Maryland Injury and Disability Law : Washington DC Metro Injury & Disability Lawyer & Attorney : Greenberg & Bederman : Accidents, Falls, Medical Malpractice : Maryland, DC, Virginia

Insurance giants like Allstate, State Farm or GEICO didn’t get to be insurance giants by signing a lot of big checks. When you get into a car accident, the first question they ask isn’t “How can we help?” but rather “How can we get out of paying for this?” And they are very good at getting out of it. Harry Houdini had nothing on your average insurance company.

MSN recently published an article about some of the more notorious insurance adjuster tricks of the trade, and you would be well advised to learn them. Knowing how they work might be the difference between getting reimbursed for your damages and getting stuck with the bill entirely.

One of the more common insurance tactics is offering you a check as soon as possible. And when we say as soon as possible, we mean as soon as possible. Some insurers have adjusters on the scene before the wrecks are even carted away, and in some cases they even show up at the hospital if you have to go there. You might be thinking that the adjuster is using his amazing damage appraisal skills to do an instant financial calculation, and to a certain extent, that’s exactly what he’s doing. The rub here is that when he offers you that check, it may be for significantly less than what the damage will cost. And when you accept that check, you essentially absolve them of any further financial responsibility. You will be footing the bill for the difference between what the insurance company paid you and the actual cost of the car accident.

That’s the obvious trick. Some of the others are a lot more subtle, and most of the time it involves just sitting back and letting you talk.

If you just got into a car accident, your nerves are probably shot. Your adrenaline has kicked in. You might not always mean what you say, or even know what you are saying, for that matter. So if you say something like “I’m so sorry!” or “That was stupid of me!” or anything that can be misconstrued as you having anything at all to do with the causing of the accident, you are giving the other driver’s insurance company an out. Your best bet is to make sure that everyone is ok, and then don’t say anything.

The aversion that insurance companies have towards paying for damage claims is nothing compared to their loathing for paying for medical bills, and people who have been injured in an auto accident often aren’t immediately aware of their injuries until hours or even days later. Just because you feel ok after an accident doesn’t mean you are ok. If your injury manifests itself after you have already told the adjuster that you are fine, you will have a very difficult time getting the insurance company to cover your medical costs. If the adjuster asks if you are injured, the smart thing to do is say “I don’t know yet.”

Bear in mind that we aren’t encouraging anyone to be obstinate or unhelpful after a car accident. But you should know that insurance adjusters have a very specific job to do, and that job involves minimizing their financial responsibilities. If you get into a car accident, you should always keep that in mind. Keep what you say to the bare minimum, and don’t sign anything until you have a clearer understanding of the real costs of your accident, or have retained a lawyer.

Greenberg and Bederman is a Maryland car accident law firm located in Silver Spring, but we can help car accident victims in Virginia and Washington, D.C. as well. If you or a loved one has been injured in an auto accident anywhere in Maryland, Virginia or the District, contact Greenberg & Bederman for a free consultation.

We saw a huge demonstration of that during Hurricane Katrina. Before that storm even made landfall, insurance companies were preparing press releases offering their condolences for “The Gulf Coast Flood,” which let everyone know how they were going to respond before there was any damage at all. They essentially offered a blanket denial of every claim in Louisiana, Florida, Mississippi, and practically the entire Southeastern United States. They were even denying damage claims in areas that were not even remotely close to standing bodies of water. Their motto was “It was a flood. Prove it wasn’t.” And when it wasn’t possible for insurers to claim that it was a flood that did the damage, they used the argument that it was a “storm surge,” which, to the best of our understanding, is not like wind because its origin point is a water-based hurricane. So, if it was wind that tore your roof off, they would be happy to replace it, but because the wind came from a hurricane, that renders your claim invalid.

This strategy brought hundreds of people to court, including a pro-tort reform U.S. Senator. Many of those cases involving Katrina and denied claims are still pending to this day. There is a chance that insurance companies in Vermont, New York, New Jersey and Connecticut might behave in a more even handed and fair manner after Hurricane Irene, but we doubt it.

We don’t expect insurance companies to pay for things that they aren’t responsible for. If a house has seven feet of water in the basement after days and days of steady rain, the damage may not be the insurance company’s responsibility. But if the wind from a hurricane causes a tree to fall on a house, thus destroying it, you can hardly expect anyone to believe that a “water based storm surge” is the culprit. 

We hate to be cynical about insurance companies, but we didn’t just pull this mindset out of thin air. As injury attorneys in the Washington, D.C. area, a great many of our cases involve going to court against insurance companies. It has been our experience and the experience of our clients in D.C, Maryland and Northern Virginia that they don’t have a “good neighbor,” they aren’t in “good hands” and nobody is “on their side” except us. The initial reaction of your average insurance claims adjuster isn’t “how can we help,” but rather “how can we get out of this?”

