Lowell Steiger's Los Angeles Law Blog

Auto Insurance Coverage from A Personal Injury Lawyer's Perspective

A friend, Johnny, asked me to evaluate his auto insurance coverage.  He lives in Los Angeles and drives an Audi TT, a small sports car.  Although my often tongue-in-cheek responses are geared for California auto coverages and, in particular, Los Angeles, this should give you an idea of what to look for in your own venue.  Most importantly you must be aware that if you do not have insurance coverage that is sufficient to compensate someone for injuries sustained in an accident that is wholly or partially your fault, you could be on the hook personally for that amount which exceeds your policy limits.  And, as we all know, accidents happen in what seems like a millisecond – it’s not something that we anticipate BUT it is something that we can prepare for.

I want to stress that laws and insurance policies and coverages are different in different states so please contact your insurance agent to be sure that you’re complying with local and state laws and are getting the coverage that best suits your own particular needs.

Please also note that I’m being relatively specific in my responses to Johnny.  I’m just being illustrative when referring to a crosswalk accident.  You can replace “crosswalk” with “running a red light,” “making an unsafe U-turn,” “rear-ending the car in front of you” or 25,000 other possible scenarios!

    Dear Johnny,

In response to your questions regarding your current auto insurance coverage:

Bodily Injury

Your Bodily Injury Coverage is $50,000/100,000.  Increase it to at least $100,000/300,000 -- right now  you have $50/100 which means that if you accidentally whack someone in a crosswalk and break their hip, the most they can recover from you is $50,000.  Also, if there are more than two people in that crosswalk, and you hit and injure all of them, then the most that will be paid out is $100,000 somehow divided by those 3 people.  You risk them getting an excess judgment against you and garnishing your wages.  In general the best coverage, in my opinion, is the maximum coverage your carrier allows.  It usually doesn't cost much more to maximize.  

Property Damage

Property Damage: Right now you have $50,000 in coverage which means that the most that your insurance carrier will pay for damage to the other person’s car, his/her rental coverage while his/her car is being repaired or evaluated for a total loss, towing and storage is $50,000.  Get the most PD coverage you can -- in L.A., the cheapest car is $50,000 so, if you cause an accident and total out a Bentley, they could sue you for the difference between $50,000 and the value of the car.  I carry $500,000 Property Damage because I know that with my luck, if I get into an accident it will be with a rock star being driven in a $250,000 tricked out Lincoln Limo. 

Medical Payments

I cannot stress the importance of Medical Payments Coverage: Get the most that you can get.  I don't remember if you have health insurance or not but, if you get into an accident, regardless of fault, you and each of your passengers will be entitled to have your reasonable medical bills paid up to the limits of  your med pay coverage.  Most people have $5,000 but, in today's world, if you can get $25,000 or more that would be great (it depends how much your carrier provides). Also, tell them you do not want excess coverage and you want it to be NON-REIMBURSABLE in a third party claim.  This means that if someone rear-ends you and they are obviously at fault, then when you get a settlement from their insurance company you do not need to pay your carrier back for the medical payments that they made on your behalf.  This also covers each of your passengers for the same amount. I always worry that if a passenger in one of our cars doesn't have health insurance and we get into an accident, that they will be unable to pay their medical bills.  With this coverage, that isn't a problem (subject to the policy limits).  Your med pay can also kick in if you're hurt in an accident in someone else's car, are on your bicycle, in a crosswalk, etc.  That's tricky but I've invoked it for many, many clients.  My carrier allows for $100,000 Medical Payments Coverage (which I have) but this is rare.  Again, check with your own carrier.

Deductibles

As for deductibles, ask how much increase your premium will suffer if you lower your deductibles to $500, $250 or even zero.  It may be de minimis and therefore worthwhile to decrease your deductibles.  It’s human nature to try to save where we can but I’ve heard many a client scream “What? I have to pay the deductible? It’s $1,000!!!” Maybe they saved a tiny bit on their premium by having a high deductible but, when the unforeseen accident occurred, it bit them in the rear.

