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Insurance
company under fire
- Former industry regulator blames costs on
premium hikes
A former top official with insurance regulatory agencies in two other states said Wednesday that Illinois' medical malpractice conundrum results from unjustified premium hikes by an insurer with a political agenda.
Jay Angoff of Jefferson City, Mo., told members of the House Judiciary Civil Law Committee that ISMIE Mutual Insurance Co. has raised premiums more than 40 percent in the past two years while paying out less in claims.
Angoff served as director of the Missouri Department of Insurance and deputy director of the New Jersey Department of Banking and Insurance. He testified before lawmakers at the request of committee chairman Rep. John
Fritchey, D-Chicago, and paid his own expenses, he said.
Angoff also criticized ISMIE and the Illinois State Medical Society for being in each other's pockets and using the same lobbyist to represent them in negotiations.
And
More...
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Guide
To Some of The Internet’s Best Health Sites
Visits to health and medical Web sites have surged in the
past year, but consumers are still missing out on some of the best
health information on the Internet.
Nearly one-third of all visits to the
Internet are for medical help and news on health issues, according
to a survey by Hitwise, which monitors Internet use.
Hitwise found that 27% of Internet users clicked to a
health site in May, compared with 19% a year ago.
The survey found that
www.WebMd.com is by far
the most popular site, along with several other general health
information sites. Two
of my favorites, www.mayoClinic.com
and www.MedHelp.org, ranked
high. But while the
survey shows consumers are doing a pretty good job of finding
credible health information on the Web, there is a lot more to be
found. Here’s a look
at a few of the best sites. And
More...
Free Consultations
You may contact us by telephone toll free at (800) 709-1123
Use our online consultation form or by e-mail.
To
Find a Good Doctor, Ask a Nurse...
Last week, I wrote about the ways doctors deal with
their own personal health issues and what we can learn from them.
As the ultimate insiders in the health-care system, I argued, they
have a built-in advantage over the rest of us for finding the best
care.
The column prompted an outpouring of mail from physicians around
the country. Many agreed with the advice, some found it off-base,
while others had more to add.
Several doctors said that the most important thing you can do for
your own health is to build a relationship with a primary care
doctor - something many doctors themselves fail to do. "It's
important to get a doctor before an emergency arises," wrote
Lost Angeles physician Carol K. Kasper. "A person shouldn't
put it off because he feels healthy. In an emergency, one get
better care faster by saying, "I'm Dr. Blank's
patient..." And
More...
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Doctor Operates on
Wrong Knee
Five years after operating on a man's healthy hip, a
surgeon in New York mistakenly operated on another patient's healthy knee, even though the
leg intended for surgery was marked "yes". The doctor will no longer practice at
the medical center where the surgery was performed, relinquished his title as president of
the medical staff and terminated his private practice. (The State
Journal-Register - March 18, 2001)
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Number Of Personal Injury Cases In Decline
The Los Angeles Times reported in a February 1,
2001 article, despite myths pushed by tort "reformers" there has not been a
recent "explosion" of litigation in this country. Instead, the article entitled
"We Aren't Seeing You in Court" reports since 1990 the nation has seen a
decrease in the number of personal injury (tort) cases brought to court, particularly in
California. In fact, the article points out, "A massive study of the behavior of
injured Americans in the late 1980's by the Rand Corp.'s Institute for Civil Justice found
that only 2 percent of injured Americans sought compensation by filing lawsuits."
Plaintiff's lawyers offer one reason for the decline in personal injury (tort) filings,
according to the article. They propose fewer people are being injured due in part to
increased product safety. Another proposed reason for the decline in tort cases is there
has, in recent years, been stigma placed on consumers who sue, the article notes. (Alta.org
- posted March 9, 2001)
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Recall On Hip Implants
On December 8,2000, Slugger Orthopedics, a
major manufacturer of hip replacement parts, recalled its Inter-Op acetabular shell for
hip implants. The part contains mineral oil that can prevent the shell's surface from
bonding properly with the patient's surrounding bone and tissue. This makes the hip joint
unstable, causes increasing abnormal pain, and ultimately creates the needs to replace the
defective implant. The recall may affect as many as 17,500 patients.
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Insurers' Failure to Pay Death Benefits Is Probed
State regulators are investigating whether life-insurance
companies for decades have profited by neglecting to alert unsuspecting beneficiaries
about death benefits owed to them. Among the life insurers already under review are
MetLife Inc. and Prudential Insurance Co. of America, the nation's two largest, and
several companies based in Illinois and the South, officials familiar with the inquires
said, adding that dozens more are likely to be added to the list.