Who knows? Maybe we’ll be wrong. Maybe the insurers will give damage claims their due consideration and will treat each one individually. If they did that, maybe they would put us out of business. 

We hope there won’t be blanket denials that are delivered sight unseen.

Greeberg and Bederman is a personal injury law firm located in Silver Spring, Maryland. As part of our injury law practice, we often help deal with insurance disputes. If you or a loved one has been injured due to no fault of your own and is experiencing resistance from any insurance companies, contact Greenberg & Bederman for a free consultation.

Generally speaking, the answer is that your insurance company and the insurance company of the other driver get together and hammer it out. In many cases, the solution ends up being that your insurance company handles your damages and the other driver’s insurance company handles their driver’s damages. This usually isn’t a problem if it’s a no fault accident with no injuries, but things get tricky if people get hurt.

Each state has minimum levels of insurance for drivers. This basically means that there is a minimum amount of coverage that you can have before you are allowed to drive. In Maryland, the minimum is $20,000 worth of coverage for one person injured in the car, with a $40,000 total for all passengers injured. In Virginia, its $25,000 for one person injured, with a $50,000 total for all passengers injured. In Washington, D.C, the minimum is the same as Maryland’s. That might seem to be a perfectly reasonable amount, but you should remember that $20,000 is not a lot of money when it comes to emergency room treatment. You should also remember that in Virginia, the “minimum” is actually just the insurance level. Virginia is one of the few states in the Union where you can simply pay a fee every year to the Department of Motor Vehicles and drive with no insurance whatsoever.

So what do you do? What happens if the accident is just one of those things, but the insurance doesn’t cover all of your physical damages? What happens if the car accident is in Virginia and the driver simply doesn’t have insurance? It has been our experience that insurance companies are profoundly hesitant to even get close to the maximum of what they are supposed to spend, and they often delay and deny payment in the hopes that their claimant will simply give up.

The smartest thing that you can do is contact an attorney for legal advice before it even gets to this point. Insurance companies are quite good at making it seem as if you have no options, when in fact you have several. An experienced attorney can help you determine the best course of action for you, and can also help you avoid the standard tricks of the trade of the insurance companies.

Greenberg and Bederman is a personal injury law firm located in Silver Spring, Maryland. We are currently offering legal assistance to people who have been injured in car accidents in Maryland, Virginia and Washington, D.C. We also help people who have been hurt in motorcycle or trucking accidents, as well as bicycle and pedestrian accidents. If you or a loved one has been injured in Maryland, Virginia, or Washington, D.C, contact car accident injury lawyers Greenberg and Bederman for a free legal consultation today.

There are many things that don’t make any sense at all about this argument. In the first place, it completely misrepresents the relationship between hospitals and insurance companies. If it were true that insurance companies were contractually and legally bound to pay for every single healthcare expenditure made on a patient’s behalf, then perhaps the tort reformers would have a point. But insurance companies most certainly are not contractually and legally bound to pay for everything. They have agreed to pay for what they deem to be “medically necessary”, and not that which they deem to be “medically unnecessary.”  And “medically unnecessary” can mean quite a few things. In fact, “medically unnecessary” can be and has been applied to almost every single pill, bandage, test and procedure that exists underneath the roof of any hospital in America.

Insurers have refused to pay for aspirin, bandages, calcium pills, ambulance rides, helicopter trips to the emergency room for patients at deaths door, broken limbs, lab tests, surgeries both major and minor, limb or finger reattachments, meals, or quite literally anything medical that you can imagine. And these decisions are almost never made by the reasoned decisions of uninterested and unbiased medical professionals. They are made by insurance claims adjusters using insurance company software to guide their decisions of what is and what is not medically necessary.

In short, insurance companies do not simply receive an invoice and then meekly write out a check. They say “no,” and leave it to either the hospital or the patient to convince them to say otherwise. If the patient or the hospital fails to do so, the hospital simply bills the patient. So the idea of hospitals overloading patients with unnecessary tests to either avoid the lawyers or just to get rich is not an accurate one. No insurance company that we have ever faced in court simply acquiesced to anything. So it is very doubtful that they would simply fork over money for an MRI given to a patient with a headache.

This is another example of insurance companies inventing a “crisis” in order to create new laws that will only benefit them, even as they claim that these new laws will benefit everyone else. The “crisis” of “preventive medicine” putting an undue burden on insurance companies does not exist. Nor did the “crisis” involving medical malpractice, in which doctors were supposedly being run out of business due to a sudden increase in lawsuits.

The invariable solution to all of these invented panics is always “caps,” or arbitrary, unfair and unrealistic limits on the amount of money that victims of injuries or medical malpractice can receive. These caps will not prevent doctors from running unnecessary tests and they won’t cause medical malpractice rates to drop or raise or lower the amount of malpractice cases that are filed, settled, won or lost every year, and they will ultimately do nothing except benefit medical malpractice insurance companies, which are the one part of this equation that doesn’t need the help.

