Fayetteville Personal Injury Lawyer - Insurance Bad Faith

MARK GERAGOS IS WASTING HIS TIME; HE WILL LOSE: ONLY THE UNITED STATES CONGRESS CAN CORRECT THE INJUSTICE

Brent Adams — Mon, 14 Jan 2008 01:09:38 GMT

The tragic story of Nataline Sarkisyan has been widely publicized. The facts are sad indeed.

Young Miss Sarkisyan was diagnosed with leukemia at age 14. The cancer went into remission for two years when the leukemia relapsed.

Just before Thanksgiving, Nataline's brother donated bone marrow for a transplant that was at first successful in putting her cancer back into remission.

Unfortunately, Nataline's liver failed from a blood-clotting complication and she was put on life support.

Four members of the organ-transplant department and the University of California - Los Angeles recommended a liver transplant and clearly indicate that she would die without such a transplant.

These doctors urged CIGNA, the administrator of her family's health benefit plan, to pay for the liver transplant.

Her family said that a liver had become available that day. However, a CIGNA employed physician, who is nothing more than a lackey of the huge insurance company, decreed that CIGNA would not pay for the transplant procedure and claimed that the young cancer victim was too sick for the surgery to work.

Even though four imminently qualified specialists at the University of California - Los Angeles strongly recommended the surgery, CIGNA continued to say no.

These four doctors immediately appealed CIGNA's decision and strongly argued that the chances of success warranted the procedure.

CIGNA then hired another lackey, an oncologist and transplant surgeon to review the appeal and he rubber stamped the CIGNA's decision. CIGNA continued to refuse to pay for the procedure.

The California Nurse's Association got involved and began picketing on behalf of the family.

This activity created a huge outcry all across the nation and strong criticism of CIGNA.

Based upon this huge outpouring of public opinion, CIGNA reversed its decision and said that the company now would pay for the transplant.

CIGNA's reaction to strong public opinion was too little and too late.

Sadly, Nataline died the very day that CIGNA tried to put on the white hat by agreeing to pay for the transplant.

Although the facts in Nataline's case are absolutely horrible, she is just one of thousands of examples of how insurance companies can evade their responsibility to their insureds. This is just one example of the grisly fact that insurance companies will always put their profits ahead of the health, life and welfare of their insureds. This is especially true when the law of the land and the judges who are supposed to enforce that law let the insurance companies get away with these shenanigans.

The family hired celebrity lawyer Mark Geragos. For all of Geragos' grandstanding, he will fail.

Unfortunately, the law and therefore the deck is stacked heavily against Nataline's family and we predict they will not recover a dime. The only person that stands to gain from this horrible tragedy is Geragos who undoubtedly win himself more publicity and more celebrity status at the expense of this unfortunate family who undoubtedly will be disappointed at the results.

The true culprits in this huge miscarriage of justice are the United States Federal Judges, from the district court level all the way up to the Supreme Court who have engineered a horrible perversion of federal legislation which congress intended to benefit the ordinary working public.

This legislation is known as the Employee Retirement Income Security Act of 1974 (ERISA). Originally, a well intended law that Congress passed in a large part to address theft of employee retirement benefits by corporations in the rust belt which were going broke. Executives of these corporations were stealing money from employee pension plans and longtime dedicated employees reached their retirement age only to find that their hard-earned pension benefits had been stolen by the corporate bosses.

Big business lobbyists were able to inject language into this legislation to encompass, not only pension plans, but any sort of employer plans to benefit employees.

The federal judiciary then took this legislation and construed it so as to place most employer health insurance benefit plans squarely within the purview of ERISA.

Over the years the federal judiciary continued to distort and pervert this legislation such that the law in virtually all federal circuits is that insurance companies who administer employee sponsored health benefit plans (in effect, health insurance policies) may serve as the judge and jury on all issues related to whether benefits should be paid.

The general public does not understand that if they are in a dispute with a health insurance company that is governed by ERISA, as most plans are, the insurance company itself gets to decide whether it should have to pay for health insurance benefits. The federal court will not intervene to help these unfortunate employees and their families who desperately need health insurance benefits.

Unfortunately, Natline and her family were covered by a health plan subject to the ERISA law. CIGNA administered the plan , but it was her fathers employer that was liable for payment of health benefits.

The federal courts will only reverse the insurance companies if the courts find that the insurance companies have "abused its' discretion" in denying benefits. In layman's terms, what this means is if there is any evidence whatsoever to support an insurance company's denial of benefits, the federal judges will turn their head and ignore this injustice.

All insurance companies have an army of lackeys, usually retired doctors, or doctors who are otherwise so incompetent they can not make a living in the real world, who are willing to place their stamp of approval on the denial of any claim. The response of federal courts is almost always something to this affect: "well, we might not have decided the case the way the insurance company did, but as long as there is some evidence to support the denial of the claim, we will not reverse the insurance company's decision." Never mind that the denial of these claims goes straight to the bottom line of insurance company's profits. Federal judges give only lip service to the reality that these insurance companies have a direct conflict of interest.

The only way to correct this ridiculous perversion of the law is to elect congressmen who will change the law to prevent this abuse. It is extremely unlikely that the federal judiciary, who do not have to stand for re-election, and are answerable to virtually no one, will ever correct this injustice.

