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“You Can Walk There”

Why did I title the blog with a quote? Because of a case that we signed up yesterday. Now let me tell you the story about that case.

A 63-year-old woman on disability was involved in a crash. The person that hit her is unquestionably, totally at fault. That driver at fault is insured by Progressive Insurance.

The lady on disability was taken to the emergency room from the scene of the crash and her car was towed to a storage yard. There it sat. Because she was hurt, she still needs treatment. However, her car is at the storage yard. As a result, she cannot drive for treatment.  She believed that the car is “drive-able” but there is  damage to her car that needs repair.

She called the Progressive adjuster, who tells her that they will not authorize repair of the car or reimbursement without an accident report. The lady tells the adjuster that she can’t get the accident report because she does not have a car.

The adjuster asks her how close she lives to the police station in this small Virginia town, where she can get the accident report. “About 8 blocks”, the lady said. The adjuster replied to this lady already on disability, “You can walk there“.

So this elderly lady walked to the police station to get the accident report. When she got there, the police officer ask her why she was there, and she repeatd the conversation with the Progressive adjuster.

The officer just shook his head and said, “You shouldn’t have had to do that. That adjuster could have easily gotten the accident report”. The police officer helped her by faxing over the report to the adjuster and then he drove the lady home.

The adjuster called and told her that they were authorizing the repair of the car and that it she should just call the storage yard and tell them where to take the car for repair. When she called, the storage yard advised that she had a towing and storage fee and that she had to pay that before they would transfer the car.

The lady took a portion of her disability check that she was going to use to pay rent and had to pay the towing and storage fee, so they would transport her car for repairs. The adjuster refuses to reimburse her for those fees. She is now unable to pay her rent.

The lady called me!

Sometimes I am asked if I ever think about retirement; or why do I keep doing what I do. Why? Because this is not an isolated story. Because the conduct of some insurance adjusters still angers me.  I just wish she had called me earlier.

After that story, I post a motivational team for pic o’ day.

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Ac-Cent-Tchu-Ate the Positive

Everyone likes positive. Many books have been written on thinking positively. Maybe that’s why the song Ac-Cent-Tchu-Ate the Positive has been so popular.  First stanza:

You’ve got to accentuate the positive
                                                  Eliminate the negative
                                                  Latch on to the affirmative
                                                  But don’t mess with Mister in-Between

I was going to post the names of everyone who has sung that song over the years. So, I went to Wikipedia and realized how long the list of singers. More proof that music and singers like positive. Then, I saw the long list of movies and TV shows that have included this song. More proof!

I thought about this as I was having breakfast yesterday, as I listened to a business venture recently started. The business is premised on organizing expenses to avoid problems with the IRS, so you can get quick documentation.

Their description of the business dealt mainly in the negative as a way to track expenses, set aside money for taxes, and properly take care of your finances to avoid an IRS audit. A good goal but sounds a bit negative to me… avoidance of an audit.

We discussed how insurance companies have learned to market in the positive. Car insurance companies market price savings, not security that you’ll know that you are covered when someone runs into you. Life insurance companies don’t focus on death. They focus on your peace of mind… knowing that your family will be fine. They… AC-Cent-Tchu-Ate the Positive!

Long ago, to properly try a case, you have to present what a verdict will do for the client. I later learned to simplify damages by addressing how to fix, help, and make up for what was caused by the crash. Juries want to hear what their verdict will do in the positive.

And then…

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Parking Lot Lesson in Coverage

I enjoy a good riddle and this one is a challenge. Look at the parking lot below. What is the number of the parking space where the car is parked? (Can you hear the jeopardy theme?)

 

 

 

 

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Well… did you get it? Are you trying to do mathematical equations or dividing by the square root of an apple pie?

The answer is “87”. It’s point of view. If you look at the parking lot from the viewpoint of the driver, then you can see that the car has backed into space number 87.

     Berkshire Hathaway just announced that its insurance companies, which include Geico and General Reinsurance, reported a $38 million underwriting loss. That is compared to their last year’s $411 million gain. The negative swing was driven by higher claims at Geico and $115 million in storm losses in Australia where Berkshire insurers provide coverage.