Greenberg and Bederman is amedical malpractice injury law firm located in Silver Spring, Maryland. We have helped malpractice victims in Virginia, Maryland and Washington, D.C. for 25 years. Our practice areas include surgical errors, missed or late diagnosis cases, prescription errors, birth injuries, and many other forms of medical malpractice. If you or a loved one has been injured due to what you believe to be medical malpractice, contact Greenberg & Bederman for a free legal consultation.

Cars with transponders are disappearing from parking lots and driveways just as fast as cars with alarms, clubs and OnStar. But the one big difference between the earlier thefts and the thefts that are happening now is that insurance companies are often refusing to cover the owners of cars with transponder systems. They are doing so on the grounds that they believe transponder technology to be unbreakable, so they are essentially making the assumption that everyone who has had their cars stolen is lying.

A 2006 article in Wireddetailed this problem quite clearly. There are multiple instances in this article where people had their cars stolen only to be treated like criminals themselves by the insurance companies. Most specifically, there is the story of Emad Wasseff, who got grilled by insurance adjusters over everything from the state of his finances to his marital troubles and still ended up paying around $800 a month for a car that he didn’t own anymore.

We found this article particularly interesting for a few reasons; Insurers know absolutely everything there is to know about cars. They know the fuel economies, the engine sizes, and safety ratings. They know how cars perform in certain types of weather, and even what the likelihood of hitting a deer is in every state in America. And you can bet that they know when transponder technology isn’t working. While we can’t comment on every case like this, we know enough about insurance companies to know that they put a lot of effort into avoiding claims that are often completely legitimate.

The second reason we found this article interesting is because we think it might have a direct bearing on quite a few Mazda 3’s that were sold in North America between 2004 and 2007. It turns out that these particular models had a defect in their door locks that made them incredibly easy to break into. You didn’t need slim Jims or lock picks or any sort of James Bond technology. All you needed was to drive your shoulder into a spot on the driver side door and it would simply pop open.

Quite a few of these cars were equipped with the so called “unbreakable” transponder technology, so while simply hot-wiring the car wasn’t necessarily an option, there are all sorts of ways to get around it, particularly if you can use the defect to enter the car multiple times. For instance, many independent companies sell blank transponder keys for Mazda 3’s, complete with programming instructions. The claim is that only an automotive locksmith or dealership can do the programming, but we have a sneaking suspicion that this isn’t exactly a necessity. After all, having automotive skills does not necessarily mean that you will use them for good and legal purposes. Most major cities have more than a few chop shops.

So if a car is easy to get into, and a new transponder is easy to acquire, program and install, there isn’t anything “un-stealable” about the car, is there? Apparently many insurance companies are the only ones willing to maintain the belief that it is.

Greenberg and Bederman is a personal injury law firm based in the Washington, D.C. area, and we are currently investigating compensation claims lawsuits against Mazda on behalf of consumers who purchased these defective vehicles. We are offering legal assistance to those who had their cars broken into or stolen, and we are also offering assistance to consumers who were not told about the lock defect when they purchased the car. If you or a loved one is a current or former owner of a Mazda 3 between the model years of 2004 to 2007, please contact Greenberg & Bederman for a free consultation.

The reasons that were given for the so-called “medical malpractice crisis” were (and still are) completely debatable. For instance, there was never any sudden onslaught of medical malpractice cases. The level of malpractice cases between 1991 and 2005 either dropped or remained relatively constant, while the amount of money paid out to medical malpractice claimants dropped significantly.

If that was the case, then why were so many medical malpractice insurance companies crying poverty and raising their rates? One study claims that it wasn’t a sudden avalanche of medical malpractice lawsuits or enormous verdicts that caused the rates as much as it was the fact that the medical malpractice insurers’ investments took a beating shortly before the medical malpractice “crisis” began. A poorly performing bond market does not make a very good villain from a PR standpoint, but the idea of “greedy trial lawyers” or the fiction of people winning millions of dollars over a stubbed toe works perfectly. And it worked quite well. There is now a limit on the amount of compensation that a medical malpractice victim can receive in many states, even though there is no such limitations on the amount of damage that a careless or incompetent doctor or surgeon can do. So in some states, it truly does not matter how badly a doctor messes up, or how much that mistake alters or even ends the victims’ life. Medical malpractice insurers have had their interests and profits protected.

The market reflects that change in the fortunes of insurance companies. Most medical malpractice insurance companies are seen as a smart investment, particularly if they only do business in states where there are legal limits to the amount of money that they are responsible for paying out. For instance, Warren Buffett’s investment group Berkshire Hathaway purchased malpractice insurer Medical Protective for $825 million. Mr. Buffett has a long history of making smart investments, and it appears that this purchase was a continuation of that trend. And FPIC purchased Advocate MD for $33 million, despite the fact that Advocate MD was only the fourth largest malpractice insurer in Texas. Since the purchase, FPIC’s shares have done nothing but increase in value. Exactly one year ago, FPIC was trading at $22 a share. Today it’s valued at $36.

