that it didn’t overcharge them and that its rates have always been fair and competitive. The dispute dates to 2003 when Texas ordered State Farm and other companies to reduce premiums the state considered excessive.

State Insurance Commissioner Mike Geeslin will have to decide who is right.

According to Alex Winslow of State Watch, a consumer group active in insurance issues, “There are now real questions about whether State Farm will have to give back every penny they owe or whether the commissioner will let them off and order them to pay only pennies on the dollar. Any decision by Geeslin that is short of the full $1 billion will be ‘a slap in the face’ for State Farm policyholders.”

“State Farm should not be allowed to benefit financially in any way from their overcharges, including investment earnings off those overcharges,” he added.

State Farm said in its filings that it is not responsible for any refunds.

“Our position has never changed. Our rates have always been fair and reasonable,” spokesman Kevin Davis said.

The rate dispute began after a massive overhaul of insurance law by the Legislature in 2003, which put home insurance rates under state control after a tumultuous period of record premium hikes.

The increases were triggered by massive mold and water damage claims across the state.

State Farm was told to cut its rates 12 percent; it responded by suing the state in a case that remains unresolved.

Geeslin is expected to or der some refunds, although probably less than the $1 billion called for by the public insurance counsel.

A figure that large “would make the largest Texas homeowners insurer insolvent,’ and the department’s $350 million proposal would under mine the company’s financial condition for several years State Farm attorney Susan Conway wrote this month.

During the hearing in the case, State Farm attorney said the insurer is still pay ing off a $1 billion loan that it had to take out from its parent company to stave off bankruptcy six years ago when mold claims were at their peak.

A question I sometimes am asked by people who were injured in an accident is whether the injured person can settle the claim on their own. Of course, you don’t need a lawyer to settle your claim, just like you don’t need a lawyer to file a lawsuit or defend against one. The real question is, under what circumstances am I better off doing the work myself than using a lawyer?

If you have read my free report, “The Ultimate Guide to Accident Cases in Texas—Five Deadly Sins that can Wreck Your Claim,” then you will know the answer, but here is a short course.

The insurance company is not there to help you. If you were hit by someone who doesn’t have any insurance and you are making a claim with your own company, they will treat you better than if you are making a claim with the insurance company of the person who hurt you, but it’s not a whole lot better.

The insurance company agents handle hundreds of cases each year. They are continuously trained. Their goal is to settle your claim as quickly as possible (because that limits their company’s liability) and as cheaply as possible. Insurance companies don’t make money paying claims. They make money by collecting premiums and paying out as slowly, lowly, and infrequently as they can. A good agent will appear nice and friendly, because they want to get you talking. The love to get a recorded statement which they can use against you later. If they find out anything about your past medical history, they will use that against you when ask for money. Then, it’s like that Southwest Airlines commercial where the ticket agent is friendly and nice, but then turns around and has a different face when the passenger asks for an extra convenience. That commercial should be about insurance adjusters—as soon as you start asking for money, they face changes and the friendly façade goes down.

You should know from your own experience, that the first time you do something, you don’t do it as well as the second, third, etc. It’s called the learning curve. So you are trying something for the first time while the adjuster is on his thousandth—you’re at a tremendous disadvantage.

A study a few years ago made at the request of one of the insurance companies determined that people who are represented by lawyers obtain more than 100% better results than if they represent themselves.

Here are some of the things I have to do to settle a case : interview clients, interview witnesses, request police report, order 911 phone calls, order ambulance records, take photographs of the area, take photographs of the vehicles, make a map of the area, request medical records and bills, review medical records and bills, interview doctors, prepare a demand letter, negotiate with the insurance company, file suit, send discovery to opposing party, defend against discovery from the opposing party, take depositions, hire expert witnesses, subpoena witnesses, negotiate with lien holders. And that’s not a complete list.

Most often, I see people try to handle the claim themselves make the following mistakes:

* They don’t preserve evidence
* They settle too soon
* They give the insurance company too much information
* They don’t know the value of their claim
* They don’t know what they are entitled to recover under the law
* They settle because the statute of limitations is running out
* They trust the insurance company to give them a fair deal

When should you handle a claim on your own? When there is very little property damage to either car. When there are no injuries or one or two doctor visits.

Remember, if you try to handle your claim on your own, be prepared to handle it on your own through trial because most lawyers will not take on your claim after you have been working it for some time. Why? Because contingency work is a gamble—if you take the first roll of the dice and come up short, don’t expect someone else to come in to take the second roll.

A McAllen cardiologist who sent medical assistants and untrained employees around South Texas in a recreational vehicle to offer “free” diagnoses and treatment – only to later bill the federal government – has pleaded guilty to health care fraud.

Dr. Fabian Aurignac billed the federal Medicaid and Medicare programs thousands of dollars for services unlicensed workers performed, according to the U.S. attorney’s office.

Aurignac, 46, used the Medicare and Midicaid numbers of the people his RV crew found to bill the government for services thatwere never performed, performed by unlicensed personnel, or performed unnecessarily, according to the indictment.

Aurignac admitted guilt as part of a plea agreement and faces up to 10 years in prison.