News on Personal Injury Law and Insurance-Related Topics

News on Personal Injury Law and Insurance-Related Topics

Woman Forced to Sue Private Health Insurer-Denied Surgery-but all GOVERNMENT-SPONSORED programs would have approved claim
Mercer Island, WA May 28, 2010 by Joel Moreno, KOMONEWS.COM Seattle
Dina Wampold pays good money for health care coverage through Regence. So when the Regence Group refused to pay for a doctor-recommended neck surgery, she was forced to file a lawsuit.

A few months ago, Wampold was suffering from a herniated disc that was only getting worse. "It felt like someone had punched me in the arm," she said, " pretty severe arm pain." After reviewing all her options, a surgeon recommended disc replacement. But Regence wasn't on board.

"I expected when I was in need that they would step up, and it's really disappointing that they don't," said Wampold.

Regence said Wampold requested coverage for a service that is "an investigational procedure." But according to Wampold, "The surgery is FDA-approved, Medicare pays for it. The state pays for it. The military pays for it, and other insurance agencies will pay for it."

Out of options, the Wampolds decided to borrow against their house to pay the $60,000 surgery fee out of their own pocket.
Copyright: Joel Moreno and KOMONEWS.COM, Seattle
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Insurance Policy Didn't Cover Chinese Sulfur-Emitting Drywall Damage
Norfolk, VA June 7, 2010, By Michael Felberbaum, The Insurance Journal
An insurance company doesn't have to pay for damages at a Virginia man's home ruined by Chinese-made, sulfur-emitting drywall, according to a decision by a federal judge Thursday that could affect how lawsuits by thousands of U.S. homeowners over defective Chinese products are settled.

Judge Robert G. Doumar in U.S. District Court in Norfolk said in the ruling that no coverage was owed under a homeowner's policy issued by Travco Insurance Co. to Larry Ward of Virginia Beach.

The judge said the policy does not cover removing or replacing the Chinese defective drywall, or any damages stemming from the material. That's because the policy excluded damage caused by latent defect, faulty materials, corrosion and pollution.

According to court documents, Ward made claims under his homeowner's policy after the Chinese drywall in his home began to release sulfuric gases into the home and damaged his air conditioning, garage door and flat-screen televisions.

Thousands of homeowners, mostly in Florida, Virginia, Mississippi, Alabama and Louisiana, have reported problems with the Chinese defective drywall, which has been linked to corrosion of wiring, air conditioning units, computers, doorknobs and jewelry, along with possible health effects.
Copyright 2010 Associated Press, Michael Felberbaum, and The Insurance Journal
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Heavy Car Insurance Mandate Begins in Wisconsin
Madison, WI; June 1, 2010, By Scott Bauer, The Insurance Journal
All Wisconsin drivers must carry heavy limits of auto liability insurance starting June 1. While the minimum policy limits in most all states does not exceed $25,000, the Wisconsin minimum level of liability insurance required is $50,000 for causing injury or death of one person, $100,000 for injury or death of two people and $15,000 for property damage.

Since Wisconsin's rate of uninsured drivers was right around the national average of 14 percent before the law passed (as reported by the Insurance Information Institute), having it in effect won't result in many new drivers signing up for coverage, said Andy Franken, president of the Wisconsin Insurance Alliance.

"The fanfare surrounding around June 1 is a false promise to the drivers of Wisconsin that everyone on the road will have auto insurance,'' said Andy Franken, president of the Wisconsin Insurance Alliance. The alliance represents insurance companies and spent more than $500,000 lobbying against the changes passed by the Legislature.

Even though some people will ignore it doesn't mean there shouldn't be a law, said Paul Gagliardi, president of the Wisconsin Association for Justice. His group, which represents trial attorneys, pushed for passage of the law and other insurance reforms they argue will make rates even more competitive in the state. Other changes that have already taken effect include increasing the minimum levels of coverage required and mandating coverage for underinsured drivers.

"Just because people turn and look the other way doesn't mean that as a government we're not supposed to try to spread risk among those that should be responsible for the risk,'' he said.
It's not fair for someone who's in an accident they didn't cause to have to pay for repairs to their vehicle because the driver at fault doesn't have insurance, said state Sen. Tim Carpenter, D-Milwaukee, who supported the law.