The bottom line is that malpractice insurance remains extremely profitable, so much so to the point that the average profit for medical malpractice insurance companies is 31.2%, which is a ridiculously high margin for any business.

Despite these consistent profits and despite the legal system being essentially rigged to ensure that they remain vibrant, you would think that from public statements and lobbying efforts, those medical malpractice insurance companies are a beleaguered minority with wolves at the door. In practically every state legislature and in every session of Congress there are several bills where representatives are demanding more and more restrictions on the liability of medical malpractice companies. In every press release malpractice insurers make it seem like they are just barely hanging on as a business, even as their quarterly reports prove otherwise.

Greenberg and Bederman is a personal injury law firm located in Silver Spring, Maryland. We are currently offering legal assistance to people in the Washington, D.C. area who have been injured due to no fault of their own. That includes injury victims in Maryland and Virginia. Our practice areas include car accidents, motorcycle accidents, pedestrian and bicycle accidents, premises liability, defective product injuries, injuries due to pollution and groundwater contamination, and injuries due to surgical errors and other medical malpractice errors, bad diagnoses, delay of treatment and other forms of medical malpractice. If you or a loved one has been injured due to no fault of your own, contact Greenberg and Bederman for a free legal consultation today.

Morally speaking, there are many things wrong with this concept. And there are more than a few examples as to how these caps exist for no other reason than the financial convenience of the insurance companies.

One example in particular is happening in Nevada right now. A doctor named Depak Disal runs an endoscopy clinic there, and it is alleged that his clinic caused a hepatitis outbreak which affected thousands of people all over Nevada. At issue is this question: Does the damage cap cover “people,” or “incidents?”

In other words, if it can be proven that Dr. Disal was responsible for “one” hepatitis outbreak, would this mean that his insurance company would be obliged to pay out the limit of the $350,000 damage cap only once? Would everyone who allegedly got hepatitis from Dr. Disal’s clinic be forced to share one capped judgment? Or would the cap apply to each individual person who contracted hepatitis? Would any of you like to take a guess as to which side of the argument Dr. Disal’s insurance company is on?

As strange as this argument seems, one court in Nevada actually agreed with the premise, but another judge ruled the exact opposite. So we expect the case to be ruled upon by the Nevada Supreme Court fairly soon. And if rulings in other states are any indication, it could be that damage caps in Nevada might be a thing of the past altogether.

Illinois and Georgia are two states where their respective Supreme Courts have ruled that caps on damages are unconstitutional, based on the grounds that they ignore the separation of powers that was written into the Constitution. In other words, damage caps lessen the ability of a judge or jury to rule effectively on a case. With damage caps, a judgment on a supposedly independent court case is essentially pre-determined by members of another branch, and that is absolutely against the premises laid out in Articles I, II and III.

While we most certainly agree with that on legal grounds, we also find it outrageous that state or federal legislators are allowed to assign market value to pain, suffering and emotional loss. We also can’t imagine that a hepatitis victim being eligible only for a “share” of a judgment rather than a separate judgment is in any way fair. Hopefully, the Nevada Supreme Court will do away with damage caps entirely, and the question of whether it was “one” incident or a few thousands separate incidents will be rendered moot.

Greenberg and Bederman is a medical malpractice injury law firm located in Silver Spring, Maryland. We are currently offering legal assistance to people in Maryland, Virginia and Washington, D.C. who have been injured due to medical negligence, misdiagnosis, violation of standard of care, or surgical errors. If you or a loved one has been hurt due to a doctor’s mistake, contact Greenberg and Bederman for a free medical malpractice legal consultation today.

As an example, let’s say for the sake of argument that you are walking across Wisconsin Avenue and you get hit by a car that ran a red light. The ambulance takes you to the hospital and you get treated. If you are like most injury victims, the last thing on your mind is sorting out which insurance company is going to pay for what. You simply hand over your insurance card and let them get on with it.

Once you recover and decide to pursue legal action against the person who hit you, that’s when things get tricky. If you end up winning a settlement or a judgment against the driver, your health insurance company will often place a lien on your personal injury settlement or judgment in order to recoup their costs for your medical treatment. The idea is that your insurance company rightly believes that since another party was at fault, they paid for medical services that they were under no legal obligation to pay for.

The legal term for this process is called subrogation, and it is a fairly common occurrence in injury cases. What is fortunate about the process is that insurance companies are only allowed to be reimbursed for what they paid for in medical expenses, and not all of what you received for medical expenses in your settlement or judgment. So if your insurance company paid $9,000 in medical expenses and you received $20,000 for medical expenses in your settlement, the insurance company is only allowed to file a lien for the $9,000 that they actually paid.

