South Carolina Personal Injury Blog - Insurance

South Carolina Jury Awards $10 Million In Health Insurance Rejection Case

Brad Hewett — Thu, 08 Oct 2009 17:07:20 GMT

The South Carolina Supreme Court upheld a multimillion verdict last month against an insurer which the Justices said revoked a man’s health policy after he tested positive for HIV based solely on a nurse writing down the wrong year for the test. The Court called Fortis Insurance Company’s actions “highly reprehensible” but reduced punitive damages awarded from $15 million to $10 million. The policyholder first found out he might have HIV when he tried to donate blood in April 2002. The Red Cross let him know his sample tested positive, and a trip to his personal physician confirmed the diagnosis.

Fortis said it revoked the policy because the policyholder didn’t reveal his diagnosis when he applied for insurance in May 2001 as the then 17 year old prepared to head to college and could no longer be covered under his mother’s policy. The company cited a note made by a nurse on a medical chart that incorrectly gave the wrong year for the test confirming the HIV diagnosis, placing it one day before the policyholder’s application for insurance.

The committee for the insurance company that decides whether to revoke policies heard the policyholder’s case along with 45 others in a two-hour session. The members were given a report from an underwriter that included the note” “Technically, we do not have the results of the HIV test. This is the only entry in the medical records regarding HIV status. Is it sufficient?” The policyholder hired a lawyer who sent the company the original test results with the correct date. But a second committee also upheld revoking the insurance and the policyholder didn’t have coverage for 20 months before Fortis reversed its decision, according to trial testimony. Fortis, which now does business as Assurant Health, appealed the case. The company’s “conduct involved repeated acts of deliberate indifference for more than two years,” the Justices wrote in their decision.

Source: Associated Press

Originally posted at InjuryBoard by Brad Hewett

Millions of Customers Likely Paid Too Much For Out of Network Health Care

Pete Strom — Fri, 17 Jul 2009 17:20:49 GMT

We all know the drill. Health insurance is expensive. Even if you are a portrait of health, and only visit your doctor one a year for preventative care, your premiums continue to go up year after year. Even with healthcare policies that we pay good money for, millions of Americans are still forced to step outside their health insurance company’s list of preferred providers to see an out-of- network physician or medical provider. In fact, statistics show that over 70% of Americans pay more for plans that allow them access to out of network providers. As we all know, our out-of-network access usually comes at a higher rate whether you pay a higher deductible, a higher percentage of the bill, or higher copayment.

If you are insured with an insurance company in South Carolina, Georgia, or North Carolina not only may you pay a higher percentage of the physician’s bill to see an out of network doctor, but what you may not realize is that your insurance company likely may not be reimbursing your claim as promised.

Although these insurers may claim to pay as much as 80% of the bill to see an out of network physician or medical provider, instead of picking up the remaining portion of the bill as promised, some insurance companies are reimbursing the physician at what they determine to be the “usual and customary cost” for such visit, not for their portion of the bill. Even worse, rather than figuring an average of what it costs for that specific type of care in your area, these insurance companies may be reimbursing based upon faulty data, leading you to be responsible for more than you bargained for. We are currently investigating claims that these insurance companies’ reimbursement rates are based upon faulty data and are extremely low, leaving you to pay more than promised. That means that millions of people in Georgia, South Carolina, and North Carolina, likely paid too much for out of network care.

Strom Law Firm, LLC, is investigating whether Blue Cross Blue Shield of South Carolina (BCBSSC), WellPoint Health in Georgia (WPH), or Blue Cross Blue Shield of North Carolina (BCBSNC) are engaged in this practice. If you or a loved one is currently insured with BCBSSC, WPH, or BSBSNC, and you believe that you have paid too much for out of network claims, contact an experienced insurance reimbursement fraud attorney.

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Strom Law Firm is a personal injury and criminal defense law firm centrally located in Columbia, South Carolina. Our firm proudly handles personal injury, criminal defense, defective products, class actions, pharmaceutical liability, toxic torts, medical malpractice, nursing home neglect, workers compensation, social security, veteran's benefits, qui tam, predatory lending, tax investigations, business litigation, and wills and estates. Our lawyers proudly edit the Columbia, South Carolina Injury Board as well as the Strom Law Blog as a pro bono effort to provide the public valuable information. Our lawyers are licensed in: South Carolina, New York, Georgia, Florida, and the District of Columbia.

Originally posted at InjuryBoard by Pete Strom

How to File an Insurance Claim as a Result of the Myrtle Beach Fire

Will Parker — Fri, 24 Apr 2009 12:10:44 GMT

I thought it may be helpful to provide some basic tips regarding the claims process in light of the recent fires in Horry County. The Sun News reported this morning that insurance companies have started sending their catastrophe teams and adjusters to Horry County, and some are setting up spots where fire victims can go to file claims, according to Allison Love with the S.C. Insurance News Service.

First, the adjusters have to be allowed access to the damaged properties. Once they are allowed to begin assessment, the adjusters will begin with the most severely damaged properties. Residents who have been evacuated may begin the claims process. Additional tips and information can be found at www.scinsnews.com. Below is a list of numbers to report claims for most major insurance companies:

Allstate Insurance: Claims #: 1-800-54-STORM (1-800-547-8676)

Builders Mutual Insurance Company: Claims #- 1-800-809-4861

Companion Property & Casualty Insurance: Claims #: 1-800-845-2724, option 2 or fax at (803) 419-8063

GEICO: Claims # 1-800-841-3000

General Casualty Insurance Company: Claims: 1-800-334-0241

GMAC Insurance: Claims # - 1-800-468-3466 Grange Insurance: Claims #: 1-800-445-3030

Harleysville Insurance: Claims #: 1-800-892-8877

Johnson & Johnson Inc Managing general Agent: Claims #: 1-800-487-7565 Ext. 3029

Nationwide Insurance: Claims # - 1-800-421-3535

Progressive Insurance: Claims # - 1-800-274-4499

PURE High Value Homeowners Insurance Claims Hotline: 888-813-PURE (7873) or e-mail claims@purehnw.com or fax claims to 914-328-3883.

