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No Fault Newsletter
Just Out! Insurance Company "Tricks of The Trade" Report from the American Association of JusticePosted On Aug 10, 2011
The American Association for Justice (AAJ) has released a brand new report condemning some insurance company claim adjustment practices. Everything from ?deny till you die? to arbitrary and irrational claim denials and disclaimers.? I have first-hand knowledge of these practices and when I represented the carriers, I advised to curtail them.? Did they listen?? No, because in doing so, they would have had to pay more money to do the right thing.
Insurance Companies Cutting Back on Training and What Does it Mean for Your Accident or No Fault Case?Posted On Aug 08, 2011
A very telling question was posed today by Mr. Gary Blake on a LinkedIn insurance industry discussion group:
?Has the economy caused the claims department at your company to slash the training budget or does training continue regardless of the tough times??
The very first answer out of the gate was posted by a senior executive at an insurance consulting company who stated that training is being cut although most insurance companies won?t admit to it.*
Interesting.? When I worked in insurance, the most prevalent training was for claim handling.? Claim handling, I can tell you, is no easy task.? Not only do adjusters have to know how to manage their files (sometimes upwards of 400 per individual), but also try to grasp the No Fault Regulation and its myriad of time frames.? Even adjusters who are not directly involved in the litigation of claims, should have a basic working knowledge of the legal consequences of the denials they decide to issue on behalf of the company.? Why?? Lack of training in No Fault can have a major impact on an insurance carrier?s bottom line in New York.? The handling and defense of No-Fault claims is one of the costliest burdens an auto liability insurer can take on.
What is potentially in it for you?? If you are a health care provider armed with the knowledge that these companies are cutting back on training, you can bet that the quality of the denials you receive from them will not be up to proper legal standards.? Every one of your denials from a No Fault insurer should be carefully scrutinized and if there is a failure to adhere to the New York No Fault Regulation, you have every right to challenge it on that basis.? Most, if not all denials which are ?out of Reg? will not hold up under the scrutiny of the court or arbitrator and you can obtain your outstanding fee plus statutory interest.
The reduction in training programs is extremely short-sighted on any insurance carrier choosing to make this decision.? Can you legally take advantage of these short cuts?? Yes, because the carrier still must follow the rules under the Reg and prevailing case law.
*Since the posting of this article, the LinkedIn question and answers have been taken down.
If you have any questions about your No Fault claim, give me a call.
New New York Court Decision: Another Insurance Company Defense Tactic Denied!Posted On Aug 07, 2011
This post is not intended to be political, but it does discuss the New York Serious Injury Statute?s definition of ?Fetus?.
In order to maintain a lawsuit for injuries you received as a result of a car wreck in N.Y., your injuries must fall within the list of ?serious injuries? contained in the New York No Fault Statute.? One of these injuries is ?Loss of a Fetus?.
In a recently decided Upstate Case McKendry v. Thornberry, the Court had to wrestle with the definition of the word ?fetus?.? The lawyers for Thornberry decided to make a motion to dismiss McKendry?s case because her pregnancy was in an early ?embryonic? stage rather than the ?fetus? stage of development.
The lawyer for McKendry argued that a pregnancy of ANY duration constitues a ?fetus? as the word is used in the statute.
Here?s a little civics lesson:? when there is a word in a statute that needs interpretation because people are arguing over it, they look to letters, documents and memos which may give an idea into the statute writers? INTENT.? This is called ?Statutory Construction?, and is even used by the U.S. Supreme Court to make decisions on the way words are used in our Constitution.? Cool, huh?
So, that?s what this court did.? It looked at a memorandum in support of the New York No Fault (Serious Injury) Statute and found this:
?A woman who is involved in an automobile accident that results in??? the termination of her pregnancy has suffered a serious injury and should have the right to recover from a negligent operator for her? loss.?
This memo made the decision a little easier for the court.? The memo discusses ?termination of pregnancy? ? not just a loss of a ?fetus? as the term is used by the medical community.
Long story short, all lost pregnancies, no matter if the are one day or one hundred days will qualify as a serious injury under New York law.
This is just another example of the extremes in which insurance carriers and their defense attorneys will go to avoid paying legitimate injury claims.
Make sure your personal injury attorney is aware of this case. He or she can Google the title.
If you have any questions, please contact me at email@example.com
Just Out! White Paper: How Recorded Claim Statements Aid in Detecting FraudPosted On Aug 05, 2011
Datascribe-Inc.com has recently released what they call a White Paper Report entitled ?How Recorded Claim Statements Aid in Detecting Increasing Fraud During a Difficult Economy.?? It?s basically a tool for them to market their digital transcription company to insurance carriers, however, you need to be aware of how they are using the economic down-turn to promote their product.
The paper describes every day consumers as turning to what they call ?desperation fraud? against insurance companies as a way for them to get out from under debt. It goes on to say that one of the ways to combat this type of fraud is to take a digitally recorded, transcribed statement from the claimant.
OK, recorded statements are routinely performed by insurers these days.? However, the folks at Datascribe go a bit further.? At the end of the White Paper, they discuss the benefits of using their services, including the ability for the carrier to ?submit the recorded claim statement via Internet for additional analysis, i.e.,
Voice Risk Analysis (VRA ? which identifies micro changes in the voice that can occur when a speaker is showing higher levels of stress while giving a statement or answering question).?