Illinois Insurance Director Nathaniel Shapo said there is
evidence that some don't attempt to contact beneficiaries even when the companies know a
policyholder has died. Many policyholders bought multiple policies - as many as five or
six in common - naming different relatives as beneficiaries. In many cases, people who are
owed benefits don't know the policies exist. Mr. Shapo said examiners discovered that,
when one relative filed a death claim, some companies didn't check for the other policies
or made no attempt to contact the other beneficiaries. He said insurers are supposed to do
this under Illinois law. Many states have similar rules.
Elsie Crowell, an official in the Florida insurance
department, said there is evidence that companies have reaped millions of added profits by
holding onto and investing the money owed for death benefits. Ms. Crowell said it is too
early to make a firm estimate, but added, "There's potentially a gold mine of money
out there of unclaimed death payments."
In a deposition, Lawrence A. Vranka, a MetLife vice
president, confirmed that when a death claim is filed, the company doesn't routinely check
to see if the deceased had other MetLife policies in force. He said MetLife's claims
processors check for other policies only if a family member specifically asks the company
to do so.
Examiners are looking into whether the MetLife has violated
rules on paying claims. The company declined to comment on whether the issue is under
investigation. A Prudential spokesman said the company wouldn't disclose whether it
routinely checks for other policies.
Meanwhile, Chicago's United Insurance Co. of America, a
unit of Unitrin Inc., confirmed the company discovered thousands of unclaimed policies for
policyholders who had died. C. Thomas Evans Jr., a lawyer for Unitrin, said United has
long had a "standing practice" of looking for other policies and attempting to
notify beneficiaries. But he said an internal review last year found "that there were
some instances where those practices weren't being followed through as completely as they
should have been." He said the company is cooperating with the investigation and is
taking steps to pay death benefits that are owed.
Regulators say some companies have difficulty checking for
multiple policies because information on older policies was never entered into the
companies' computer databases, and many policies still on the books were issued before
Social Security numbers were widely used.
If no claim is filed on a life-insurance policy, companies
are required to turn over, or "escheat," the death benefits as unclaimed
property to the state in which the policyholder lived. But in general, companies are
required to do so only once the presumed age of the policyholder reaches the end of the
mortality table, which on many policies is when the individual would have been 99 years
old. So if a policyholder had actually died at, say, age 65, the company would have had
used to the funds for an extra 34 years.
J. Robert Hunter, director of insurance for the Consumer
Federation of America, faulted state regulators for not having picked up on unpaid death
claims, long before then. He noted that states do "market conduct" examinations
of companies every few years, which are supposed to check on issues including payment of
claims. He said the lawsuits and information turned up by regulators in recent months show
the routine examinations "are incredibly weak, pro forma investigations that don't
dig in."
Source: Excerpts from article by Scot J.
Paltrow, The Wall Street Journal - April 2001
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HMO's Held Accountable for Medical Malpractice
Illinois leads a national trend of holding Health Maintenance
Organizations (HMOs) accountable for medical malpractice. Illinois courts have decided
several major cases against HMOs in the past year. In Illinois, an HMO can now be held
liable for its own direct negligence (corporate or institutional negligence) and
indirectly, for the negligence of one of its independent-contractor physicians.
Instead of simply reviewing medical treatment and medical
bills after the fact, Health Maintenance Organizations are now heavily involved in the
delivery of health care to the patient. Cost-controlling measures employed by HMOs are
designed to reward physicians for minimizing health care services, and penalize them for
"excessive treatment." In one recent case decided by the Illinois courts, the
HMO's contract with the primary care physician provided that the HMO would contribute
$75,000 at the beginning of the year to a fund, which was to be used for referrals and
outside diagnostic testing for patients. If money were left over in the fund at the end of
the year, the balance would be shared between the doctor and the HMO. However, once the
fund was exhausted, the doctor would have to pay for consultations and testing. Talk about
a financial incentive to under treat a patient!
In another case, the HMO assigned between 4,500 and 6,000
patients to one of its primary care physicians, when federal guidelines called for a
patient load of no more than 3,500. The court held that by overloading a primary care
physician, the HMO could have foreseen that a serious injury was likely to occur. In that
case, the physician was alleged to have been inattentive to the signs and symptoms of a
three-month-old child, who developed bacterial meningitis, which resulted in a permanent
disability. The court found that the doctor's failure to respond to the signs and symptoms
of this patient and the failure to properly diagnose and treat this patient resulted from
the doctor's inability to serve an "overloaded patient population."
When HMOs step in and exercise a great deal of control over
the arrangements and administration of the health care being provided to the patient,
their actions have a direct and sometimes significant impact on the quality and outcome of
patient care. It is only appropriate that when the policies, procedures and practices of
an HMO interfere with a patient receiving proper medical care, that the HMO be held
accountable.
February 2001
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Breast
Cancer Law Provides Vital Care
Women whose breast cancer is discovered early enough have a
five-year survival rate of 96 percent. That means it is critical that women be
regularly screened for breast cancer and get follow-up treatment.