The question that many of you might be asking is “Why would I get a settlement for $20,000 in medical expenses if it only cost the insurance company $9000?” The answer to that question is that under Maryland law, there is an evidentiary rule that prohibits the admission of evidence that a victim will be compensated from a third party in a tort case. This prevents the person who was responsible for the injury from saying “What’s the big deal? He got his bills paid for. No harm, no foul, right?”

This part of Maryland law is known as the “Collateral Source Rule,” and it is a very important element of what the attorneys at Greenberg and Bederman are trying to do for our clients. When we represent an injury victim, our intention isn’t to simply get the bills paid and nothing more. The vast majority of our clients have been injured due to the negligence of someone else. They were hit by a driver that wasn’t paying attention, or their doctor made an easily preventable negligent error.

The Collateral Source Rule has been in place for as long as we can remember, and it is, of course, one of the main targets of tort reform organizations everywhere. They argue that it is unfair for a defendant to have to pay more for medical expenses that what the victim’s insurance companies paid, to which we say hogwash. For one thing, insurance companies carry negotiating weight that individuals do not. An insurance company that brings thousands of patients to hospitals and clinics can very easily ask for a lower price, while individuals carry no weight whatsoever. Nor do insurance companies negotiate lower prices on behalf of their patients. They do so on behalf of themselves. And again, a tort case is not simply a tit for tat accounting of dollars and cents. It is a legal way of both rectifying financial damages and bringing the responsible parties to account for their actions. It is important to remember that the driver hit you, not Blue Cross Blue Shield. And the Collateral Source Rule is the courts way of recognizing that.

If you or a loved one has been injured in an accident, contact Greenberg and Bederman for a free legal consultation today.

The problem is that with health care, there is no such thing as a “Usual and Customary” rate. Big insurance companies are able to negotiate lower costs for services because of the volume of care seekers that they bring to hospitals, clinics and doctors’ offices. Once you go out of network, you no longer have the weight of your insurance company’s negotiating skill behind you. So the costs for your treatment vary wildly from place to place. A sprained ankle in Tacoma, Washington might cost much more than the same injury in Yuma, Arizona. It depends on who owns the hospital, whether the facility is independent or whether an HMO runs the facility, or what their billing policies are. Health care is quite literally wide open. There is no “invisible hand of Adam Smith” keeping the price of services up or down.

So for the sake of argument, let’s say you are on vacation in rural Vermont and you break your leg. The non-negotiated, out-of-network costs might be a lot higher than the costs of the same injury at the hospital you would go to in Bethesda, Maryland, Arlington, Virginia or Washington, D.C. So if you paid extra on your policy every month for out of network costs, you would probably assume that your insurance policy would pick up 80% of whatever the hospital in Vermont is charging you. But instead, your insurance policy is picking up 80% of what Ingenix decides is “Usual and Customary.”

And that’s exactly what the problem was. Attorney General Cuomo discovered that Ingenix was skewing its “Usual and Customary” rates so that everything was reported as much cheaper than it was in real life, which lowered the amount that insurance companies were obligated to cover. So if the guy with the broken leg in Vermont is presented with an out of network bill for $4000, the insurance company can say “According to our calculations, the Usual and Customary rate for your injury is $2500, of which we will pay $2000.” This leaves you on the hook for $2000, as well as all the extra money you had been paying each month for the out of network coverage, which was evidently completely useless due to Ingenix.

It wasn’t only the policyholders who were getting stuck with huge medical bills. Most people don’t have the amount of cash on hand that it takes to pay for enormous medical expenses (this is why they had insurance, after all,) so the providers end up selling their debt to bill collectors for nickels on the dollar just so they can recoup some of their losses. So both the policy holder and the healthcare provider lose out, but guess who doesn’t? The insurance companies that use Ingenix software for their out of market billing. Which is to say almost all of them.

All of this is bad enough, but what makes the whole scenario even worse is that Ingenix was actually a wholly owned subsidiary of United Health Care, one of the biggest health care insurance providers in the United States. This is like a professional football team being allowed to bring its own referees to the Super Bowl. Who do you think is going to win out?

We would like to say that this case of price fixing was an isolated incident, but we can’t for two reasons. The first reason is that this rigged software was used by practically the entire American health insurance industry. How “isolated” could something be if the entire system is using the same flawed data? The second reason is that this is not the first episode of big insurance using skewed data in their software to maximize profits at the expense of their policyholders. Auto insurance companies are still to this day using a program called “Colossus,” which uses skewed data to “average out” the costs of physical injuries. Just like Ingenix, Colossus also leaves policyholders on the hook for thousands of dollars worth of medical costs that should have been paid by the insurer in the first place.