The remedy will have to come from Congress. Presidential Candidate John Edwards is doing his best to make the public aware of these horrible injustices.

All it will take to correct this debacle is for a majority of congressmen to exercise common sense and fairness and enact legislation that modifies the ERISA law so as to give beneficiaries of health insurance policies a right to a trial by jury on all issues related to the obligation of insurance companies to pay health insurance benefits. Under the law as it stands now, not only do these unfortunate victims of health insurance fraud have no right to a jury trial, they don't have a right to a trial at all.

For more information on this subject, please refer to the section on Wrongful Death.

Originally posted at InjuryBoard by Brent Adams

American workers do not have enough disability insurance

Brent Adams — Sun, 30 Sep 2007 22:51:51 GMT

According to the Social Security Administration, the odds are very high that an estimated 30 percent of American workers will be affected by a disability in their lifetime. However, in spite of these high odds, Americans are making no plans for income alternatives. According to a recent survey by Country Insurance & Financial Services only 3 percent of workers have paid for enough disability insurance to replace their income. One third of those workers have said that if they become disabled, none of their income will be replaced.

Many consumers said that if they become disabled, their current standard of living would not be able to be maintained for any time period. One third of the responders said that if they were unemployed due to disability, they could preserve their standard of living for 90 days.

One out of every three individuals will rely solely on the government to support them if they become disabled. However, according to the Social Security Administration, less than half of all disability claims are approved. Social Security provides benefits to those that are "insured," meaning that they have worked long enough and paid into the program to receive their benefits. SSI pays individuals based on financial needs. However, the approval process is a lengthy one with quite a bit of documentation

Originally posted at InjuryBoard by Brent Adams

Bad Faith Insurance Verdict Against Fireman's Fund

Brent Adams — Sat, 28 Jul 2007 01:03:18 GMT

The Supreme Court of the State of Washington, on July 26, 2007 upheld a jury verdict of $750,000 against Fireman's Fund Insurance Co. and it's subsidary National Surety Co. for bad faith insurance practices. Fireman's refused to defend a lawsuit against Dr. Robert C. Woo, a dentist who was sued by a former enployee Tina Alberts who had also been his dental patient.

The suit against Woo which Fireman's Fund refused to defend accused him of outrage, battery, invasion of privacy, false light, public disclosure of private acts, nonpayment of overtime wages, retaliation for requesting payment of overtime wages, medical negligence, lack of informed consent, and negligent infliction of emotional distress.

Alberts worked for Woo as a dental surgical assistant for about five years.
Her family raised potbellied pigs, and she often talked about them at work. She
claimed that over the course of her employment, Woo made several offensive
comments about her pigs. Woo claimed his comments about Alberts' pigs were part
of a "friendly working environment" he encouraged in the office.

The event that precipitated the claim occurred during a procedure Woo agreed
to perform for Alberts to replace two of her teeth with implants. The procedure
required Woo to install temporary partial bridges called "flippers" as spacers until
permanent implants could be installed. When he ordered the
flippers for Alberts' procedure, Woo also ordered a second set of flippers shaped
like boar tusks to play a practical joke on Alberts. While Alberts was under
anesthesia, Woo and his staff removed Alberts' oxygen mask, inserted the boar tusk
flippers in her mouth and took photographs of her, some with her eyes pried open.
After taking the photographs, Woo completed the planned procedure and inserted
the normal flippers.

Woo subsequently had the photographs developed but claims that when he
saw them he concluded they were ugly and should not be shown to Alberts. He also
claimed he told another surgical assistant he thought the photographs were ugly. He
claims that he did not expect his staff to give them to Alberts before talking with
him. However, about a month later, Woo's staff gave Alberts the photographs at a
gathering to celebrate her birthday.

The insurance policy issued to Dr. Woo by the defendants covered him against professional liability, employment practices liability and general liability.

Five months after Alberts filed suit, Fireman's Fund informed Woo that his policy did not cover claims asserted in the lawsuit and refused to defend him.

Dr. Woo hired a lawyer at his own expense and settled with Alberts just prior to trial for $ 250,000.

Woo then filed this insurance bad faith action against Fireman's Fund.

At trial, the jury found that Fireman's Fund had failed to act in good faith and violated Washington's, Consumer Protection Act and awarded Woo $ 750,000. The trial court also awarded attorney's fees and costs and recovery of the $ 250,000 settlement Woo negotiated with Alberts.

The Supreme Court held that Fireman's Fund did have a duty to defend against the professional and genteal liability claims and upheld the entire award by the jury and the trial court.

A large part of the $ 750,000 verdict was based upon Dr. Woo's claim of emotional distress. It is interesting to note that the emotional distress claim was based entirely upon Dr. Woo's testimony. He did not present any medical, psychiatric testimony.

In North Carolina if the trial court finds that the failure to defend under a liability insurance policy is an unfair trade practice, the law requires that the insured will recover three times the jury's verdict plus attorney's fees.

If you feel thtat you have been treated unfairely by an insurance company, fill out the short form on this page and an experienced lawyer will contact you.

Originally posted at InjuryBoard by Brent Adams