Health Insurance Companies May Be Under Paying Claims

What happens if you are traveling and have to visit a hospital or doctor? Or what happens if you need to see a local doctor immediately who may not be in your health insurance company’s “approved network of doctors?” You would expect your health insurance company to pay a reasonable amount towards those bills, wouldn’t you? But that doesn’t always happen.
Recent cases from across the country indicate health insurance companies may be significantly under paying out-of-network claims. This means consumers are unfairly left to pay the balance of these charges. In a recent Federal case, California based Health Net Inc. agreed to repay $215 million to its customers for using an out dated and lower than reasonable payment schedule for out-of-network claims. The company also agreed to spend $40 million to update its claims processing protocol to avoid this problem in the future.
DO YOU THINK YOU’VE BEEN THE VICTIM OF AN UNDERPAYMENT FOR AN OUT-OF-NETWORK CLAIM? Please call us or e-mail us at mcw2@moore-wolfe.com and put “underpayment” in the subject line. You may be entitled to a refund.

MASS TORT UPDATE

Mass Tort litigation refers to issues in which a company or
individual does harm to a large number of people or their
property as a result of an action or product. Cases in this
practice area range from defective products, such as
pharmaceutical drugs and building products, to large “manmade”
disasters such as plane crashes and chemical plant
explosions. While M & W does not commonly practice in the
area of mass tort litigation, the firm does assist many with
locating experienced legal representation in this area. Many
law firms are advertising for Mass Tort cases but many of
these law firms are not actually handling the claims or
litigation. It’s important for the victim to hire an experienced
law firm related to a particular claim or case. Recently, our
office has assisted victims with questions regarding the
following products:

Chinese Sheetrock/Drywall – Homes and buildings
constructed between 2005 – 2007 and having recurring A/C
problems and/or electrical problems, may have been built
with Chinese sheetrock or drywall. It is suspected that
chemicals in the defective drywall are causing the
problems. If Chinese drywall was used in the construction
of your home or building, it will be necessary to remove all
sheetrock and replace all metal wiring. A certified Chinese
drywall remediation contractor should be used, and the
drywall should be properly disposed in a hazardous
substance facility.

Yaz (drosperinone & ethinyl estradiol) – The New York
Times recently published a major news story on the
growing safety concerns with Yaz. Numerous lawsuits have
been filed against Bayer HealthCare Pharmaceutical for the
birth control drug Yaz. Lawsuits and claims have also been
filed related to Yasmin and Ocella. Yaz, Yasmin and Ocella
birth control pills all contain drospirenone, a synthetic form
of progestin which works in combination with ethinyl
estradiol (estrogen) to prevent pregnancy. Drospirenone is
not contained in other forms of birth control and is believed
to be the major cause of side effects from Ocella, Yasmin
and Yaz. Two recent case-control studies published in the
British Medical Journal show that patients on the birth
control pills containing drospirenone have a 200% higher
risk of serious injury than those patients using first or
second generation oral contraceptives.

Bexta (valbecoxib) – used as treatment for mild to severe
arthritis (osteoarthritis & rheumatoid arthritis) and other
chronic pain. Bextra has been linked to heart attacks,
strokes, gastrointestinal problems, and Steven Johnson
syndrome, a potentially fatal skin condition. This drug was
recalled in 2005.

Avandia (rosiglitazone) – was prescribed to control blood
sugar in adults with Type 2 Diabetes. The FDA has
monitored several heart related adverse events associated
with Avandia, such as fluid retention, edema and congestive
heart failure. The most recent labeling change included a
new warning about a potential increase in heart attacks and
heart related chest pain in some individuals.

Reglan – Reglan is a drug used to treat gastrointestinal
problems caused by gasteroesophageal reflux (GER) and
gasteroesophageal reflux disease (GERD) in adults and
children. Reglan has a number of serious potential side
effects including Neuroleptic Malignant Syndrome, Tardive
Dyskinesia and Tardive Dystonia. Reglan side effects
appear to increase with prolonged use.

