How the Medical/Auto Insurance Industry Ran Over Me

[JimBowie1958]

OK, this is a long post, but the details matter to udnerstand what happened here and the core to my complaint.

1. In 1978 while stationed in Germany serving in the US Army I had an accident that injured my upper back. Despite the pain I had, X-Rays showed nothing and that it was apparenlty muscular-tendon related.

2. I had my back pop in a very painful way in my upper back and an MRI showed it was a herniated disc at my T7-T8 disc in August 2013. The lower lumbar area was also MRIed and it showed that my lower back was healthy with only a minor bulge in my L4-L5 lumbar disc. I could not work as the muscle cramping was too severe if I sat or stood in one place very long. I lost my job, but got disability that ended suddenly in May of 2014.

3. In September of 2014 I had an automobile accident where I got run off into a curb in a parking lot. there were no witnesses and I could not get the other drivers information, as they drove away. The insurance company covered the damage on my car. I saw my back doctor 3 days later and his office notes noted that this was the first time I saw him for lumbar pain issues and that they were much more severe. Despite this, he would not send me to get an MRI done. He said I was just having a 'flare up'.

4. Despite several more visits complaining of pain, my first back doctor persisted in refusing me my MRI, and the PA nurse asked me why I had not had one yet when I told her my symptoms. The MRI showed I had a new herniated disc with disc material hanging down several mm's below my L5 vertebrae. I got a new back doctor who then advised me to get surgery immediately and I did, and have had a full recovery, thank God. But the treatments have been expensive.

5. I file the paperwork for the auto insurance to recover my costs for the auto accident and it drags out from June of 2015 to today when I finally got my rejection based on an 'Independent Medical Examiner' report that says that my L4-L5 herniated disc is the result of normal degeneration, not related to the accident and he said that my lumbar issues had a long pre-existing history. All of that being absolute total bullshit.

6. I can file some kind of contest to the IME report from my auto insurance company, but I have to have new medical evidence to do so. I have called several lawyers and none of them will take the case because I am only 4 months from the deadline to file and that exposes them to legal malpractice if they screw something up.

Some people like to present this fantasy of the poor doctors and insurers being submerged under medical liability and other legal costs, but maybe this would not be the case of MDs and insurers didnt fuck things up so much. Meanwhile the public has no protection from medical malpractice or insurance malpractice if the legal establishment will only pursue low hanging fruit cases all the time.

What particularly outrages me is how these so-called Independent Medical Examiners are really in effect employed by the insurance companies to give the insurance companies legal CYA to deny claims. In my particular case the guy got his facts wrong and apparently didnt even read the reports or the MRIs.

As to what I can do it about it now, so close to legal expiration; I just dont know.

 

[Wyatt earp]

I mother fucking hate car insurance company's, so in cahoots with the states


After what 30 years since most states made car insurance mandatory how come full coverage is not like $25 bucks a month?

I am 51, not even a speeding ticket in 25 years and still paying $500 every six months for two pick up trucks .

 

[Fenton Lum]

That would be because america floats on a predatory societal wealth extraction paradigm, just as you've observed here. Now, who orchestrated this and why is it done on this absurd state boundary façade rather than opening up the competition nationwide? Isn’t the purpose of insurance to spread the risk (voluntary socialism until it’s mandated)? Less profitable for the industry whose desire is to sell you a service they never have to honor, honoring the service sold reduces profit margin. Who did this to you? Poor folk with no voice? Black folk? "Liberals"? Or lobbyists with corporate power and funding money that both parties really represent instead of the unsubstantial working class people?

Privatized gains versus socialized losses for the Wall Street Bankster class
Internalized profit versus externalized risk and expense for the “job creator” class
Socialism for the aristocracy versus laissez-faire capitalism for the masses

That’s how it really is here.

 

[Crixus]

OK, this is a long post, but the details matter to udnerstand what happened here and the core to my complaint.

1. In 1978 while stationed in Germany serving in the US Army I had an accident that injured my upper back. Despite the pain I had, X-Rays showed nothing and that it was apparenlty muscular-tendon related.