South Carolina Farm Bureau Mutual Insurance Company: Claims Hotline: 1-800-799-7500

South Carolina Wind & Hail Underwriting Association: Claims #: Call your insurance broker/agent

The Seibels Bruce Group, Inc.: Catawba Insurance Company Claims: 1-800-525-8835

Southern Mutual Insurance Company: Claims #: 1-800-226-1919

Southern Mutual Church Insurance: Claims #: 1-800-922-5332

State Farm: Claims #: Contact your agent or 1-800-SF-CLAIM State Auto Insurance: Claims #: 1-800-766-1853 or e-mail claims@stateauto.com

USAA: Claims #: 1-800-531-8222

Universal North America Insurance Company: Claims #: 866-999-0898

Utica National Insurance Group: Claims #: (Fax) 315-266-4121 or 1-800-274-1914 ext. 2772

Originally posted at InjuryBoard by Will Parker

What Happens if AIG Goes Bankrupt?

Will Parker — Wed, 11 Mar 2009 13:47:47 GMT

This is a fairly common question I receive as an attorney, particularly from my worker’s compensation clients. These injured workers’ employers’ insurance is through AIG and, consequently, they receive their weekly checks and, ultimately settlement money from AIG. So, what happens if AIG blows through the bailout money on expensive retreats and poor executive decisions. First of all, let me make it clear President Obama’s idea of transparency and accountability within the government itself and related to government assistance to private entities make it much more likely AIG is successful in the future.

However, what happens if AIG fails? Honestly, insureds have relatively little to worry about. Similar to FDIC insurance for bank deposits, significant regulation and state guarantee funds protect insureds to a fairly large extent.

It is simply not as well known to the average person. The FDIC is well known because the federal government has made it well known to protect against a banking collapse like the one during the Great Depression. Essentially, state and federal regulations will assure that AIG subsidiaries are solvent and able to pay claims. Additionally, AIG’s subsidiary assets would be sold and state guarantee funds that assist in claims pay outs would kick in, if necessary.

On a side note, the real threat to the AIG insureds is the potential of losing coverage at the renewal period if AIG did become insolvent and left the market. In that sceanrio, the more risky the type of coverage, the more difficult it would be to find another insurer. Even in the worst cases, however, eventually other insurers would fill the market vacancy. AIG insurance products, in particular, are, for the most part, not so specialized and their insureds would likely have no problem finding other carriers.

I hope this helps answer a very important and timely question on the minds of many.

Originally posted at InjuryBoard by Will Parker

Auto Accidents - What am I Owed?

Will Parker — Thu, 20 Nov 2008 11:41:14 GMT

So you get in an accident and it is not your fault. This scenario, which occurs on a daily basis, is frustrating to say the least. Many times, the victim simply wants to get the process over with. Insurance companies know this and, on many ocassions, will contact injured parties quickly in order to induce a quick settlement.

DO NOT MAKE THE MISTAKE OF ACCEPTING A QUICK, PRESSURED SETTLEMENT!

I have heard so many horror stories involving injured parties that accept settlement amounts that don't even cover their initial medical expenses, more less future medical care, pain and suffering, etc...

You need to keep in mind how many ways an automobile accident can affect your life....

Medical care and related expenses

Income lost because of the accident, because of time spent unable to work or undergoing treatment for injuries

Permanent physical disability or disfigurement

Loss of family, social, and educational experiences, including missed school or training, vacation or recreation, or a special event

Emotional damages, such as stress, embarrassment, depression, or strains on family relationships -- for example, the inability to take care of children, anxiety over the effects of an accident on an unborn child, or interference with sexual relations, and

Damaged property.

The role of an attorney is to work to ensure you receive a fair and reasonable settlement, after considering each and every way you have been "injured" by an accident. Attempting to settle without the help of an attorney can be a very costly mistake. Keep in mind, almost all personal injury attorneys will speak with you at no cost. Further, almost all attorneys will only recover a fee if they are successful at obtaining a settlement in your favor. Particularly with the current economic climate, an attorney is essential to obtaining a favorable settlement. Don't go it alone!

Originally posted at InjuryBoard by Will Parker

"Thank You for the Pedicures, America," states an AIG Executive at a California Retreat

Will Parker — Tue, 21 Oct 2008 15:24:26 GMT

Maybe that wasn't said aloud, but I can almost bet you it was said. This one was so unbelievable, even I had to read it twice....

Apparently, less than a week after the feds offered an $85 billion bailout to insurance giant AIG, the company held a week-long retreat for its executives at the luxurious St. Regis Resort in Monarch Beach, California. The tab....$440,000.00, according to Rep. Henry Waxman (D-Calif.).

Holding a photograph of the resort, Waxman said the executives spent $200,000 for rooms, $150,000 for meals and $23,000 for the spa.

"Less than a week after the taxpayers rescued AIG, company executives could be found wining and dining at one of the most exclusive resorts in the nation," Waxman said. "We will ask whether any of this makes sense. "

My favorite comment:

"They were getting their manicures, their pedicures, massages, their facials while the American people were paying their bills," thundered Rep. Elijah E. Cummings (D-Md.), of the executive retreat at the Monarch Resort.

What a joke.

Originally posted at InjuryBoard by Will Parker