Rental Coverage

ental Coverage: I don't like the fact that you have to pay 20% of the rental bill and that you're capped out at $500.  This means, with today's rental prices, you'll be covered for a max of approximately 20 days or so.  It sometimes takes longer than that just for the insurance carriers to get the preliminaries started!  I know you don't really care what type of car you rent so ask them to give you different options for rental coverage and then ask me and I'll tell you which is the best.

Uninsured/Underinsured Motorist Coverage

Uninsured / Underinsured Coverage: Just like with Bodily Injury, get the most that you can afford.   You're driving a small car.  If someone whacks into the back of your TT, you and your passengers could get seriously injured.  Right now you've only got $30,000/60,000 coverage which means that if the other party is uninsured or only has a $15,000/30,000 policy, the most that each person in your car is entitled to is $30,000 -- up to a maximum of $60,000 for all of the people in your car (again, having to divide the $60,000 between everyone).  Not good.  What if you need surgery or other extensive short or long-term treatment?  Your case could be worth in the six figures yet there's no coverage for this. You should have as much coverage for yourself and your passengers as you have for the unknown person with whom you might find yourself in a wreck.

Let me know if you have any questions 

Feel free run the new or current coverages by me.  

If you, or someone you know, has been injured in an accident, please contact me immediately at

(323) 852-1100

lowell@steigerlaw.com

Skype (with or without video): Lowell_Steiger

"Treated With the Respect That You Deserve"

Woman Charged with Insurance Fraud for Second Time in Two Years

Commissioner Poizner Announces Bakersfield Woman Charged With Insurance Fraud For Second Time In Two Years

Commissioner Steve Poizner announced today that Shawn Rene Dodd, 43, of Bakersfield, was arrested on Wednesday, and charged with uncertified practice of medicine, making false or fraudulent insurance claims, money laundering, commission of a felony while on bail and selling stocks without a license.  Dodd's bail was set at $1,000,000. If convicted, she could face a maximum of nine years four months in prison for these charges.

"I will not tolerate those who abuse the insurance system to satisfy their own greed," said Commissioner Poizner. "CDI experts are quick to stop anyone who attempts to scam insurance companies and drive up the cost of insurance for all consumers."

Since her previous arrest in 2007, Dodd allegedly continued to operate medical corporations, which were used to fraudulently bill insurance carriers.  At one point, insurers were billed for medical services reportedly rendered when there were no doctors present. It is alleged that Dodd attempted to defraud insurance companies of at least $100,000. The California Department of Insurance and the Kern County District Attorney's Office jointly investigated this case.

Dodd allegedly operated these fraudulent companies while on $500,000 bail for previous felony charges.  In January 2007, Dodd was charged with felony insurance fraud, workers compensation insurance fraud, tax evasion and money laundering.  She was released from Kern County Jail and remained free on bail until her arrest on Wednesday. 

The Kern County District Attorney's Office is prosecuting this case.

Commissioner Poizner oversees sixteen CDI Enforcement Branch regional offices throughout the state.  Close to 1900 insurance fraud-related arrests have been made by the Department of Insurance's Enforcement Branch since Commissioner Poizner took office in 2007 - more arrests than have been made during any other two year period, under any previous insurance commissioner.    

