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Faced With More Claims, Long-term Care Insurers Deny Benefits

Nick DiCello — Wed, 02 Sep 2009 09:26:19 GMT

As Baby Boomers aged, there was a boom in the sale of long-term care insurance during the 1990’s. Now, however, an ever increasing portion of our population, which is living longer and longer, is seeking protection under their long-term care policies. One insurance company executive described the situation as follows: “The long-term care party of the 1990s gave us one hell of a hangover in the 2000’s.”

Long-term care insurance is a contract or policy of insurance which promises, in exchange for the timely payment of premiums, coverage for expenses of long-term care, such as the costs of a nursing home or assisted living facility. As more and more Americans with long-term care insurance enter these facilities, the insurance industry is faced with making good on their promises. Some insurers, however, have miscalculated the profitability of certain long-term care insurance products. For example, many insurers fighting to get into the “long-term care party of the 1990s” overestimated policy lapse rates and miscalculated the mortality rates for the target population. Now, during the “hangover,” insurers too commonly attempt to refuse payment of legitimate claims, sometimes on a global scale.

On March 15, 2006, Penn Treaty President and CEO issued a news release indicating that a “review is showing us that our policyholders remaining on claim beyond three years (particularly on policies issued prior to 2002) appear to be living longer than we had previously anticipated, which will likely cause us to pay higher future benefits due to the expanded duration of these claims.”

Denial of a long-term care claim or the loss of one’s long-term care coverage can be devastating. Imagine becoming accustom to life in a long-term care facility only to one day receive a letter from your long-term care insurer stating that it is “no longer medically necessary” that you or a loved one continue to receive nursing home care, and that benefits will end. This is a common exclusion cited by long-term care insurers to deny benefits. Without benefits, the elderly individual must tap into his or her assets to continue to pay for care, or must burden their family for assistance. Ultimately, once one’s assets are exhausted, he or she is forced to seek government assistance.

If you or a loved one has had their claims for long-term care benefits denied or their policy rescinded, contact the trial attorneys at Spangenberg, Shibley & Liber, LLP for a consultation, and protect your legal rights.

Originally posted at InjuryBoard by Nick DiCello

Spangenberg Lawyers File Wrongful Shooting Case Against Hancock County Sheriff

Nick DiCello — Wed, 24 Dec 2008 13:19:14 GMT

On December 10, 2008, the lawyers at SS&L filed suit in federal court in West Virginia against the Sheriff of Hancock County on behalf of Charles Penson, a 37-year old Ohioan who was shot multiple times in the neck and back rendering him permanently quadriplegic.

On April 18, 2007, Hancock County Sheriff Deputies lured Mr. Penson to a private residence in Newell, West Virginia under the false pretenses of meeting Mr. Penson’s auto mechanic. In reality, the Sheriff’s Deputies intended to serve a federal arrest warrant on Mr. Penson.

As he approached the doorway at the rear of the house, Mr. Penson was shot in the neck. Claiming not to know who had shot him, Mr. Penson attempted to run to his vehicle. He was shot multiple times in his back as he attempted to flee. Charles Penson was unarmed.

As a result of multiple gun shot wounds, Mr. Penson is permanently quadriplegic. He has no use of his arms or legs and requires 24-hour care.

Law enforcement may only use deadly force when faced with the threat of imminent death or serious physical injury to themselves or others, or when the suspect has committed a crime which has caused or threatened death or serious physical injury. Mr. Penson claims the shooting which left him permanently and significantly disabled and disfigured was unlawful. Specifically, he claims the Hancock County Sheriff’s Deputies violated his constitutional rights, including his right to be free from unlawful arrest and seizure and the use of excessive force.

Originally posted at InjuryBoard by Nick DiCello

Cell Phone Distraction Causes Thousands Of Car Crashes and Injuries Every Year

Nick DiCello — Thu, 01 May 2008 22:00:02 GMT

Cell phones have become mandatory for any professional adult. Once a high tech luxury gadget, now almost everyone has a cell phone, and increasingly more people have two. Cell phones have made modern life more convenient, allowing us to keep in touch and remain available at all times. Cell phones have helped to define the modern understanding of "multi-tasking" that has become so entrenched in America's social culture.