Of course, they must have the means to pay for screenings
and subsequent medical care. If they don't, the outlook is grim.
Women who are uninsured are 40 percent more likely to die
from breast cancer than women with insurance, according to President Clinton.
That terribly unacceptable situation should change with the
enactment of the Breast and Cervical Cancer Act. Under this new law, detailed by the
president on January 4, 2001, women who are uninsured or under-insured will be able to
access Medicare funds for breast and cervical cancer screenings and treatment.
This expanded Medicare coverage will cost $995 million over
10 years. But it will save countless numbers of lives.
Women who make too much money to qualify for Medicaid but
not enough to afford private health insurance shouldn't have to deny themselves routine
health screenings, and be without funds for treatment, when it is found they have breast
or cervical cancer.
Source: Daily Herald - January 8, 2001
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For Your Safety - Recalled Product Roundup
Here are some recently recalled products you may have in your
home or at work.
- Cadet Manufacturing Co. - recalled 1.9
million Cadet and Encore brand in-wall electric heaters, distributed mainly in California,
Idaho, Montana, Oregon, and Washington. Cadet and Encore heater models FW, FX, LX,
TK, ZA, Z, RA, RK, RLX, RX, and ZC can overheat, catch fire, and cause electrical shock.
- Mountain High Hosiery, Ltd. - recalled
360,000 pairs of Tommy Hilfiger socks for infants and children. Heat-sealed Hilfiger
flag logo appliqués can detach and choke children.
- Prime, Inc. - recalled 126,000
ceiling-mounted light fixtures, which can short-circuit and catch fire.
- Nordstrom, Inc. - recalled 2,250 infant and
toddler jackets. Flap pocket snaps may be removed and choke infants and children.
- Cole Sewell Corp. - recalled 23,000 storm
doors manufactured without retaining pins in the upper windows, which can fall out and
cause injury.
Source: Fall 2000 issue of R. F. Wittmeyer,
LTD., Attorney at Law Newsletter
Free Consultations
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You Can Sue City Hall!
Who says you can't sue City Hall? People do it all
the time when municipalities, or state or federal governments unfairly harm them.
Here are several examples of how our courts and juries hold governments liable for
injuries:
- When a city bus hit a pedestrian in Atlanta, causing amputation of a toe, a jury held
the city's driver responsible and awarded damages to the street-crosser.
- After a New York City medical examiner failed to correct a mistaken homicide autopsy
diagnosis, the plaintiff erroneously became a target for criminal investigators. A
court found that the examiner's negligence inflicted emotional distress on the plaintiff.
- Twiggs County, Georgia, settled with a woman's estate when her husband's lawyer
demonstrated that a defectively designed, constructed, and maintained road contributed to
her death in an accident.
- In New Orleans, a man was injured running from an opening drawbridge. The city
settled with the plaintiff after his lawyer demonstrated its negligence in failing to use
proper lighting and warning mechanisms.
- As Chicago police were in hot pursuit, a traffic violator rammed a plaintiff's car,
inflicting brain injuries. A jury awarded damages because the police failed to use
flashing lights and sirens during the chase.
Source: Fall 2000 issue of R. F. Wittmeyer,
LTD., Attorney at Law Newsletter
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Nation's Largest Med Mal Insurer
- Declares Caps on Damages Don't Work
The nation's largest medical malpractice insurer, GE Medical Protective, has admitted that medical malpractice caps on damage awards and other limitations on recoveries for injured patients will not lower physicians' premiums. The insurers' revelation was made to the Texas Department of Insurance in a regulatory filing obtained by FTCR. The revelation was contained in a document submitted by GE Medical Protective to explain why the insurer planned to raise physicians' premiums 19 percent a mere six months after Texas enacted caps on medical malpractice awards. According to the Medical Protective filing, "Non-economic damages are a small percentage of total losses paid. Capping non-economic damages will show loss savings of 1.0 percent." The company also notes that a provision of the Texas
law allowing for periodic payments of awards would provide a savings of only 1.1 percent. (FTCR press release - October 26, 2004).
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Judge Rules Allstate Is Liable For 'Misleading' Consumers
A Pennsylvania judge ruled that Allstate Insurance Co. is
liable for illegally discouraging consumers from hiring attorneys to resolve personal
injury claims against the giant auto insurer.
Commonwealth Court Judge Dan Pellegrini ruled that by sending a pamphlet headed
"Do I Need an Attorney?" to people injured in accidents with Allstate's
policyholders, the car insurer's intent "was to create confusion in the minds of its
third-party claimants." The pamphlet, which the Allstate Corp. unit started
sending in 1995, emphasized that disputes were settled faster without an attorney.
It told victims that, although they weren't Allstate customers, Allstate would provide
them with "quality service" and their own claim representative.