Is this starting to sound like an episode of ?24???? Luckily, evidence such as Voice Risk Analysis is similar to Lie Detector Test results, which are not admissible in a court of law in the State of New York. However, at the risk of repeating myself, if the insurance carrier for the vehicle you are making a claim against requests a recorded statement from you, please contact your lawyer before doing so.
Here?s a link to the White Paper
Car Accidents and Chiropractic in New York StatePosted On Aug 02, 2011
Hat tip to San Fransisco Personal Injury Lawyer Arkady Itkin for posting an article which is very important for victims of New York Car Accidents to read:
?It is very important to be aware of the general perception of chiropractors in the community and particularly in the insurance business. The opinion of chiropractors, although has a weight, is significantly inferior to that of an M.D. (medical doctor) or a surgeon (such as an orthopedic surgeon).?
Why is this information important?? ? Many people who suffer serious injuries in car accidents or other injury incidents end up in a chiropractor?s office shortly after sustaining an injury.? They may undergo 3-4 months of chiropractic treatment and don?t bother to see any other doctors.
In New York State, this is likely to dramatically reduce your potential settlement or trial verdict. It may even result in getting your case dismissed by the court. The insurance company will argue that you weren?t injured as badly, because if you were, you would have gone to see a ?real? doctor.
Mr. Itkin correctly points out: ?remember, it?s not how badly you are injured but it?s what you can prove that determines the outcome of your injury case.?
Therefore,? if you suffer an injury, it?s very important that you see a medical doctor shortly after the incident. The doctor will likely refer you for further evaluation, such as MRI, Nerve Testing, etc.., and may recommend that you see a specialist, such as orthopedic surgeon, neurosurgeon or another specialist as might be medically necessary. You may supplement your treatment with seeing a chiropractor, but if you sustained a serious injury, chiropractic treatment should never be the only medical care you receive.
I could not agree more, Arkady. Additionally, In New York State, the No Fault insurance carriers will send claimants for Independent Medical Examinations very soon after the accident.? The negative results of these examinations can be extremely detrimental to any subsequent testing or treatment patients may require.
If you are not getting any relief from your chiropractor, make sure you see a medical doctor before you are scheduled for your insurance medical exam.
Arkady Itkin?s Blog Post is Here.
Top 5 Reasons Insurance Consumers File Complaints Against InsurersPosted On Jul 30, 2011
Did you know that you can file a complaint against your auto, homeowners, health? insurance carrier if you feel you have not been treated fairly by the company?? The complaint procedure can be found on the New York State Insurance Department Website.? Click here to access an online complaint form.
According to the National Association of Insurance Commissioners (NAIC), the top five reasons consumers filed formal complaints against their insurance companies in 2008 were claim delays, claim denials, unsatisfactory settlement offers, premium/insurance rating and policy cancellation issues.
The NAIC collected the data through its centralized electronic Complaint Database System (CDS), through which states voluntarily report ?closed? complaints.
A total of 195,669 confirmed consumer complaints on insurance companies were?reported in 2008?calendar year.
Accident/health and auto insurance coverages were the target of the most complaints.
Top Five Reasons for Complaints in 2008 and total no. percentage
- Delays 26,844 19.1%
- Denial of Claim 25,851 18.4%
- Unsatisfactory Settlement/Offer 20,021 14.2%
- Premium and Rating 6,644 4.7%
- Insurance Policy Cancellation 5,618 4.0%
Source: National Association of Insurance Commissioners www.naic.org
If you have any questions about filing a formal complaint against your insurance carrier, feel free to use the contact form on this website to speak with me.
New York No-Fault Law Suit Attorney FeesPosted On Jul 29, 2011
I received this question and it was such a good one, I?wanted to share with all of my New York No-Fault collection clients and potential clients:
Question:? If the insurance carrier pays a portion of a law suit, must they still pay attorney fees?
Answer:? Yes.? The insurance carrier is obligated to pay statutory attorney fees to the lawyer who filed the no-fault law suit, but only on that portion (plus interest, if any) which was paid to the insured or no-fault health care provider.
If you are seeking payment on one or many denied New York no-fault bills or claims, contact a lawyer with over 10 years no-fault experience working on the inside of the insurance business.
What Should I do if I am in an Accident in a Taxi Cab?Posted On Jul 28, 2011
I was a passenger in a taxi involved in an accident. I injured my back and head. What do I do?
Try to get as much information at the scene of the accident as you can including the following:
- The license plate number and medallion number (if applicable) of the taxi cab in which you were a passenger;
- The name and address of the driver of the vehicle;
- The name of the taxi company where the driver works;
- The license plate of the other vehicle involved in the accident;
- The name and address of the driver of the other vehicle involved in the accident;
- If no one has contacted a police officer or ambulance to the scene and you feel that they are necessary, call 911.? Obtain a copy of the police field report, which will contain a Complaint Number which can be picked up later;
Make sure that you contact the cab?s and your own insurance carrier within 30 days of the accident and let them know that you are making a claim for No Fault Benefits.
Taxi Cabs in New York City must be insured for 100/300 in liability.? Outside of New York City, livery vehicles are allowed to carry the minimum limits of 25/50.? In either case, it is advisable to contact an attorney as soon as possible, who can properly put your own insurance carrier on notice for an UNDERINSURED MOTORIST claim in the event there is not enough liability insurance on the taxi to cover you for your injuries.
If you have any questions about accidents involving Taxi Cabs, please contact Long Island Personal Injury Lawyer, Jeena R. Belil, using the contact form on this site or at 631-445-7380.