What does it mean. Well, just like the parking place, it’s the viewpoint in how you look at things. Insurance companies receive premiums. Their profit is based on the receipt of premiums and if they have to make payment on claims… not so much profit. So, they look at claims as the enemy of profit. Point of view!

And for pic o’ day…

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An Insurance Comparison

How did Noah keep up with it? A baby turkey is called a poult. A group of hogs is a herd. A gathering of quail is a covey. A picture is worth a thousand words. (Just seeing if you are really reading)

A group of geese is known as a gaggle. A group of foxes is known as a skunkel. I wonder why they aren’t just called a group of foxes? A baby kangaroo is a joey. And a Koala bear is not really a bear.

When an insurance company does not want to pay a claim, what do you call it?  Just another day at the office. Boom!

And finally… a happy insurance boss said to his employees, “You worked hard this year. As a reward, I am going to give everyone a check for $5,000. If you work real hard this next year… I will sign the checks.”

(Yes, I just decided to write a blog to pick on insurance.)

And for pic o’ day…

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The Value of a Finger

During my second year of law school, I started looking for my first job at a law firm. I was hired as a law clerk at a busy Oklahoma City personal injury firm (Homsey Law Center).

Initially, I was assigned as an all-purpose clerk, which is code for duties that included going to the bank… and stacking the cokes and diet cokes in the kitchen. My office was in the storage room/closet. After they put my desk in there, it was still the storage room/closet, that now had a desk pushed against the wall. I was just excited to have a legal job.

Soon, I was assigned to the worker’s compensation section which included working for an attorney who was very long suffering with my lack of knowlege. On the first day as he was describing the laws of an Oklahoma job injury, he also showed me his hand. He did so to explain that he had lost a portion of his finger on the job when he was in college. Then, he went on to explain what he had been paid for a partial loss of a finger, and what it would mean under those existing Oklahoma worker’s compensation laws. Basically, he was explaining the value of the loss of a finger.

Over July 4th, it was reported that New York Giants defensive player Jason Pierre-Paul was injured in a fireworks accident. Soon, it was reported that the injury had caused him to have his right index finger amputated. That led everyone to wonder if it would impact his football career. That is still a question.

Prior to the injury, Pierre-Paul had been offered a franchise tag (How NFL teams can contractually control players who have not signed) one-year offer of $14.8 million dollars, because he and the Giants had been unable to agree on a long term deal. At that time, the Giants had reportedly made a contract offer of 60 million dollars over 5 years with 30 million of it guaranteed. Now, it’s being reported that the long term offer has been withdrawn and there is question about the franchise tag one-year offer.

The loss of Pierre-Paul’s index finger may have significant financial consequences to him after the report that the long term contract offer has been withdrawn. It is a reminder that a person’s loss from injury has different values because each loss has its own factors.

I regularly get asked the question, “what is my case worth?”. Sometimes I will have a person ask me, “Isn’t it true that the insurance company is supposed to pay me three times medicals?”. I have heard people say that they were going to wait to hire a lawyer because they first wanted to find out what the insurance company was going to offer for their case. The two stories above show the difference in potential claim value, even thought they both lost all or a portion of an index finger.

There are a lot of factors that determine the value of a claim. Of course, it helps to have experience and to  have handled other claims similar, as well as understanding what juries might consider in determining the value of a case at trial. What it doesn’t include is some mathematical equation for the injury, and it shouldn’t include the false hope of waiting on an adjuster to say what is fair. Just my 2 cents.

And since it’s Monday, I figured that we needed to be all business for pic o’ day!

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Insurance in Sports

This picture with chopstick instructions made me laugh.

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It’s why the Preakness horse race on Saturday would cause people to bet on the horses. Different odds for different beliefs in their possibility of winning. Although, the result would cause me to believe that only American Pharoah had a chance.

While many of us don’t believe that life is just about luck or chance, insurance companies look at it as risk measurement. A belief that life is a bit of chance is what insurance companies count on in selling their product. They collect premiums with the hope that you will never need payment of insurance. We make payment for insurance premiums… with the hope that we will never need to collect!

That brings me to Ekpre-Olomu. The fact that you probably don’t know the name is part of the story. He used to play cornerback for the University of Oregon and was expected to be drafted in the first round of the NFL draft.