All of us have either been or seen the motorist chatting away on his or her cell phone, oblivious to other vehicles. And with texting technology becoming more widely used, it is not uncommon to see motorists texting while driving! Whether you are dialing, answering, talking, or texting, cell phones are a distraction and a danger on the roads. Consensus data on the number of accidents and injuries caused as the result of cell phone distraction on the roads is not readily available, however, some sources report as many as 2,600 deaths and 330,000 injuries are caused in the United States each year because of cell phone distraction. http://www.livescience.com/technology/050201_cell_danger.html

Younger generations entering the driving public take cell phones for granted. Indeed, they have nver known life, or driving, without cell phones.

More and more states are addressing the use of cell phones while driving through legislation. 5 states (California, Connecticut, New Jersey, New York and Washington), the District of Columbia and the Virgin Islands have enacted jurisdiction-wide cell phone laws prohibiting driving while talking on handheld cell phones. 17 states and the District of Columbia have special cell phone driving laws for novice drivers. No state completely bans all types of cell phone use (handheld and hands-free) while driving. For more information on your state's cell phone laws, see the Governors Highway Safety Association website at http://www.ghsa.org/html/stateinfo/laws/cellphone_laws.html.

Regardless of the law in your state, if you cause a motor vehicle accident because you were distracted by your conversation or text messaging on a cell phone, chances are you will be and should be held liable. Talking on your phone while driving and allowing your phone use to distract you is negligence. When involved in an accident, you should try to determine if the other driver was talking on his or her cell phone. If you have been injured in an automobile accident, you may want to consider seeking the cell phone records of the other driver to determine if he or she was talking on their cell phone or texting at the time of the accident.

To avoid being a hazard on the road, invest in a hands-free unit or consider available technology that transfers your cell call to your car's audio speakers when you enter the vehicle. At a minimum, every driver should have a hands-free option for using their cell phone while driving. Almost all cell phones can now be voice programmed to call those stored in your phones list of contacts so you don't have to manually dial the number. Many newer vehicles are being sold with the option of installing your cell phone and service into the car.

Cell phones are a wonderful convenience. We have become so acustom to using our cell phones almost everywhere that talking on the phone while driving can easily become second nature. Don't allow your phone, however, to interfere with your ability to drive safely or endanger others around you. Cell phones can be used responsibly while driving. All of us just need to take the time to familiarize ourselves with the technology so we can eliminate or at least reduce the danger posed by talking on our phones while driving.

Originally posted at InjuryBoard by Nick DiCello

Greedy Insurance Companies Squeeze Doctors to Pad Their Own Pockets

Jack Landskroner — Sat, 15 Jul 2006 09:43:00 GMT

The Insurance Industry has misrepresented that an increase in claims and injury awards have caused a so call " insurance crisis" prohibiting carriers from making a profit and in turn resulting in a skyrocketing increase in doctors malpractice insurance premiums. This is the classic Insurance spin and doctors as well as the general public have bought it hook, line and sinker. The industry's media arm has even gone so far as to put in writing these false claims. The truth is a far cry from what the greedy insurance companies want consumers to believe.

A new study by Dartmouth College researchers suggests that huge jury awards and financial settlements for injured patients have not caused the explosive increase in doctors' insurance premiums. ''The simple explanation that comes to mind is the underwriting cycle. If they're making less money from the investment side of things, it's going to cause [insurance companies] to raise rates."

On the flipside, doctors continue to receive lower reimbursements for the services they provide. Reimbursement cuts going into effect across the country are affecting medical practices and causing doctors threaten to limit new patients or drop out of the insurance networks making cuts.

Physicians have grave concerns about the future of their practices.