2. I had my back pop in a very painful way in my upper back and an MRI showed it was a herniated disc at my T7-T8 disc in August 2013. The lower lumbar area was also MRIed and it showed that my lower back was healthy with only a minor bulge in my L4-L5 lumbar disc. I could not work as the muscle cramping was too severe if I sat or stood in one place very long. I lost my job, but got disability that ended suddenly in May of 2014.

3. In September of 2014 I had an automobile accident where I got run off into a curb in a parking lot. there were no witnesses and I could not get the other drivers information, as they drove away. The insurance company covered the damage on my car. I saw my back doctor 3 days later and his office notes noted that this was the first time I saw him for lumbar pain issues and that they were much more severe. Despite this, he would not send me to get an MRI done. He said I was just having a 'flare up'.

4. Despite several more visits complaining of pain, my first back doctor persisted in refusing me my MRI, and the PA nurse asked me why I had not had one yet when I told her my symptoms. The MRI showed I had a new herniated disc with disc material hanging down several mm's below my L5 vertebrae. I got a new back doctor who then advised me to get surgery immediately and I did, and have had a full recovery, thank God. But the treatments have been expensive.

5. I file the paperwork for the auto insurance to recover my costs for the auto accident and it drags out from June of 2015 to today when I finally got my rejection based on an 'Independent Medical Examiner' report that says that my L4-L5 herniated disc is the result of normal degeneration, not related to the accident and he said that my lumbar issues had a long pre-existing history. All of that being absolute total bullshit.

6. I can file some kind of contest to the IME report from my auto insurance company, but I have to have new medical evidence to do so. I have called several lawyers and none of them will take the case because I am only 4 months from the deadline to file and that exposes them to legal malpractice if they screw something up.

Some people like to present this fantasy of the poor doctors and insurers being submerged under medical liability and other legal costs, but maybe this would not be the case of MDs and insurers didnt fuck things up so much. Meanwhile the public has no protection from medical malpractice or insurance malpractice if the legal establishment will only pursue low hanging fruit cases all the time.

What particularly outrages me is how these so-called Independent Medical Examiners are really in effect employed by the insurance companies to give the insurance companies legal CYA to deny claims. In my particular case the guy got his facts wrong and apparently didnt even read the reports or the MRIs.

As to what I can do it about it now, so close to legal expiration; I just dont know.

sucks man. my ma is a retired lawyer who has delt with this type stuff. she always said don't sign anything and get ready to sue them. medical though is a compleatly diffrent critter though.

 

[JimBowie1958]

That would be because america floats on a predatory societal wealth extraction paradigm, just as you've observed here. Now, who orchestrated this and why is it done on this absurd state boundary façade rather than opening up the competition nationwide? Isn’t the purpose of insurance to spread the risk (voluntary socialism until it’s mandated)? Less profitable for the industry whose desire is to sell you a service they never have to honor, honoring the service sold reduces profit margin. Who did this to you? Poor folk with no voice? Black folk? "Liberals"? Or lobbyists with corporate power and funding money that both parties really represent instead of the unsubstantial working class people?

Privatized gains versus socialized losses for the Wall Street Bankster class
Internalized profit versus externalized risk and expense for the “job creator” class
Socialism for the aristocracy versus laissez-faire capitalism for the masses

That’s how it really is here.

I agree. The only good thing insurance is for is the occasional obvious case that has a low cost. If it involves anything over a certain average, then they will do everything they can to screw you over.

But what particularly galls me is that this IME report is just total bullshit. The dude said I had a history of Lumbar back issues and the medical evidence plainly shows that I did not. He lied and there is not one thing I can do about it. The use of IME reports is totally self serving and I am going to try and dig into what the percentages are for IME reports being for or against customers based on whether they have hired a lawyer and who much the claim is for. My bet is that if the benefit goes over a certain amount the IME report is 99% against the beneficiary.

 

[JimBowie1958]

OK, this is a long post, but the details matter to udnerstand what happened here and the core to my complaint.

1. In 1978 while stationed in Germany serving in the US Army I had an accident that injured my upper back. Despite the pain I had, X-Rays showed nothing and that it was apparenlty muscular-tendon related.

