May Madness – State Farm Insurance Company – Make the victim pay!!!!

Don’t be stupid like we were.  

Facts:

7/25/08 – 2003 Chevy Trailblazer making a left turn hit into the driver’s side of our 2002 Dodge Intrepid ES – driver of Intrepid was on his way to work.  Driver of Trailerblazer received citation.  Both parties insured by State Farm.  Intrepid was deemed ‘totaled’ mostly due to frame damage both bottom and middle. 

Since victim was in shock, he went into work.  He did call his doctor and got the first available appointment per her office on Tuesday.  By Tuesday, his neck and shoulder were hurting and there was a visible bruise on his shoulder.  She prescribed 3 months worth of ibuprofen and told him to ice it.  Because he wasn’t looking to make a buck off the insurance company, because he was glad that his injuries weren’t worse (as they would have been had he been driving the Toyota Tercel) and because his doctor made it seem as if it was no big deal (not even sending him for x-rays or an MRI), he iced his shoulder and took the ibuprofen.

He took the ibuprofen for 3 months fully expecting the pain to lessen and go away at some point (as long as he took the ibuprofen, he was pain free).  At his next doctor’s appointment, he again complained that the shoulder pain hadn’t gone away.  His doctor blew it off telling him to take more ibuprofen and didn’t even mention it in her notes from that visit.  However, her outside billing service billed the visit to the victim’s car insurance claim  and not the health insurance – someone from the doctor’s office had to tell them to do so but because there was no mention of shoulder injury in her notes, the billing service coded it as a regular follow up visit with his medical dx (a HIPPA violation as the insurance company hadn’t requested his non-accident related medical record) and the insurance flagged it as ‘not accident related’. 

The pain continued to slowly increase and now his back was hurting as well even though he continued taking over the counter ibuprofen.  In early January of 2009, he made an appointment to see his wife’s chiropractor at her insistence.  When he told this to his doctor, she was not pleased but did document that he complained about the shoulder and even checked her notes from the initial visit.  After he had already consulted the chiropractor, his doctor offered to send him back to the orthopedic surgeon.  At this point he said no since he already had an appointment to start treatment with the chiropractor.  He was treated through July 2009. 

The victim’s State Farm coverage paid the bills up to the max of his policy - $5,000.

The party at fault’s State Farm claim rep intentionally misled the victim’s wife by first saying, ‘You haven’t hired an attorney have you?’ and then telling her that they did not need to hire one as they would settle the claim when treatment was finished, implying that they would pay for treatment.  The claim rep continued to imply that they would pay for treatment in subsequent phone calls and correspondence.  After treatment was finished, when the chiropractor’s office would call about what info was needed by the insurance claim rep so the bills would be paid, the rep would refer them back to the victim’s claim rep knowing that it would delay the settlement offer and give the victim less time to find an attorney willing to take the case just before the 2 year deadline.

Now, close to the 2 year deadline, these issues were brought up:

1)     Victim did not see a doctor nor go to the ER the same day of the accident.

2)     Victim waited 5 months for treatment (not true – went to doctor 3 days after accident and was treated with 3 month prescription of ibuprofen).

3)     Victim had previous injury – not relevant because they would then have to pay for aggravating a previous injury.

After finally letting the chiropractor’s office know what info was needed, the claim rep left a message on voice mail the other day that they would only pay for that first initial doctor’s visit. 

A grossly unfair settlement offer in light of the fact that:

They do not dispute responsibility.

They do not dispute that victim was injured (they know that a driver’s side impact of a sedan by an SUV hard enough to cause frame damage and total the car had to have caused some thoracic trauma and pelvic deceleration).

They do not want to pay because it was 5 months before seeking treatment which we know is not true.  This should not be a cause for non-payment when they do not dispute injury. 

His former doctor’s actions/inaction does not change the fact that he was injured in the car accident whether it exacerbated an old injury or caused a new one. Injury was documented at first doctor’s visit.  This should not be cause for non-payment when they do not dispute responsibility. 

There are many other cases where the car accident victim did not seek medical treatment for several months because they, as did this victim, thought that their pain would get better instead of worse.  My sister-in-law was one of those people.  She didn’t even go to see a doctor for 3 months and then had 5 months of physical therapy.  The party at fault’s car insurance brought up the same type of issues but ended up paying for all her medical and treatment as well as pain and suffering and attorney’s fees.

We were willing to settle for just the cost of treatment – silly us being honest and trying to do the right thing.  The claim rep intentionally used tactics that would compromise our ability to get an attorney to represent us.  Mind you, this is also our insurance company (we have 3 cars and our home insured with them) and we (stupidly) didn’t want to sue our own insurance company and they took full advantage of that fact. 

Don’t be stupid like we were.  Hire an attorney.  Run up doctor bills.  No matter how nice the claim representative is – remember he/she is out to screw you especially when you are honest and only want what’s right.