While it’s a good thing that Ingenix was essentially forced out of business by Mr. Cuomo, and it is good that users of Colossus are facing similar investigations, these changes have come a little too late for the hundreds of thousands of patients and medical professionals who have been ripped off as a result of these skewed computer programs. We think that the country would be better served if the states or federal government were more proactive about examining healthcare billing software. It’s good that we have firemen, but we have more of a need for Smokey the Bear.

The data that these companies use to determine pricing should be open to review, not kept as a trade secret. Nor should any companies that develop similar software have any financial ties to insurance companies. The fact that Ingenix was owned by one of the biggest health care companies in America is a massive conflict of interest, and one that cost Americans millions of dollars.

Greenberg & Bederman is a personal injury law firm located one half block from the SIlver Spring metro station.  We have been handling personal injury law since 1985.  To learn more about our personal injury lawyers, please read about Andrew Bederman, Roger Greenberg, or Jason Fernandez, or watch some of our personal injury videos on Youtube.

The example of the dead infant isn’t mere conjecture on our part. According to an investigative piece by Paul Adrian that was broadcast on a Fox TV affiliate in Dallas, a family from that area made the decision to take their infant son off of life support. The infant’s parents were convinced that a preventable medical error had been made which placed their child in that position, but due to the non-economic caps, the cost of bringing the case to court would have cost more than the damages they would have received. As awful as this sounds, it turns out that the only way that damages in a malpractice trial involving a dead baby can be taken seriously in Texas is if the baby was making money. The life altering pain of the parents counts for nothing.

What was the situation like in Texas where such absurd and draconian measures were actually voted into law by its own citizens? Were people whose injuries involved nothing more than stitches walking out of courtrooms with million dollar verdicts? Was the Texas judicial system nothing more than a free ATM machine for unethical people and their equally unethical attorneys? Was there an exodus of doctors from Texas, leaving the injured and sick to fend for themselves? Were the insurance companies bleeding money so badly over lawsuits that they had no choice but to raise their rates to astronomical proportions?

The answer depends on who you ask. If you ask insurance companies and their public relations teams, the answer is yes. If you ask a bipartisan group of college professors, the answer is no.

The piece on the Fox affiliate cites a study that provides 14 years worth of Texas malpractice data, including claims and payouts, through both settlements and verdicts. In this study,

“…The data present a picture of stability in most respects and moderate change in others. We do not find evidence in claim outcomes of the medical malpractice insurance crisis that produced headlines over the last several years and led to legal reform in Texas and other states. At least in Texas, the rapid rise in insurance premiums that sparked the crisis may reflect, in significant part, insurance market dynamics rather than changes in claim outcomes.…Controlling for population growth, the number of large paid claims (over $25,000 in real 1988 dollars) was roughly constant from 1990-2002. The number of smaller paid claims declined. Controlling for inflation, payout per large paid claim increased over 1988-2002 by an estimated 0.1% (insignificant) - 0.5% (marginally significant) per year, depending on the

dataset we use to define "medical malpractice" claims. Jury awards increased by an estimated

2.5% (insignificant) - 3.6% (barely significant) per year, depending on the dataset, but actual

post-verdict payouts in tried cases showed little or no time trend. Real defense costs per large

paid claim rose by 4.2-4.5% per year. Real total cost per large paid claim, including defense

costs, rose by 0.8-1.2% per year.”

In other words, according to the actual numbers, there wasn’t much to panic about in terms of medical malpractice lawsuits.

So why were groups like Texans for Lawsuit Reform claiming that the sky was falling? If there was no big leap in judgments or payouts or even malpractice claims, then why were the premium rates going through the roof?

According to Paul Adrian, the answer might be, ironically, tort reform.

In 1995, Governor George W. Bush enacted what were called “Tort Reform Rate Reductions,” which forced medical malpractice insurers to lower their rates over a period of five years. How significant were the overall rate reductions?

·         1996: $435.5 million in rate reductions

·         1997: $441.2 million in rate reductions

·         1998: $656.4 million in rate reductions

·         1999: $699.5 million in rate reductions

·         2000: $685.5 million in rate reductions

So between 1996 and 2000, the state of Texas enacted regulations that cost medical malpractice insurers a little under THREE BILLION DOLLARS in premiums. Once the five year period was up and the mandatory rate reductions were over, insurance companies were quite eager to make up their losses. Hence the skyrocketing rates.

Insurance companies needed both a fall guy and justification for the spike in premiums, and they found them in trial lawyers. They also needed any sort of legislative leg up that they could get in order to maximize their profits. Since the insurance companies weren’t comfortable with going through the very legislature that made them lower their rates in the first place, they did an end run around them and, with the help of tort reform organizations that they financed and PR firms that they hired, they managed to get Proposition 12 on the ballot. It was voted in to law in November of 2003, and as a result a case involving a dead baby can’t even get to court.