"I'm trying to run a business here. My rents go up, my employees demand salaries, my gas prices go up, my malpractice rates go up, but my reimbursement rates go down -- that's no way to run a business," said [Dr. Stephen Rockower, a Rockville orthopedist]. "If I'm losing money on each visit, seeing more patients doesn't help me." ..."Ultimately, patients are going to be harmed when they can't find doctors or doctors leave the state or retire or go bankrupt,"

The insurance industry is simply maximizing profits at the expense of the medical community and to the detriment of the consumer in need of medical care and treatment. While profit is certainly not a dirty word, its time that the insurance industry come clean with the medical community and the general public. It is not the lawyers that are driving doctors from the practice of medicine but the insurance companies. Rather than attacking trial lawyers perhaps the medical community should consider embracing trial attorneys who would willingly fight side by side with doctors against the greedy insurance industry in order to disclose the truth about why doctors are leaving the practice of medicine.

Originally posted at InjuryBoard by Jack Landskroner

Trucking Industry Poses Serious Hazards for Motoring Public

Halli Brownfield — Fri, 04 Apr 2008 13:18:17 GMT

United States Department of Transportation Statistics show that tractor-trailers are involved in over 300,000 accidents per year resulting in the death of approximately 5,000 individuals. Given the immense size and weight of these vehicles and their cargo, the consequences of these accidents can be disastrous. Attorneys representing injured victims of trucking accidents must be familiar with federal regulation of commercial motor carriers to ensure the maximum recovery for their client.

The truck driver who caused the accident and the truck’s owner may be liable to the plaintiff, but often times do not have the financial ability to pay damages. The federally mandated MCS-90 endorsement to commercial trucking insurance policies provides an important, and potentially the only, source of recovery. This endorsement was intended to ensure that innocent victims of truck driver’s negligence have a source of recovery and provides insurance coverage in many situations where traditional insurance would not. The endorsement prevents insurance companies from asserting coverage limitations contained in the policy against victims of their insured’s negligence. For example, even if the truck that caused the accident is not listed in the policy, the insurance company may not deny coverage to the injured party on that basis. An insured’s failure to notify the insurance company of a claim or to cooperate with the insurer will also not relieve the insurance company of its obligations to injured victims of its insured’s negligence. Attorneys handling these types of cases should scrutinize any defenses asserted by commercial trucking insurers in light of the MCS-90 endorsement’s requirements.

Commercial insurance companies are not without recourse against their insured. If the insurance company is forced to pay an innocent tort victim pursuant to the MCS-90 for damages it has no obligation to pay under the terms of the insurance policy itself, it has the right to seek reimbursement from the truck driver or the trucking company. This process essentially ensures that when a truck driver or trucking company cannot pay the damages they owe an injured person, the insurance company, not the injured party, is the one left bearing the loss.

Originally posted at InjuryBoard by Halli Brownfield

Medical Malpractice: Defense Refuses $275,000, Jury Says $28 Million

Staff Writer — Mon, 26 Jun 2006 15:56:38 GMT

The always tongue-in-cheek Greedy Trial Lawyer brings my attention to a Florida medical malpractice lawsuit in which the defendants refused to settle for $275,000 before trial began. An Altamonte Springs woman had surgery to treat minor incontenence back in 2001. Things didn't go quite as expected, however, and now she must catheterize twice-daily for the rest of her life. At trial, the jury awarded the woman $28 million - one of the biggest malpractice verdicts ever in Central Florida.

The award will probably be reduced on appeal, but I'm sure the the physicians group wishes they had taken the victim's offer.

Originally posted at InjuryBoard by Staff Writer

New Nursing Home Quality Rating - Get Informed

Nick DiCello — Fri, 13 Mar 2009 17:58:31 GMT

The U.S. government's Centers for Medicare and Medicaid Services recently instituted a quality rating system for all nursing homes that are eligible to receive federal funds through Medicare or Medicaid. The scoring is based on a 5-star quality rating system, with 5 out of 5 stars being the highest rating. The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily and help identify areas about which you may want to ask questions. The website is easy to use and offers other useful links and information.

Nursing homes are rated based on information obtained from health inspections and include certain results from recent inspections. The ratings also address staffing and other important quality measures such as how well the nursing home helps people keep their ability to dress and eat, or how well the nursing home prevents and treats skin ulcers. In addition to the ratings, consumers can compare a facility's performance with average national and state scores for specific quality measures. Now, anyone contemplating entering a nursing home or placing a loved on in a nursing home has access to the information necessary to make an informed decision.