Asbestos – continues to bring serious illnesses from
exposure in the 1940s and 1950s. The most common
types of illnesses directly associated with asbestos are:
mesothelioma, lung cancer, asbestosis, throat cancer,
colon cancer, and stomach cancer. Asbestos exposure
could have occurred in any number of occupations,
including shipyard workers, brake mechanics, factory
workers, construction workers, power plant workers and
refinery workers. Veterans, particularly those who served
in the U.S. Navy, may now bill ill because of asbestos.

If you, or a friend or family member, may have a mass tort
claim, please contact Knox Boteler at M&W to discuss
your case and for assistance in finding the right law firm
for your particular claim or case. There is no charge for
consultations at M&W. 433-7766, also toll free 1 866 975-
7766 or visit our web site and blog for regular Mass Tort
updates: www.moore-wolfe.com.

State Farm Must Pay Victim

A Mobile County jury ruled against State Farm and in favor of their insured in a civil trial that concluded on January 7th. Moore & Wolfe attorneys, Steve Moore and Karlos Finley, represented Francilla Ridgeway during the two day trial. Ms. Ridgeway was the victim of a serious motor vehicle collision that occured on Novemebr 14, 2006 near Chickasaw. The collision occured as she moved into an intersection with a green light and was hit by an Alabama State Trooper vehicle that was involved in a high speed chase. The jury concluded after only about an hour and a half of deliberation that State Farm owed their insured $100,000.

The trooper was pursuing Daniel Keith Gibson who, just seconds before the collision, had gone through the intersection at over 90 miles per hour and was headed directly towards a school zone just a block away. Ms. Ridgeway testified at trial that she did not see or hear the approaching trooper vehicle. When pressed on cross examination by State Farm’s attorney, Ms. Ridgeway said she was distracted by Gibson’s vehicle and when her light turned green she moved into the intersection but was looking down the road in the direction of the fleeing vehicle. That afternoon, Gibson led law enforcement officers on a high speed chase through Mobile, Saraland and Chickasaw. He admitted to speeds in excess of 140 miles per hour and said he attempted to ellude police because he, “didn’t want another speeding ticket.”

State Farm, who provided underinsured motorist coverage to Ms. Ridgeway, never offered her any of those benefits under the policy, claiming Daniel Keith Gibson was not at-fault in causing the collision which left Ms. Ridgeway with over $24,000 in medical bills. They maintained this position even though Mr. Gibson’s insurance carrier had earlier paid his policy limits to Ms. Ridgeway. “Underinsured motorist coverage is a safety net that you pay a premium for,” explained Steve Moore. “If you are injured through the fault of someone else and they don’t have enough insurance to cover all of your damages, then you can use your underinsured motorist coverage to make up the difference,” he explained.

Besides incurring over $24,000 in medical expenses, Ms. Ridgeway lost almost $8,000 in wages as she recovered from shoulder surgery necessitated by the collision. At trial, State Farm said the accident was not the fault of Mr. Gibson but rather the fault of Ms. Ridgeway, in closing argument State Farm’s attorney even implied that Ms. Ridgeway lied under oath when she said she was not on her cell phone at the time of the collision as he suggested maybe she was distracted by talking on her cell phone.

“For over two years State Farm has refused to pay the benefits owed under this policy by continuously blaming Ms. Ridgeway for this accident. She was an innocent victim of Mr. Gibson’s idiotic decison to run from the police,” said Moore in closing argument. Ms. Ridgeway is a single mother of four with her oldest son in college at the University of South Alabama. She testified that every month for years and years she struggled to pay her insurance premiums to State Farm, which she said were about $70 per month. “At her income level she had to work about 10 hours every month just to cover her premiums and this is what she gets for her hard work,” her attorneys told jurors in closing argument referencing State Farm’s blaming her for the collision.

For additional information on this story visit the Mobile Register online.

Innocent Victim of High Speed Chase has to sue her own Insurance Carrier for Benefits

The Mobile Press Register recently reported on an interesting case pending in Mobile County involving a State Farm insured who was an innocent victim of a high speed chase. On November 14, 2006 Francilla Ridgeway was injured when a State Trooper vehicle collided with her vehicle at an intersection in Chickasaw, AL. Ms. Ridgeway entered the intersection on a green light and did not see or hear the approaching Trooper vehicle. The Trooper was engaged in a high speed pursuit of a fleeing motorist who had led law enforcement on a 30-40 minute high speed chase throughout the Mobile, Saraland and Chickasaw area. The fleeing motorist, Daniel Gibson, was driving a highly modified Ford Focus and admitted to traveiling in excess of 140 miles per hour and driving recklessly as he attempted to evade the pursuing law enforcement officers.

