I'm headed to Court this morning because Allstate Insurance has decided they want to try to go around the law. The Kentucky Supreme Court (KYSCT) decided in Adams v. State Farm (Aaron Murphy argued this case. He is brilliant.) that an insurance company, when questioning personal injury protection benefits, is allowed to question their insured about the facts of an accident. All of the medical bills and medical records are submitted to the insurance company for review of treatment. In making the Adams ruling the KYSCT held that the insurance companies don't get to question about medical treatment/bills. This makes sense because injured parties aren't medical professionals. The reason this is important is that nobody remembers whether or not the massage therapist six months ago at the physical therapy clinic massaged them for twelve minutes or fifteen minutes. In the past insurance companies were allowed to question about injuries/treatment which inevitably led to their clever lawyers trying to trick my clients and make a big issue out of something a lay person stated about medical treatment or something innocuous like whether or not an ultrasound was provided (I had one case where my client thought it was pregnancy ultrasound). The KYSCT held that if there are questions about medicine that the law provides the insurance companies a means to investigate. The means is an "independent" medical examination. The problem from the insurance companies perspective is that the doctors performing these "independent" medical examinations are expensive and that the insurance company also has to prove to the court (aka hire lawyers) to show there is "good cause." This costs the insurance companies money and is more expensive than what they are currently trying to do.
Side note: I've spoken to my clients medical providers and they are willing to answer Allstate's questions about treatment. Allstate refuses. I've also had my clients in this case go over all of their medical bills and records. They did so and submitted an affidavit to the court stating they received the medical treatment submitted to Allstate. Nonetheless, Allstate won't hassling my clients.
What is really happening behind the scenes is defense lawyers are trying to strum up business and save insurance companies money they ought to pay out. The way to do that is to hassle insureds and hope they will find a plaintiff's lawyer that won't fight them; or a judge that will allow them to disregard the law. The worst part is that the insurance companies are fighting their own insureds and attempting to stick them with thousands in medical bills. The way the insurance companies do this is to sensationalize their pleadings. This particular insurance company has a lawyer (who I really like) that alleges Allstate has a duty to investigate fraud and that because they have a duty he must put my client through ANOTHER deposition (he already asked about what happened in the wreck). The issue is that the insurance company lawyer puts nothing of substance in his pleadings. It is all hunches and speculation. The law requires fraud to be plead with specificity. As a result my response is always put your money where your mouth is show us the proof. I have hunches and speculations about whether or not Allstate insurance underpays minorities on bodily injury claims, but I don't get to put in a pleading and have a judge grant me depositions based on theories. The issue we run into is that when a judge hears fraud they get understandably apprehensive about not granting the insurance company requests.
I think we can all agree that fraud is something that should be investigated. The question is by who....should it be insurance companies and their lawyers trying to make a buck? Or should it be the government authorities? As a former prosecutor, I believe it should be the latter.
The request Allstate has made today is really on account of my clients traveling twenty minutes to get to a chiropractor for treatment. My clients are hardworking, responsible people who already told Allstate under sworn statement that they decided to drive twenty minutes for treatment because a family member recommended the chiropractor. I've driven an hour and a half to doctors in Cincinnati for treatment, but twenty minutes is too much for Allstate. Its absurd and from my perspective really dishonorable corporate behavior from Allstate. My guess is some MBA decided this is good corporate policy from a financial standpoint. It's not good policy for their insureds.
Lets see what the Judge does.
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