Unfortunately, nursing home neglect and abuse is endemic. The Government's new rating system, however, provides an invaluable resource to the public. The more informed we become, the better able we will be to reduce neglect or potential abuse. Ultimately, a better informed public will put pressure on the industry to raise its standards.

Before deciding on a nursing home facility check out Medicare/Medicaid's Five-Star Quality Rating System.

Originally posted at InjuryBoard by Nick DiCello

The Dangers of Coumadin

Halli Brownfield — Mon, 05 Jan 2009 09:37:41 GMT

Spangenberg partners, Rhonda Baker Debevec and Stuart Scott, recently handled two separate malpractice cases for clients who suffered severe bleeding complications related to a commonly prescribed anti-coagulant or “blood-thinner” called Coumadin. This medication – also sometimes called Warfarin – is prescribed for medical conditions that increase the patient’s risk for forming potentially fatal blood clots like atrial fibrillation (an abnormal heart rhythm) and deep vein thrombosis (DVT). By inhibiting the blood’s complex clotting or coagulation mechanism, Coumadin prevents the formation of new clots and the growth or extension of old clots.

To test whether appropriate amounts of Coumadin have been prescribed, the prescribing physician must carefully and consistently monitor the patient’s blood for its anticoagulation or INR (International Normalized Ratio) level. If the level is too low, the patient is once again at risk for blood clot formation. If the level is too high, the patient’s risk for severe internal bleeding, hemorrhagic stroke, and death is increased. While Coumadin is an effective treatment, it can also be extremely dangerous for several reasons. First, the therapeutic range for this medication is quite narrow. In other words, the difference between a safe level of Coumadin and a dangerously high level is quite small. Second, several different factors can magnify the medication’s blood thinning properties including the patient’s liver and kidney function, diet, alcohol consumption, age, and prior medical history. As such to maximize patient safety, prescribing physicians must provide dietary guidance to their patients and properly educate them about this drug and its potentially dangerous side effects. Equally critical, physicians must be on the alert for signs and symptoms of excessive blood thinning and know how to appropriately manage it. If a patient’s blood test reveals an excessively high INR level and/or the patient has active bleeding, this is a medical emergency requiring immediate hospitalization and rapid reversal of the Coumadin’s anticoagulant effect with intravenous medication.

In the case handled by Mr. Scott, the patient’s blood-work revealed an abnormally high level of INR or in layman’s terms that the blood was too thin. Moreover, the patient also had blood in his urine which can be an indication of internal bleeding. Instead of informing his patient that he had a life-threatening overdose of Coumadin requiring immediate hospitalization, the Defendant doctor merely told the patient to stop taking Coumadin over the weekend and come into the office on Monday for a repeat test. Left untreated, the patient suffered a severe hemorrhagic or bleeding stroke on Saturday which left him permanently and functionally disabled. Had his physician appropriately provided immediate treatment, the patient’s stroke probably would have been averted. Unfortunately, this particular physician was unaware that rapid reversal treatment for Coumadin overdose existed until after the patient’s stroke. Through the efforts of Mr. Scott, the case was settled at a confidential mediation.

Similarly, in the case handled by Ms. Debevec, blood tests showed that the patient’s INR was exceedingly high and that the patient’s risk of suffering from spontaneous internal bleeding was likewise exceedingly high. Rather than treating the situation as a life-threatening medical emergency, the treating doctor instructed the patient to discontinue her Coumadin, failed to re-check her blood and did not administer the life-saving medication to counteract the Coumadin’s effects. As a result, she suffered internal bleeding and passed away in her home a few days later. This matter was also resolved in a confidential proceeding.

As both of these cases illustrate, the proper management of patients on Coumadin therapy is critically important to patient safety. While some bleeding complications from Coumadin therapy may be unavoidable, many are preventable with effective and competent management. If you or your loved one has been prescribed this medication, please take the medication exactly as prescribed and consult your medical professional to learn more about how to maximize your safety while taking this beneficial medication. If you or your loved one has suffered a bleeding complication from the improper administration and/or management of Coumadin (Warfarin), please contact us to learn whether you may have potential recourse against the prescribing physician.