The law "will provide the extra incentive for all drivers in Wisconsin to be responsible and to carry automobile insurance,'' he said.

Under the new law, drivers must purchase liability insurance or face a fine of up to $500.
Copyright 2010 Associated Press, Scott Bauer, and The Insurance Journal
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State Farm First To Offer Pay-As-You-Drive Insurance in California
Sacramento, CA June 1, 2010, The Insurance Journal
State Farm is the first insurer to submit a rating plan in which drivers' auto insurance rates will depend on actual mileage driven instead of estimated mileage. The new approach to rating has been made possible by the pay-as-you-drive regulations introduced by Commissioner Poizner. The regulations went into effect in October 2009.

Assuming that State Farm obtains approval from the Department, State Farm customers will have an option to move into the new verified mileage plan, which State Farm has labeled its "Drive Safe and Save" program. Those who enroll will be given an initial discount for joining the program.

Drivers who choose to purchase this policy will then be rated based upon the actual annual miles they have driven. Under the proposed program, consumers who reduce their driving habits by as little as 500 miles per year will see a reduction in their rates.

The filing is now under review by the Department of Insurance. This new plan proposed by State Farm must be approved by Commissioner Poizner before being placed on the market for consumers to purchase
Copyright 2010 The Insurance Journal
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Serial whistle-blower Joseph Piacentile makes millions helping the government uncover fraud. That's how the False Claims Act is supposed to work. Or is it?
New York, N.Y; June 01, 2010 By Amy Kolz; The American Lawyer.com
Some call Joseph Piacentile a hero. Over the last 15 years, the New Jersey physician has been a whistle-blower in antifraud lawsuits that have returned more than $1 billion to the U.S. Treasury.

His weapon has been the False Claims Act, whose qui tam provisions allow private citizens to sue-on behalf of the government-companies, or individuals that falsely or fraudulently claim federal funds.

Among the notches on Piacentile's qui tam belt are a $155 million settlement with Medco Health Solutions, Inc., in 2006; a $515 million settlement with Bristol-Myers Squibb Company in 2007; and a $425 million settlement with Cephalon, Inc., in 2008.

In a February 2004 filing in Medco, the doctor explained that he discovered potentially fraudulent conduct at Medco "during the course of considering a business opportunity in 1999." His subsequent inquiry included "nine months conducting multiple interviews with a variety of Medco employees, including pharmacists and a vice president, and collecting internal company documents." Piacentile "personally secured admissions on tape from Medco pharmacists and Medco officials who were engaged in the fraud," according to his opposition to a motion to dismiss the case in January 2004. Posing as a prospective employer or business partner is standard practice for Piacentile in his efforts to glean information from inside sources, say more than six lawyers who have been involved in litigation involving Piacentile.
Copyright Amy Kolz; The American Lawyer.com
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Malpractice lawsuits decline in PA-FIFTH straight year
Philadelphia, PA April 21, 2010, By Josh Goldstein, Philadelphia Inquirer
In 2009, the number of new medical-malpractice lawsuits filed in Pennsylvania courts fell for the fifth straight year, according to a report released Tuesday by Pennsylvania Chief Justice Ronald D. Castille.

The report provides new evidence that the malpractice climate in Pennsylvania has cooled since the early part of the decade, when rising costs led many doctors and hospital administrators to worry that the state's medical system might collapse.

Philadelphia - long considered the center of the state's malpractice crisis because of the large number of generous verdicts here - saw the most dramatic declines in new suits and in large jury awards, as well as a rise in defense verdicts.

The number of new malpractice suits in 2009 fell to 1,533 from 1,602 cases initiated in 2008. That marked a 47 percent decline from the 2,904 suits filed in 2002.
And in Philadelphia, new malpractice suits fell even more dramatically to 491 from 1,365 in 2002 - a 64 percent drop.

Moreover, doctors and hospitals who took cases to trial in 2009 did well, winning 85 percent of the cases statewide and 79 percent in Philadelphia.

In 2002, the state legislature passed Act 13, a measure aimed at limiting the number of medical-malpractice suits and reducing medical errors. In 2003, the state Supreme Court ordered that medical-malpractice lawsuits be filed in the county where the alleged injury occurred. The court also required that plaintiffs obtain a so-called certificate of merit from a doctor, saying that negligence occurred.
Copyright Josh Goldstein, Philadelphia Inquirer
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