He was a concensus All American who tore his ACL in December practice. Because of that knee injury, he was unable to perform at the NFL combine nor at pro day at his school. Those are the times when NFL scouts make their recommendations.

Because of his injury and subsequent fall in the recent draft, Ekpre-Olomu is now in line to collect on a 3 million dollar insurance policy. Last year, to encourage him to stay and play at the school, Oregon took out an insurance policy against such an injury that would effect his pro career.

When he wasn’t selected in the first round, he was eligible to collect on a portion of the policy. When he fell out of the second round, he was in line to collect the full 3 million. It won’t make up for his full loss because if he had been drafted around the 12th pick, he would have collected somewhere around 10.5 million in guaranteed money in that slotted spot. Still, that insurance policy will be a helpful offset as he works to get better from his injury.

That’s a form of disability insurance that is now becoming more popular among athletes. When I first started practicing law, I purchased a disability policy that would  pay if I am unable to physically try cases in a courtroom. I am thankful to be paying those small premiums… without ever collecting.

 

And for our Monday pic o’ day, a lack of confidence…

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Trusting the Doctor

Dr. Custer was trying to tell us what might be important for an upcoming Bible test. Since we were a class of a bunch of ninth-graders, I am not sure that I can even imagine the expressions on our faces. Then he told us to remember what “walking circumspectly” was describing.

There are many things that I do not remember from school. I still remember the lesson on “walking circumspectly “. Dr. Custer told us it was “walking with eyes in the back of your head”. Then, he physically demonstrated as though he was walking with eyes in the back of his head. Like the old saying, “be alert… we need more lerts!”.

That memory came to mind when I saw a Washington Post story about a trial that was scheduled to start on Wednesday morning in Alexandria, Virginia. It also was a reminder that just because a person has Dr. in front of their name does not mean that they are not susceptible to greed and fraud.

Dr. Amir Bajoghli, owner of Skin & Laser Surgery Center, has been charged with 60 counts of fraud that involved his patients who were seen and treated between the years of 2009-2012. According to his indictment, he also billed insurance companies for surgeries that he did not perform. In addition, it is alleged that he had unlicensed and unqualified medical assistants to close wounds and perform skin grafts while unsupervised.

In fact, Dr. Bajoghli had been named as one of the regions “Best of”, when considering top dermatologists in the area.  He also had multiple offices throughout Virginia and the surrounding D.C. area.

The prosecutors intend to prove that this doctor performed unnecessary surgeries and also was intentionally misdiagnosing his patients with skin cancer. Not only profiting in his billing by intentionally providing insurance codes that allowed him higher reimbursement, but also scaring his patients by  telling them they falsely needed treatment for their skin cancer . Mostly, he was telling elderly people that “you have skin cancer and I have to operate (cut it off or out)”.

Pair that alleged fraud with the charge that he improperly billed and received $31,000 for procedures that were done improperly by a nurse practitioner or assistant.

Because I regularly see a dermatologist, I think that this kind of charge and trial hits close to home. Isn’t it true that we want to trust our doctors and in fact need to trust them? Hence, the reminder of the need of “walking circumspectly”.

We basically have to have eyes in the back of our head today. It’s also why I don’t get excited about “Best of” lists. Instead, there is nothing like a personal referral. I gladly tell anyone to go see my dermatologist. It also reminds me of those Hotel commercials with “Captain Obvious”, who says that you should read the reviews of someone who has actually stayed in the room instead of a review from someone who was paid to write it . That really does seem obvious.

DID YOU KNOW that the Internet was originally called the ARPANet? (Advanced Research Projects Agency Network designed by the U.S. Department of Defense)

And for our pic o’ day, here’s a nod toward decisions for Halloween costumes:

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Cards and Numbers

One insurance company advertises that in 15 minutes you can save 15% or more on your car insurance. Another company named Esurance has decided to combat that kind of claim. Their ads say that getting a quote takes only 7 1/2 minutes to get a quote. Neither advertises how fast that they pay a claim. Here’s some more useless statistics that may only fascinate me:

There are 52 cards in a standard deck of cards. There are 52 weeks in a year. There are 4 different suits (hearts, diamonds, spades, clubs). There are 4 seasons in a year. If you add the values of all cards in a deck,  with the numerical assignments of jack equals 11, queen equals 12, King equals 13 etc., you get a total of 365. Yep, the same as the number of days in a year. And a picture is worth a thousand words? Or how about that the average McDonald’s Big Mac has an average of 198 sesame seeds on its buns. I think about as useful as getting a fast quote.