Ms. Ridgeway originally named Gibson as a defendant in the civil action claiming his negligence or wantonness caused the collision with the Trooper vehicle. Mr Gibson’s insurance company paid their liability limits but the amount was insufficient to cover the full extent of Ms. Ridgeway’s injuries. Under her policy with State Farm, Ms. Ridgeway has “underinsured” motorist coverage which provides additional benefits if an at-fault driver does not have enough liability coverage. State Farm denied Ms. Ridgeway’s claim and never offered any underinsured motorist benefits to her claiming the collision was not Mr. Gibson’s fault but rather Ms. Ridgeway’s fault for not seeing the oncoming Trooper even though she entered the intersection with a green light.

Steve Moore, Ms. Ridgeway’s attorney said he elected not to sue the Trooper involved in the incident because he did not believe he did anything wrong. “While some people may look at this situation and say the Trooper should have backed off from the pursuit or maybe he should have gone through the red light at a slower speed, I just felt legally the person who should be accountable is the person who caused this situation to begin with and that is Daniel Gibson.” State Farm “stands in the shoes” of Mr. Gibson for any damages he may legally owe Ms. Ridgeway per the terms and conditions of the underinsured motorist provisions of their policy with Ms. Ridgeway. “They do not want to pay benefits that Ms. Ridgeway paid a premium for so they argue that the accident wasn’t Mr. Gibson’s fault and have forced their insured to litigate this case,” said Moore.

The Mobile Press Register online at al.com has more on this story.

Innocent Victim of High Speed Chase has to sue her own Insurance Carrier for Benefits

The Mobile Press Register recently reported on an interesting case pending in Mobile County involving a State Farm insured who was an innocent victim of a high speed chase. On November 14, 2006 Francilla Ridgeway was injured when a State Trooper vehicle collided with her vehicle at an intersection in Chickasaw, AL. Ms. Ridgeway entered the intersection on a green light and did not see or hear the approaching Trooper vehicle. The Trooper was engaged in a high speed pursuit of a fleeing motorist who had led law enforcement on a 30-40 minute high speed chase throughout the Mobile, Saraland and Chickasaw area. The fleeing motorist, Daniel Gibson, was driving a highly modified Ford Focus and admitted to traveiling in excess of 140 miles per hour and driving recklessly as he attempted to evade the pursuing law enforcement officers.

Ms. Ridgeway originally named Gibson as a defendant in the civil action claiming his negligence or wantonness caused the collision with the Trooper vehicle. Mr Gibson’s insurance company paid their liability limits but the amount was insufficient to cover the full extent of Ms. Ridgeway’s injuries. Under her policy with State Farm, Ms. Ridgeway has “underinsured” motorist coverage which provides additional benefits if an at-fault driver does not have enough liability coverage. State Farm denied Ms. Ridgeway’s claim and never offered any underinsured motorist benefits to her claiming the collision was not Mr. Gibson’s fault but rather Ms. Ridgeway’s fault for not seeing the oncoming Trooper even though she entered the intersection with a green light.

Steve Moore, Ms. Ridgeway’s attorney said he elected not to sue the Trooper involved in the incident because he did not believe he did anything wrong. “While some people may look at this situation and say the Trooper should have backed off from the pursuit or maybe he should have gone through the red light at a slower speed, I just felt legally the person who should be accountable is the person who caused this situation to begin with and that is Daniel Gibson.” State Farm “stands in the shoes” of Mr. Gibson for any damages he may legally owe Ms. Ridgeway per the terms and conditions of the underinsured motorist provisions of their policy with Ms. Ridgeway. “They do not want to pay benefits that Ms. Ridgeway paid a premium for so they argue that the accident wasn’t Mr. Gibson’s fault and have forced their insured to litigate this case,” said Moore.

The Mobile Press Register online at al.com has more on this story.