San Antonio Injury Law Blog : San Antonio Injury Lawyer & Attorney : The McKinney Law Firm : Auto Accidents, Wrongful Death, Work Accidents : Bexar County, Travis County, South Texas

This week the Centers for Medicare & Medicaid Services began issuing its initial ratings in the federal regulators' new "five-star" system.  Nursing home operators should receive advance notice of their first ratings by Wednesday. 

Beginning on December 18th, the public will be able to access individual nursing home's ratings on the CMS website 'Nursing Home Compare.'  The agency will also be issuing a manual to explain the complex formulas that a panel of "leading academic researchers" devised to calculate the ratings. Staffing levels will be compared at a national level while survey results will be juxtaposed only in-state, thus making nationwide rating comparisons impossible.

The hope is that this system will develop into a robust ratings system that consumers can eventually use to contrast and compare objective data about nursing homes in their area and helping them find the highest quality care available to them. 

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Take a few minutes to look at this personal injury video and then ask yourself why has the insurance industry been lying about supposed runaway verdicts, the real causes of insurance rate hikes and so-called "tort reform."

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Unlike many other nations, the United States has no federal agency charged with hospital oversight. Instead, it relies on a patchwork of state health departments and a nonprofit group called the Joint Commission that sets basic quality standards for the nation. Hospitals are rarely closed or hit with significant financial penalties for hurting patients. One of the reasons is that even troubled hospitals are major employers, and communities generally rally behind them when they face the threat of cuts.

We haven’t been forthright about the dirty little secret, the huge variation of quality and safety in the system.  Despite the efforts of patient advocates and reports shining a light on these issues for years, preventable errors remain shockingly common.

Hospitals account for the largest single slice of the nation’s medical spending, 31 percent, or about $650 billion in 2007, according to Medicare. Despite that enormous bill, hospital care is uneven, and often deadly. In 1999, a report from the Institute of Medicine found that hospital errors caused as many as 98,000 deaths a year in the United States.

At present, Medicare pays the same amount to a hospital for treating a patient, whether that patient lives or dies — even if the hospital made a preventable error that caused the patient’s death.

Follow up: Measuring the Quality of Care

LInk to the Entire Story.

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"[I]nsurers generally are attempting to convince the customer when selling the policy that everything is covered and convince the court when a claim is made that nothing is covered."

 -- South Carolina Supreme Court

Last week we had an article outlining common tactics used by insurance companies to avoid paying on legitimate insurance claims.  This week we wanted to provide some tips to help you as a consumer deal with these tactics and protect yourself and your family. 

• READ YOUR POLICY CAREFULLY - You should know exactly what is covered and how to appeal a denial by your insurance company. If you don't understand your policy, get with somebody other than your insurance agent to help explain it to you. 

• BE VERY CAREFUL FILLING OUT FORMS - Even if you make an honest mistake your insurance company may seize on that as a reason to retroactively deny your coverage.

• DO NOT CASH A PREMIUM REFUND CHECK - If your insurance company rescinds your insurance they may send you a refund for the premiums you paid. Cashing it may be interpreted as accepting their decision. 

• PUT EVERYTHING IN WRITING - Calling your insurance company is likely to be a frustrating experience, and you will not be able to prove anything that a company representative tells you over the phone. Keep records of all bills and correspondence.  The basic rule when dealing with an insurance company is "If it isn't in writing, it never happened."

• CONTACT YOUR STATE INSURANCE DEPARTMENT - They may be able to help you. But they will not represent you in a private matter, so if all else fails you may need to consult with an attorney.

• AND MOST OF ALL, DO NOT GIVE UP - Insurance companies count on you giving up. Fight for your rights and never, never, never give up.

Thanks again to the excellent publication put out by the The American Association for Justice, which is the source for much of this series. 

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"[T]he bottom line is that insurance companies make money when they don't pay claims...They'll do anything to avoid paying, because if they wait long enough, they know the policyholders will die."

 -- Mary Beth Senkewicz, former senior executive at the National Association of Insurance Commissioners

The American Association for Justice has recently published an excellent publication detailing common tactics used by insurance companies to avoid paying on legitimate insurance claims.  I'll link to a copy of the full publication below.  Some of the most common insurance tactics outlined by the report include:

• Denying Valid Claims - A very common tactic is for the insurance company to simply deny a claim, despite the fact that it is, on its face, obviously valid.  Some companies even give employee awards and bonuses to claims adjusters who deny the most claims. 