2. I had my back pop in a very painful way in my upper back and an MRI showed it was a herniated disc at my T7-T8 disc in August 2013. The lower lumbar area was also MRIed and it showed that my lower back was healthy with only a minor bulge in my L4-L5 lumbar disc. I could not work as the muscle cramping was too severe if I sat or stood in one place very long. I lost my job, but got disability that ended suddenly in May of 2014.

3. In September of 2014 I had an automobile accident where I got run off into a curb in a parking lot. there were no witnesses and I could not get the other drivers information, as they drove away. The insurance company covered the damage on my car. I saw my back doctor 3 days later and his office notes noted that this was the first time I saw him for lumbar pain issues and that they were much more severe. Despite this, he would not send me to get an MRI done. He said I was just having a 'flare up'.

4. Despite several more visits complaining of pain, my first back doctor persisted in refusing me my MRI, and the PA nurse asked me why I had not had one yet when I told her my symptoms. The MRI showed I had a new herniated disc with disc material hanging down several mm's below my L5 vertebrae. I got a new back doctor who then advised me to get surgery immediately and I did, and have had a full recovery, thank God. But the treatments have been expensive.

5. I file the paperwork for the auto insurance to recover my costs for the auto accident and it drags out from June of 2015 to today when I finally got my rejection based on an 'Independent Medical Examiner' report that says that my L4-L5 herniated disc is the result of normal degeneration, not related to the accident and he said that my lumbar issues had a long pre-existing history. All of that being absolute total bullshit.

6. I can file some kind of contest to the IME report from my auto insurance company, but I have to have new medical evidence to do so. I have called several lawyers and none of them will take the case because I am only 4 months from the deadline to file and that exposes them to legal malpractice if they screw something up.

Some people like to present this fantasy of the poor doctors and insurers being submerged under medical liability and other legal costs, but maybe this would not be the case of MDs and insurers didnt fuck things up so much. Meanwhile the public has no protection from medical malpractice or insurance malpractice if the legal establishment will only pursue low hanging fruit cases all the time.

What particularly outrages me is how these so-called Independent Medical Examiners are really in effect employed by the insurance companies to give the insurance companies legal CYA to deny claims. In my particular case the guy got his facts wrong and apparently didnt even read the reports or the MRIs.

As to what I can do it about it now, so close to legal expiration; I just dont know.

sucks man. my ma is a retired lawyer who has delt with this type stuff. she always said don't sign anything and get ready to sue them. medical though is a compleatly diffrent critter though.

I have been told that there is something called a 'bad faith' lawsuit one can file against an insurance company, but Google isnt really helping me here.

 

[Fenton Lum]

That would be because america floats on a predatory societal wealth extraction paradigm, just as you've observed here. Now, who orchestrated this and why is it done on this absurd state boundary façade rather than opening up the competition nationwide? Isn’t the purpose of insurance to spread the risk (voluntary socialism until it’s mandated)? Less profitable for the industry whose desire is to sell you a service they never have to honor, honoring the service sold reduces profit margin. Who did this to you? Poor folk with no voice? Black folk? "Liberals"? Or lobbyists with corporate power and funding money that both parties really represent instead of the unsubstantial working class people?

Privatized gains versus socialized losses for the Wall Street Bankster class
Internalized profit versus externalized risk and expense for the “job creator” class
Socialism for the aristocracy versus laissez-faire capitalism for the masses

That’s how it really is here.

I agree. The only good thing insurance is for is the occasional obvious case that has a low cost. If it involves anything over a certain average, then they will do everything they can to screw you over.

But what particularly galls me is that this IME report is just total bullshit. The dude said I had a history of Lumbar back issues and the medical evidence plainly shows that I did not. He lied and there is not one thing I can do about it. The use of IME reports is totally self serving and I am going to try and dig into what the percentages are for IME reports being for or against customers based on whether they have hired a lawyer and who much the claim is for. My bet is that if the benefit goes over a certain amount the IME report is 99% against the beneficiary.