Tort reform organizations all over Texas and all over America are touting the results of these economic caps as the reason that Texas malpractice insurers were able to offer even lower rates to their doctors, as shown in an article in The Austin Business Journal:

“In recent months, the state's top medical malpractice insurance companies have trumped rate cuts. They're crediting the lower rates to Proposition 12, a constitutional amendment approved by Texas voters in September 2003. That amendment cemented the Legislature's decision that year to cap noneconomic medical malpractice damages at $250,000.”

The article also mentions that the Texas Medical Liability Trust will reduce its rates by 5%, while Americans Physician Insurance Exchange is cutting theirs by 13%. And why wouldn’t they? By all accounts insurers in Texas have been making money hand over fist. And the $250,000 cap on non-economic damages is a miniscule proportion of that money.

Remember that after the “Tort Reform Rate Reductions” in the late 90s, insurers raised their rates to astronomical levels, and although they lowered them a bit after Proposition 12 was voted into law, the rates were still incredibly high. We refer again to the remarkable piece by Paul Adrian:

“Insurance premiums did drop for Texas doctors. According to TDI, the state’s largest insurer of doctors, The Texas Medical Liability Trust, dropped its rates 31% between 2004 and 2008, but that's after the rates had jumped up 148 percent between 1999 and 2003.  Insurance rates have come down, but not by nearly as much as they had previously increased.”

For a real world analogy, the Texas Medical Liability Trust bragging about dropping its rates 31% is the equivalent of an 800 pound man losing about forty pounds and then putting out a press release proclaiming that he is “thin.”

To summarize, “Tort Reform Initiatives” cost insurers in Texas billions of dollars, so they spiked the rates and blamed the lawyers in order to recoup what they lost. After securing legal limitations to the rights of Texans, they lowered the rates just enough to appear magnanimous, but not really enough to bring them down to normal levels. They then made it seem that the reason that they could finally “afford” to bring the rates down was not because of the windfall profits that they have made over the past six years, but because of a ballot initiative that states that unless a Texan makes money, then that Texan isn’t worth anything.

It should be mentioned here that the term “emotional pain” does not exist to simply make people rich. It is rather an acknowledgement that incompetence and preventable mistakes can cause crippling emotional hardship. If you think that’s an exaggeration, try to imagine how Paul Pinsukanjana felt when he ordered his infant son taken off life support. Try to imagine how he felt when he discovered that, thanks to the laws of his own state, lawyers can’t even afford to accept his case. Try to imagine how he feels, living with the knowledge that there might be a doctor or nurse still at work at that same hospital who was directly responsible for his son’s death. Try to imagine how he feels, knowing that that same doctor or nurse can continue to practice, with no fear of any adverse consequences if another mistake is made.

As we said, it’s impossible to put a price tag on that kind of pain, but we think that $250,000 feels pretty cheap.

To learn more about medical malpractice law, please read our medical malpractice law home page.  To learn more about our medical malpractice lawyer, John Sellinger, read about John Sellinger, or watch the medical malpractice video by John Sellinger..

While this might be a great thing for the insurance companies, it most assuredly isn’t a positive development for accident victims.

According to the website, the purpose of Colossus is to:

“…interpret medical reports and look up definitions of injuries, treatments, complications and permanent impairments using AMA 5th edition data. Through a series of interactive questions, Colossus guides the adjuster through an objective evaluation of medical treatment options, degree of pain and suffering, degree of permanent impairment to the claimant’s body, and the impact of the injury on the claimant’s lifestyle.”

What this means is that Colossus uses data from the American Medical Association to lump your injury into a specific injury category, whether that category is accurate to your circumstances or not. As far as Colossus is concerned, a broken leg is a broken leg, no matter if the victim is an office worker or a construction worker or a fire fighter.  Obviously, no two injuries are exactly the same. There is no such thing as an “average” broken leg, or an “average” rib fracture, or an “average” head injury.  Lumping them all together as if they were identical is disingenuous at best.

Another problem is that Colossus uses pricing data to determine exactly how much your injury should cost, regardless of how much it actually costs. For instance, if you receive a broken leg in an accident, Colossus determines the amount of money that an average broken leg settlement costs in your state, and that is the amount of money that is put towards your settlement. Where they happen to be getting this pricing data is anyone’s guess, as many insurers who use Colossus consider that information a “trade secret,” and have even taken former employees to court over allowing that information to be made public. 

Aside from all of these serious shortcomings, there are two aspects of this software that we find even more disturbing. The first is that Colossus makes no allowances for physical pain and suffering or emotional damage. The pain that your injury caused you or the possible detrimental mental effects of the accident is, as far as Colossus is concerned, worth absolutely nothing.

The second shortcoming goes back to the idea of simply automating injury claims. As we mentioned earlier, insurance adjusters used to be experienced human beings who could hear arguments from injury victims and could be made to see reason. Now, insurance adjusters are shackled to the results that are given to them by a computer program, which often leads many injury victims with the choice of either accepting an artificially low settlement or taking their case to court.