The suit was brought by Pennsylvania Attorney General Mike Fisher in December 1998, the
only such case brought by an attorney general concerning Allstate's mailings to
third-party claimants. A hearing to set civil penalties against Allstate is
scheduled for February 15th. The attorney general's office said it is seeking as
much as $1,000 per violation. A spokeswoman for the office said there were
"thousands" of violations involved.
In a statement, Allstate said it respectfully disagreed with the judge's opinion and
intended to appeal. "We no longer use the specific forms questioned by the
court in Pennsylvania," the statement said, noting the forms had been revised but
still answered "frequently asked questions that claimants have." Allstate
said the judge's decision didn't address the revised materials.
Judge Pellegrini ruled that Allstate's mailings were "misleading and
deceptive." He wrote in the decision that by asking for authorization to
collect medical information Allstate was likely to "cause confusion and
misunderstanding" and that without an attorney "the information could be used
against" the accident victims if the matters subsequently went to litigation.
Separately, Allstate said it reached an agreement with about 300 of its former agents
in California who had opted out of a previous settlement related to expenses those agents
incurred in running their agencies while they were employee-agents. The suit was
filed at a time when Allstate was converting its agents to independent contractors.
Under terms of the new settlement, the company agreed to pay $19.5 million to the
agents, which includes interest and attorneys' fees, to dismiss the agents' claims.
The pact still needs the approval of the 9th District Federal Court in Oakland, Calif.
Source: The Wall Street Journal
Free Consultations
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You may need personal injury lawyers to protect your
rights! Where a more serious and/or permanent injury has been sustained, an
individual who does not have the training and experience in personal injury law, is not on
an even playing field with the claims representative. Claim reps have specialized
training, experience, and are closely supervised to operate within strict insurance
company guidelines. Nonetheless, insurance adjusters many times will go to great lengths
to keep an injured accident victim from hiring a personal injury lawyer to represent them.
Their insurance
company is motivated to do only one thing,
settle your claim as cheaply as possible.
Free Consultations
You may contact us by telephone toll free at (800) 709-1123
Use our online consultation form or by e-mail.
Guide
To Some of The Internet’s Best Health Sites
Visits to health and medical Web sites have surged in the
past year, but consumers are still missing out on some of the best
health information on the Internet.
Nearly one-third of all visits to the
Internet are for medical help and news on health issues, according
to a survey by Hitwise, which monitors Internet use.
Hitwise found that 27% of Internet users clicked to a
health site in May, compared with 19% a year ago.
The survey found that
www.WebMd.com is by far
the most popular site, along with several other general health
information sites. Two
of my favorites, www.mayoClinic.com
and www.MedHelp.org, ranked
high. But while the
survey shows consumers are doing a pretty good job of finding
credible health information on the Web, there is a lot more to be
found. Here’s a look
at a few of the best sites. And
More...
Free Consultations
You may contact us by telephone toll free at (800) 709-1123
Use our online consultation form or by e-mail.
The True Story of the McDonald's Coffee Case
How twelve everyday Americans decided Stella Liebeck’s case was not a joke.
By the End of the Trial, the Jury Was Outraged
79-year-old Stella Liebeck of Albuquerque, New Mexico was in the passenger seat of her grandson's stopped car when she was severely burned by spilled McDonald's coffee. Stella suffered 3rd-degree burns over 6% of her body, including her inner thighs, genitals, and buttocks. She was hospitalized for eight days, undergoing skin grafts.
Stella, a Republican who had never filed a lawsuit in her life, didn’t want to go to court. She offered to settle with McDonald’s for the cost of her medical expenses, but the company refused - even after a mediator suggested they should settle. Once in court, it was revealed that McDonald’s deliberately kept its coffee 20 degrees hotter than industry standards and was aware from 700 prior incidents that this practice could result in severe burns. The company decided not to reduce its temperature and not to warn its customers of any risk.
In the end, McDonald’s behavior outraged jury members who were skeptical of the case. Even the judge – who reduced the jury verdict by more than 80% – called McDonald’s conduct reckless, callous, and willful.
Stella Liebeck’s case is a prime example of why cases are tried in a courtroom and not newspaper headlines. Yet, cases like Stella’s are repeatedly misused by Members of Congress as excuses to interfere with the courts. In fact, almost 20 bills are pending that would restrict ordinary Americans’ access to the courthouse and the right to trial by jury. Members of Congress should not use one-sided half truths to limit people’s rights.
Free Consultations
You may contact us by telephone toll free at (800) 709-1123
Use our online consultation form or by e-mail.
R. F. Wittmeyer, Ltd.
1635 N. Arlington Heights Rd., Suite 104
Arlington Heights, Illinois 60004
(847) 577-1123
Fax (847) 577-2827
E-mail: rfw@injurylawattys.com
      
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