
THOSE **#@%!!! INSURANCE COMPANIES!!
Just before undertaking to write an article for my monthly newsletter, I received a copy of a denial of claim report regarding a client who was struck by a car. The driver of the car was at fault hitting my pedestrian client, and the driver’s no-fault insurance coverage had been paying the client’s bills. “Had been” being the key phrase, as the company has decided recently to stop paying the medical bills as their doctor, who never examined my client, determined that her injuries were “unrelated” to the accident. That my client had surgery on her left knee, the same knee that was struck by the vehicle, apparently held little weight for the insurance company doctor.
Fortunately for my client, the bone doctor who performed the surgery is fired up and angry at the insurance company and its doctor. To quote him in a letter written to the insurance company appealing its decision denying payment, “In more than thirty years of practicing orthopedic surgery, I have never occasioned a situation such as this, where a physician retrospectively reviews notes, and without having had the benefit of talking to and examining the patient, takes it upon himself to overrule a treating physician who has been directly involved in the patient’s care.”
As a lawyer and a person who has to pay for health insurance out-of-pocket, I hope that the insurance company will change its mind, do the right thing, and pay for the surgery. If not, the bill will be presented to the client’s private health insurer, who will then pay it. Who ultimately pays for it? You and I do, in the form of higher health insurance premiums. Wonder why your health insurance costs so much? This is one of the reasons- the insurance company that should be paying for this surgery wants to keep its money instead and pad its profits, while you and I end up paying more for our health insurance as a result.
I'd like to think that I will get my pound of flesh out of the insurance company for this rotten tactic by winning a whole bunch of money on the case for my client. Unfortunately, the person who injured my client had only the minimum required liability insurance in New York of $25,000, so $25,000 is all the client will get from the driver's insurance company. Remember, receiving no-fault insurance benefits are completely different from and have nothing to do with money that you might win when suing the driver for your injury (pain and suffering) under the driver's liability portion of his/her insurance policy. Unfortunately, many times the dishonest insurance company tactics are the same no matter what type of coverage we are talking about. You can learn more about the differences in these types of insurance coverage at http://www.cannonlaw.net/reports/the-insiders-guide-to-buying-car-insurance.cfm
An Insider's Guide to Avoiding Mistakes That Can Ruin Your Injury Case
The Ultimate Guide to Protecting Your Family From Irresponsible Drivers in New York
Please fill out the form and we will be in touch with you shortly.
Law Offices of Scott D. Cannon
28 Main Street
Geneseo, New York 14454
Phone: (585) 243-9330
Toll Free: (800) 343-6918
Get Directions