• Delaying Until Death - Another common tactic taken by insurance companies when facing an obviously valid claim is to delay, delay and delay some more.  Paperwork is requested...then it didn't get received....then it turns out it was different paperwork that was needed...then it was lost and another copy is needed...then the claim has been moved to another adjuster...etc.  The hope is that if they put off paying the claim long enough the insured may simply give up or...simply die.  Sadly, they are often correct.

• Confusing Customers - Have you read and fully understood your insurance policy.  No, of course you haven't.  Many lawyers could not read and fully understand the average insurance policy.  This is by design.  So how do you know really know what your policy covers?  Answer: You don't!  Just ask the victims of Hurricane Katrina who were told by insurance companies that their so-called hurricane insurance coverage had an obscure clause that allowed the companies to deny paying them. 

• Abandoning the Sick - In an effort to cut costs, some insurance companies will cancel the policies of people whose conditions have become expensive to treat, such as cancer patients.  They save money by abandoning policy holders and rescinding policies at the time when people need the coverage most.

I wish I could say that these example tactics are the exceptions to the rule.  Unfortunately they have increasingly become the rule.

Next week we will discuss steps you can take to help protect yourself from these types of tactics. 

Source: The American Association for Justice

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Medicine mix-ups, accidental overdoses and bad drug reactions harm roughly one out of 15 hospitalized children, according to the first scientific test of a new detection method.

That number is far higher than earlier estimates and bolsters concerns already heightened by well publicized cases like the accidental drug overdose of actor Dennis Quaid's newborn twins last November.

In the study, researchers found a rate of 11 drug-related harmful events for every 100 hospitalized children. That compares with an earlier estimate of two per 100 hospitalized children, based on traditional detection methods. The rate reflects the fact that some children experienced more than one drug treatment mistake.

The new estimate translates to 7.3 percent of hospitalized children, or about 540,000 kids each year, a calculation based on government data.

Simply relying on hospital staffers to report such problems had found less than 4 percent of the problems detected in the new study.

Read the full article from the associated press here.

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President Bush is working to enact a wide array of federal regulations, many of which would weaken government rules aimed at protecting consumers and the environment, before the President leaves office in January.

The new rules would be among the most controversial deregulatory steps in over a decade and could be difficult for his successor to undo. Some would ease or lift constraints on private industry, including power plants, mines and farms. They include new rules governing employees who take family- and medical-related leaves, new standards for preventing or containing oil spills, and a "simplified" process for settling real estate transactions.

Once such rules take effect, they typically can be undone only through a laborious new regulatory proceeding, including lengthy periods of public comment, drafting and mandated reanalysis.

Read the Story in the Washington Post.

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To identify the worst insurance companies for consumers, researchers at the American Association for Justice (AAJ) undertook a comprehensive investigation of thousands of court documents, SEC and FBI records, state insurance department investigations and complaints, news accounts from across the country, and the testimony and depositions of former insurance agents and adjusters. Their final list includes companies across a range of different insurance fields, including homeowners and auto insurers, health insurers, life insurers, and disability insurers. 

Their ranking of the 10 Worst Insurance Companies in America came out as follows:

1. Allstate
2. Unum
3. AIG
4. State Farm
5. Conseco
6. WellPoint
7. Farmers
8. UnitedHealth
9. Torchmark
10. Liberty Mutual

According to the report, one company stood out above all others.

"Allstate’s concerted efforts to put profits over policyholders has earned its place as the worst insurance company in America."

You can download the organizations entire report here.

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Earlier this year, in Riegel v. Medtronic, the U.S. Supreme Court held that the 1976 Medical Device Amendments to the Food, Drug, and Cosmetic Act pre-empt injured consumers' rights and immunize medical device manufacturers from liability. Now, in Altria v. Good and Wyeth v. Levine, the court will decide whether to expand federal pre-emption and grant tobacco and drug companies immunity by judicial fiat, too. If it does, it will be making the same fatal mistake it made in Riegel — ignoring Congress' intent.

See the entire National Law Journal article on this topic here. 

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