I'm tryna toldja mang, it's the system and it bears down on all of us. They need us, the masses, quibbling amongst ourselves over anything to keep the angst, anxiety and emotional level high so we react emotionally instead of coherently. There indeed HAS been a vast wealth redistribution scam afoot over the past 4-5 decades or so, just not in the direction the 6 multinational corporate media machine (which presides over 90% of what americans see and hear) are always blathering on about. Fox News and MSNBC are selling the same perceptual reality; just tickling different neural reward centers in their respective constituencies. It’s really all the same schtick. You got fucked. We’re all getting fucked, but we can’t put the picture together and pull together. By design.

 

[Crixus]

OK, this is a long post, but the details matter to udnerstand what happened here and the core to my complaint.

1. In 1978 while stationed in Germany serving in the US Army I had an accident that injured my upper back. Despite the pain I had, X-Rays showed nothing and that it was apparenlty muscular-tendon related.

2. I had my back pop in a very painful way in my upper back and an MRI showed it was a herniated disc at my T7-T8 disc in August 2013. The lower lumbar area was also MRIed and it showed that my lower back was healthy with only a minor bulge in my L4-L5 lumbar disc. I could not work as the muscle cramping was too severe if I sat or stood in one place very long. I lost my job, but got disability that ended suddenly in May of 2014.

3. In September of 2014 I had an automobile accident where I got run off into a curb in a parking lot. there were no witnesses and I could not get the other drivers information, as they drove away. The insurance company covered the damage on my car. I saw my back doctor 3 days later and his office notes noted that this was the first time I saw him for lumbar pain issues and that they were much more severe. Despite this, he would not send me to get an MRI done. He said I was just having a 'flare up'.

4. Despite several more visits complaining of pain, my first back doctor persisted in refusing me my MRI, and the PA nurse asked me why I had not had one yet when I told her my symptoms. The MRI showed I had a new herniated disc with disc material hanging down several mm's below my L5 vertebrae. I got a new back doctor who then advised me to get surgery immediately and I did, and have had a full recovery, thank God. But the treatments have been expensive.

5. I file the paperwork for the auto insurance to recover my costs for the auto accident and it drags out from June of 2015 to today when I finally got my rejection based on an 'Independent Medical Examiner' report that says that my L4-L5 herniated disc is the result of normal degeneration, not related to the accident and he said that my lumbar issues had a long pre-existing history. All of that being absolute total bullshit.

6. I can file some kind of contest to the IME report from my auto insurance company, but I have to have new medical evidence to do so. I have called several lawyers and none of them will take the case because I am only 4 months from the deadline to file and that exposes them to legal malpractice if they screw something up.

Some people like to present this fantasy of the poor doctors and insurers being submerged under medical liability and other legal costs, but maybe this would not be the case of MDs and insurers didnt fuck things up so much. Meanwhile the public has no protection from medical malpractice or insurance malpractice if the legal establishment will only pursue low hanging fruit cases all the time.

What particularly outrages me is how these so-called Independent Medical Examiners are really in effect employed by the insurance companies to give the insurance companies legal CYA to deny claims. In my particular case the guy got his facts wrong and apparently didnt even read the reports or the MRIs.

As to what I can do it about it now, so close to legal expiration; I just dont know.

sucks man. my ma is a retired lawyer who has delt with this type stuff. she always said don't sign anything and get ready to sue them. medical though is a compleatly diffrent critter though.

I have been told that there is something called a 'bad faith' lawsuit one can file against an insurance company, but Google isnt really helping me here.

It's a tough one. every bit as tough as say, getting disability is some times. I was always told insurance companies are not so much in business to cover you, so much as cover you as little as possible. maybe start with a probono legal advice place ? just be ready to be frustrated. it sucks.

 

[JimBowie1958]

I talked to my daughter who used to work in the auto insurance industry as a claims adjuster and she told me I can make a complaint to the state regulatory agency and they might reverse this decision and also that I can find lawyers that specialize in 'bad faith' lawsuits against insurance companies and their settlements are unlimited by law.

I had no desire to sue these bastards until this experience, and all I can say now is 'Go Trial Lawyers, go!'

 

[Crixus]

that's good.court is expensive even for the insurance companies. Just make them be fairs about it. and watch the doctors to. sometimes they just love handing out dope. Bt good deal.I hope you get it done.