DID YOU KNOW that 7.5 million tooth picks can be made from one cord of wood? Now that’s not useless!

And for pic o’ day, here’s more online fast stuff!

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The Hidden Agenda

During World War II, Hitler kept floating information of a planned date for the Invasion of France. Then, that date would pass and nothing had happened. This method of misinformation was repeated many times. Eventually, France and England no longer took the notice of information seriously because of the previous hoax dates. Then one day, Germany did invade France. The misinformation strategy worked for Germany.

Also during the Second World War, the Allies also used their own deception in 1944: Operation Body Guard. The plan contained several components to mislead Germany as to where Europe invasions would occur. It included systematic radio decryptions in sending false messages of landings. Ultimately, the Allies were successful with their tactical surprise Normandy landings (D-Day) which led to the restoration of the French Republic. Germany had been beaten at their own game.

Now, let me get a little political with hidden agenda comparisons.  Two especially get my attention. First, in the insurance industry. It bothers me to see ads that suggest that membership in USAA is something to “pass down” to members. In my world, I see USAA fighting claims for medical payments for their policy-holders. I have blogged about it before but the hidden agenda continues.

Other insurance companies regularly process medical payment coverage. To me, USAA seems to delay and deny instead of making payments. Conversely, they advertise that membership is an asset with a sentimental bend. Their hidden agenda seems to be, to get family members to also pay premiums, while not wanting to pay claims. I would recommend a different insurance company for coverage. That’s my opinion and I’m sticking to it.

The second hidden agenda? All the pharmacy companies that advertise drugs that supposedly help with health matters while causing harms. For instance, Vioxx was marketed as a drug for aches and pains and headaches. Then, it became clear that people could suffer strokes. The hidden agenda must have been money instead of health. Yep… my opinion! I could just keep going.

DID YOU KNOW that Pepsi was first known as “Brad’s Drink”? In 1893 Caleb Bradham made the fountain drink at his drug store. Later, it was renamed after its recipe that included pepsin and kola nuts.

And for pic o’ day

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Riddle Me This

How do you get out of a room that has no windows or doors and the only thing in the room is a mirror? Answer: You look in the mirror and you see what you saw. With the saw, you cut the mirror in half. Two halves make a hole… and you crawl out!

Why are fire engines red?

     Books are read, and magazines are read, too. Two plus two is four. Four times three is 12. There are 12 inches in a ruler. Queen Elizabeth was a ruler. Queen Elizabeth was also a ship. Ships sail in the sea. Fish swim in the sea. Fish have fins. Finns fought the Russians. Russians are always red. Fire engines are always rushin’. And THAT is why fire engines are red.

Yes, these riddles make no sense at all really. Maybe that’s why they remind me of insurance ads.

A recent ad that was created in Richmond by the Martin Agency features a magician and his trainee/protegee in medieval days, sitting at a table. The magician is teaching “his tricks” by starting out with his first riddle/question:  “Trick Number One… Lookest over there”. His trainee looks over in the direction that the magician indicated. The magician then says, “Ha-Ha! Madest thou look. So endeth the trick”.

Maybe it’s just me, but this ad/riddle seems to be the hidden message of the insurance company campaign. Distract with pricing by getting people to look only at pricing. That way, they don’t worry about whether the insurance company will be there with benefit when they need the coverage. “Hey, look over here at our pricing not our coverage”. Yes, I could write a very long blog on this topic of torment for me.

Speaking of marketing, DID YOU KNOW that Colgate faced a very big obstacle in marketing their toothpaste in Spanish speaking countries. Colgate sounds like the word in Spanish (from the root word colgar)  that means “Go hang yourself”.

And for pic o’ day, here is a funny that was sent to me:

Love grand

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