State Farm Final Resolution:

We received the paperwork for the settlement and it looks as if the $5,000 in medical that was paid out by our State Farm coverage will be reimbursed.   The only one that will still end up with the short end of the stick is our chiropractor as our medical insurance discounted quite a bit off of his charges (even though his charges were reasonable compared to the physical therapist’s charges in 2007).

As I told my husband, he should have been entitled to some more pain & suffering compensation, but he didn’t listen to me when I told him to seek help elsewhere sooner than he did and so it was a learning experience.  In addition, we are getting much better medical care from our new primary care doctor and hospital and that in itself makes up for it.    

If you are in a car accident, I still recommend hiring an attorney who will make sure that the proper 'paper trail' is documented and that the settlement is fair and equitable for all.  It is unfortunate that this is how the system is set up to work.  

My husband and I are honest people and not scammers and we believe that most people are decent and will do the right thing, but we sure learned our lesson with this experience!!!!

Additional info re: 7/25/08 car accident:

State Farm cannot dispute fault because the 7/25/08 accident was witnessed by a DuPage County sheriff’s police officer who clearly saw that my husband had the green light as he went through the intersection when the young lady, who was talking on her cell phone, decided to make a left turn.  This officer spoke with the responding Wheaton officer and the young lady was issued a citation.  It was obvious that this was not a staged accident to scam the insurance company.

Just as it was not immediately apparent that my car had frame damage and was totaled, it was not immediately apparent that my husband was indeed injured (no external bleeding, didn’t feel as if there were broken bones and he was in shock). 

State Farm cannot dispute injury because the doctor’s official dx according to the paperwork from the 7/29/08 appointment was neck strain and spasm (with swelling and bruising on the shoulder) due to a car accident on 7/25/08.

When you are not a doctor and have never studied medicine, you have to rely on the judgment of the ‘professional’ (who you pay for their expertise) – your doctor.  Our now former doctor (given the severity of the accident and the fact that there was swelling and bruising, indicating an internal injury) should have sent my husband for x-rays and an MRI and possibly back to the orthopedic surgeon he had seen the year before (especially in light of the fact that my husband had been treated for pain in his shoulder by him at a prior date and it was probable that an existing problem could have been aggravated).  If she had indeed written in his medical record that his previous pain was work related, it was certainly news to my husband as she had not mentioned that to him and he had never told her that he had been injured at work.  Had he been injured at work, he would have been sent to a company approved facility for evaluation and treatment.  Had the orthopedic surgeon told him that his pain was work related (and he hadn’t because I was there with him), he would have followed the proper company procedures and filed a workman’s compensation claim and his company’s workman’s comp insurance not our health insurance would have paid the bills and saved us quite a bit of money in out of pocket co-pays and deductibles for 2+ months of physical therapy.  

It is true that our former doctor dropped the ball in her treatment or rather lack thereof.  She examined my husband and told him he was fine except for some swelling and the bruise.  She prescribed 3 months worth of ibuprofen, told him to ice his shoulder and to remember that since he was a diabetic, it would take longer to heal than if he wasn’t.  She had him make an appointment in 3 months.  Her official dx according to the paperwork from the 7/29/08 appointment was neck strain and spasm due to a car accident.  When he complained of continued pain at his appointment in October, she blew it off, told him to take over the counter ibuprofen and didn’t even record it in his medical record.  When my husband told her he was seeking other help for the pain in January since she was not doing anything for him, I’m sure she realized that she screwed up and could possible be sued.  That would explain her covering her ass with a claim of a previous ‘workman’s comp injury’ in her report to State Farm. 

However, even this should not absolve State Farm from settling the claim in a fair and equitable manner.  Just because you can deny a legitimate claim by law does not make it right or fair.   It’s all about money and greed.   We were screwed by our former doctor and by State Farm because we were not out to make a quick buck from this accident and therefore hadn’t hired an attorney. 

And so, in hindsight, I recommend:

Don’t be stupid like we were.  Hire an attorney.  Go to the emergency room.  Take photos of any visible signs of injury.  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.  They get rewarded when they save the company money – that’s their job.

State Farm – Make the Victim Pay Madness Follow Up

We spoke with several attorneys regarding the July 25, 2008 accident, all of whom would have taken the case right from the beginning and 3 who would have taken the case when my husband sought treatment from the chiropractor in January of 2009 or if he was still suffering from the injuries at this date.  Because it wouldn’t be a mega $$$$ case, he is now fine and it is close to the 2 year deadline to settle, no attorney would take our case unless we funded the expenses upfront – exactly what the State Farm insurance claim rep counted on when she said that we didn’t need to hire an attorney because they did not dispute fault nor did they dispute injury. 