Originally posted at InjuryBoard by Halli Brownfield

Allstate Hit With $16 Million Bad Faith Award

Halli Brownfield — Tue, 14 Oct 2008 18:12:09 GMT

Demonstrating why the American Association for Justice has named Allstate the worst insurance company in America, a Missouri appellate court has upheld a $16 million judgment against it for failing to settle for the $50,000 policy limits in a clear cut case of its insured's liability.

Allstate's insured drove left of center on a highway causing a head on collision with another vehicle resulting in life threatening injuries to its two occupants, Edward and Virginia Johnson. The Johnsons required extensive hospitalization and treatment. After Allstate refused to settle for the policy limits, the Johnson's reached a $5 million settlemement with the tortfeasor in which they agreed not to collect against him but allowed the Johnson's to bring a bad faith refusal to settle claim against Allstate.

Allstate defended the case by arguing that it was uncertain whether the collision caused the Johnsons' injuries. Not surprisingly, the jury didn't buy it and awarded the Johnson's $5.8 million in compensatory damages and $10.5 million in punitive damages. In July of this year, the Missouri Court of Appeals affirmed finding the verdict justified: "Allstate's failure to recognize the severity of the Johnson's injuries and the probability that the claim would far exceed Davis's policy limits; its failure to investigate the claim and respond to the demand in accordance with insurance industry standards and its own good faith claim handling manual; and its failure to advise Davis [the tortfeasor] of the demand, his likely exposure for an excess judgment, and his right to reain counsel, are all circumstances supporting a reasonable inference that Allstate's refusal to settle was in bad faith."

For more information see:

http://www.insurancejournal.com/news/midwest/2008/07/30/92333.htm

http://www.justice.org/cps/rde/xchg/justice/hs.xsl/604.htm

Originally posted at InjuryBoard by Halli Brownfield

Former Allstate CEO to Run AIG - Yikes!

Nick DiCello — Fri, 19 Sep 2008 17:50:26 GMT

Next in line for a government, i.e taxpayer, bailout is the biggest insurance company in the world, American International Group, Inc. ("AIG"). The United States government has been forced to supplement the premiums AIG collects from us with $85 billion of our tax dollars. And if this news was not bad enough, AIG recently announced the appointment of former Allstate Corp. CEO, Edward Liddy, as the new Chairman and CEO of AIG. Allstate recently topped the list of the Top Ten Worst Insurance Companies in America, a report published by the American Association for Justice ("AAJ").

According to the AAJ's report, "there is no greater poster child for insurance industry greed than Allstate." AAJ's investigation revealed that when Allstate policyholders file a claim, they are often offered an unreasonably low payment for their injuries. This offer is generated by a secretive claim-evaluation computer program called Colossus. Allstate insureds who accept the low settlement offer are treated with "good hands." Those who refuse the low offer usually get the "boxing gloves": an aggresive litigation strategy aimed at denying the insured's claim at any cost. Allstate implemented this unconscionable practice while Edward Liddy was at the helm from 1999 to 2006 when he retired, receiving more than $25 million in benefits. Liddy was paid almost $19 million in salary for 2006.

According to Liddy's immediate successor at Allstate, its corporate mission is clear: "our obligation is to earn a return for our shareholders." Unfortuntately, Allstate's mission and dedication to its shareholders comes at a huge cost to its insureds.

Now Liddy will take his experience gained in maximizing Allstate's returns, at the tremendous cost to Allstate's insureds, to the largest insurance company in the world, AIG. His task at AIG? To stem record losses, maximize corporate returns and raise cash to pay back the $85 billion government bailout loan. Its no wonder why Edward Liddy was chosen to run AIG and, given his track record, its no wonder how he will do it. Looks like more bad news for AIG policyholders, and the rest of us who seek security and fairness in the insrance industry.

Originally posted at InjuryBoard by Nick DiCello