At Greenberg and Bederman, we have spent the past few decades fighting for fair treatment for injury victims in Maryland, Virginia and Washington, D.C. A significant part of that process is helping those who have been hurt due to no fault of their own get past the disingenuous practices of insurance companies, including the use of software that automatically stacks the deck against the injured.

If you or a loved one has been injured in an accident anywhere in the D.C. metropolitan area, contact the law offices of Greenberg and Bederman for a free legal consultation today.

If you want to learn more about personal injury please read our personal injury page. 

“First, the company evaluates claims with a computer program designed to reduce payouts by as much as 20 percent of what the company once paid for the same injuries.

Second, Allstate pushes policyholders to accept quick settlements without the help of lawyers. Policyholders who try to fight for more money face Allstate attorneys coached to refuse to negotiate and to drag out litigation.

The approach often forces car accident victims to take what Allstate offers right away or spend years in court while their bills go unpaid -- a strategy Allstate spelled out in guidelines for claims adjusters that ‘forces the claimant and attorney to think about the obstacles they must overcome’ ..."

Some insurers aren’t even that clever. In some cases they will simply deny the claim, often referring to fine print in the contract, and sometimes not even offering an explanation at all.

A perfect example of a high profile claim denial would be State Farm’s blanket refusal to help any of their policyholders in the wake of Hurricane Katrina:

“Thousands of families who lost everything to Katrina's fury last August are now facing a second disaster: their insurers won't pay them a dime. The homeowners say they were led to believe they'd be covered when they signed up for their policies. The companies insist they're off the hook because of exclusionary clauses that distinguish between damage caused by wind (covered) and water (not covered). The courts will decide who's right: hundreds of homeowners have sued their insurers, among them U.S. Sen. Trent Lott, who lost a house in Pascagoula, Miss., and Congressman Gene Taylor, whose home in Bay St. Louis was destroyed.

While it's hardly unusual for homeowners and insurers to find themselves at loggerheads after a disaster, the wind vs. water debate has been especially rancorous. Earlier this month, 669 plaintiffs sued State Farm for allegedly denying their claims without properly investigating the cause of the damage to their homes. And last year, Mississippi Attorney General Jim Hood launched a suit against five big insurers--State Farm, Allstate, Nationwide, United Services Automobile Association and Mississippi Farm Bureau Insurance--for allegedly tricking Katrina victims into signing forms stating that their homes sustained flood damage, which isn't covered. ‘The robber barons of our time,’ Hood calls the insurers.”

These abhorrent and unfair practices fall quite neatly under the heading of what is called “bad faith insurance,” and quite often the best way past them is to acquire the services of an attorney. These insurers are banking on what you do not know about the law, and having a lawyer who knows how insurance companies work as well as what your rights are as an injury victim can put you back on equal ground.

By contacting Greenberg and Bederman, thousands of residents of the Washington, D.C. metropolitan area were able to get past these abhorrent insurance company practices, and were also able to receive the compensation that they needed to get their lives back on track.

We have law offices in Silver Spring, Baltimore, Washington, D.C. and Northern Virginia, and as long as insurance companies believe more in their profit margins than their obligations to policy holders, we’ll be here to help.

Contact Greenberg and Bederman for a free legal consultation today.

 To learn more about personal injury law, please read Greenberg & Bederman's personal injury page..

Most states follow a fairer system of ‘comparative negligence,’ which allows for reduced recovery, taking into account any negligence on the part of the injured party, and subtracting it from the final award. If you live in Maryland, D.C. or Virginia, you should be aware of the defense that contributory negligence may raise by the insurance company against those bringing a claim for personal injury. If the defendant is successful in raising this defense, the injured party is barred from any recovery. For example, if one did not exercise reasonable care, such as looking both ways before crossing the street and was subsequently hit by a car, they may not recover.
Many criticize this approach for its unfairness and inflexibility towards the plaintiffs. Despite the continuous lobbying efforts in an attempt to abolish the antiquated system, it remains in place due to support from insurance and business lobbyists. Insurance companies who want to take a chance in convincing a jury that the victim was partially at fault, instead of paying for injuries, may be willing to take a chance in litigating the case, because they may end up paying nothing. You should consider contacting an experienced personal injury attorney if you encounter reluctance on the part of the other driver’s insurer to compensate you for your injuries and/or damages. You should not communicate with the other driver’s insurance company without first contacting an attorney, as any statements made by you regarding your fault may serve as the basis for contributory negligence defense in court. Be wary when attempting to navigate the system on your own, as there are many avenues of harm that may bar you from recovering. Contributory negligence is one of them.
 

To learn more about personal injury issues, please see our website at G&B website and click on the personal injury tab.