They still do not dispute fault and they still do not dispute injury. 

The supervisor my husband spoke with today said that they don’t have to pay because there is no paper trail even though they have documentation of injury from the 1^st visit to the doctor in July 2008.  Then he kept claiming that January 2009 was the 1^st time he saw the doctor for the accident according to the doctor’s report (we have paperwork from the doctor’s office from the 7/29/08 visit that states injury from a car accident) and that (again supposedly according to her report) the injury was from a workman’s comp case from 2007.   Who is lying - the insurance company or our former doctor or both?   My husband had not been injured at work and had never filed for workman’s comp ever.   Had he been injured at work, his boss would have made sure that the proper company procedures were followed and a claim would have been filed. The party at fault's car insurance would still be liable for aggravating an existing injury.  This just doesn’t make any sense.  Someone is lying and it is not us. 

This is what happens when you do not hire an attorney right away. 

After our insurance (also State Farm) paid the $5,000 max for medical and the chiropractor’s office got tired of waiting for the rest of the payment and billed our health insurance for the balance owed, we still owe $570.74.  My husband lost time from work and we had to pay the co-pays for the 3 months of ibuprofen the doctor prescribed.   Not to mention the pain he was in and because he is diabetic, the fact that everything takes longer to heal. 

Finally, the State Farm supervisor conceded to settling the case by paying the lost time from work, the amount still owed the chiropractor, the prescriptions and $141.27 for pain and suffering.  What a joke!!!   We decided it was not worth the stress it was causing us, and as long as we would not owe any money due to this accident that was totally not my husband’s fault, we agreed to the settlement offer. 

Just to give you something to compare it to:

In July of 2010, my husband was rear ended by a car that had been rear ended.  Since he was in stop and go traffic on the expressway, it was a small jolt and the only damage to my car was a cracked bumper shell.  The party at fault was also insured by State Farm.  My husband was just being released by the chiropractor from care from the 2008 accident.  (FYI - my husband hadn’t been in an accident for about 30 years prior to these 2 accidents and was not at fault in any of the total of 3 accidents he had ever been in.)  Because this accident aggravated the injury from the accident in 2008, the State Farm claim rep offered a settlement equal to the 5 weeks of chiropractic care and physical therapy my husband had after the accident, his lost wages and $500 for pain and suffering (which we did not ask for but the claim rep said it was part of the settlement he was offering and we have to take it).  

Compare the severity of the 1^st accident where he was hit broadside into the driver’s side by a large SUV damaging the frame and totaling the car to a small jolt that only cracked a thin plastic bumper shell and you can see why the settlement for the 1^st accident is a total joke!

I will only say this to our 'covering her ass' former doctor, the State Farm claim rep and her supervisor – remember that what goes around, comes around. 

On a lighter note, I am never lending my husband my car to drive to work in the month of July again.

This is a repost prior to the follow up. 

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 delay 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.

Being just, fair, doing the right thing and ethical treatment of our fellow man all get thrown out the window because of greed.

The people at the top of corporations increase their own salaries and benefits while raising prices and laying-off workers – greed.

Corporations model their businesses based on greed especially public corporations that have stockholders.  Before you get all riled up at the greedy corporations, research what your pension and 401k plans invest in and you may find that ‘they’ are in fact ‘you’.

Unions, originally formed to protect the worker against greedy business owners fell prey to greed a long time ago and have been a cash cow for union leaders and representatives – again greed.

Our government officials – people who we have elected to represent our interests and who we pay with our tax dollars – raise their own salaries and cut essential services – greed.

Everyone points the finger at the other guy. 

Insurance companies have been complaining for years that the reason premiums are so high is because of lawyers.  They have to defend themselves from all these law suits and it is expensive.  But what do they do if you don’t have a lawyer represent you; do they offer a fair settlement?  No.  They want to pay out the least amount of money they can.  They encourage their employees to use tactics that will confuse, delay, distract, etc. and then they screw you.  Most of us are not lawyers or insurance agents or claim reps and we don’t know how the system works and without someone who does, we are sitting ducks.

Greed.

Our country is in the mess it is in because of greed.

The world is in the mess it is in because of greed. 

In the face of all this, I refuse to be greedy but I will fight for what I feel is right and fair. 

I know I am not alone.

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.