More on Insurance Fraud

Big RIgging Lawsuit against Great American Insurance Company

Coalition Against Insurance Fraud - Fascinating site with latest news, articles and fraud related stories

What is Consumer Fraud? - California Department of Insurance

National Insurance Crime Bureau

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If you, or someone you know, has been injured in a motorcycle or automobile (or similar) accident, please call me, Lowell Steiger, immediately at

(323) 852-1100 or send an e-mail to me at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

Uh Oh, Car Accident With No Liability Insurance: "But I'm Not At Fault"

So what happens when you're in a car accident in California, you're injured badly, it's the other driver's fault and you have no liability insurance?  Back in 1996, Californians passed Proposition 213 which then became California Civil Code Section 3333.4 which states "in any action to recover damages arising out of the operation or use of a motor vehicle, a person shall not recover non-economic losses to compensate for pain, suffering, inconvenience, physical impairment, disfigurement, and other non-pecuniary damages if any."  What does this actually mean?  Well, to give an extreme example, let's say that you're driving along and someone makes an illegal left turn in front of your car.  You can't avoid the collision and the collision is clearly not your fault.  You break 7 ribs.

Under normal circumstances, there is nothing that a doctor can do to help speed the healing of broken ribs. It just takes time.  As a result, your medical bills for this nasty, excruciating, debilitantingly painful injury are minimal -- maybe $2,000-3,000.  Yes, you are entitled to be reimbursed for your medical bills.  If you have liability insurance, you'll also be entitled to be compensated for the pain and suffering that you experience as a result of the broken ribs -- several thousand dollars in excess of the $2,000-3,000 in medical bills.

However, if you have no liability insurance covering you for the operation of the vehicle that you were driving at the time of this accident, you get no money, zero compensation for your pain and suffering.  Not a penny more than your reasonable medical bills.  Period.  End of story. (The only exception to this hard and fast rule is if the at-fault driver was convicted of driving under the influence pursuant to California Vehicle Code Section 23152 or 23153).

To add insult to injury, driving without insurance will subject you to having your car impounded, temporarily losing your driver's license and paying a hefty fine.  See California Vehicle Code Section 16029 for further details.

Bottom line: If you're going to drive in California, get auto insurance.

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The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger now at (323) 852-1100       

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com 

If you have suffered a Personal Injury, Call for a Free Consultation

What To Do If You're In An Accident

Things to Do If You're Involved in an Auto Accident

CALL 911 IMMEDIATELY TO SUMMON POLICE and/or PARAMEDICS

Then get the following information:

1. Name, address and phone number of other driver(s) involved in the accident
2. Driver's license number of other driver(s) involved in the accident
3. Insurance information of other driver(s) involved in the accident, name of insurance company, policy number
4. Registered owner information of other vehicles involved in the accident
5. If any of the other drivers appears to be on the job for a company, get the name of that company
6. Passengers in other vehicles? Get their names, addresses, phone numbers
7. Actual location of accident (street, intersection, exact address, if possible)
8. Witness information: Names, addresses, phone numbers
9. Jot down basic information such as weather conditions, street condition, traffic (light, medium, heavy), time of day that accident happened

10. Very Important: Do not speak to anyone other than your doctor(s) without the advice of an attorney.  In particular, DO NOT give a statement to any insurance company, recorded or not, without the advice of an attorney.

Keep a camera in your car at all times (disposable, camera phone, digital camera, etc.) and take pictures of the cars (including damage, license plates), people, scene.

Some excellent links What To Do If You're In An Accident

MSN Money: Insure Your Car.  Important tips on basic auto insurance

State Bar of California. Links to 14 important questions such as "What Information Should I Get at the Scene" and "Do I Need Auto Insurance?" as well as a link to download an entire pamphlet on the subject.

Roadragers.com. Practical tips and advice from the site whose tagline is "when you just can't take it anymore."

The following video report from Allstate and Newstream explains what to do if you're ever involved in a traffic accident.

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The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

If you have suffered a Personal Injury, Call for a Free Consultation

Work Injuries Resulting From Negligent Third Party (Someone Other Than Your Employer)

Through California's Worker's Compensation Laws injured employees are able to recover from the limited benefits of their employer's insurance.  But what happens in cases where an employee has sustained an on-the-job injury caused by someone other than the employer? Simply put, in addition to filing a workers’ compensation claim, the injured employee may sue this third party (i.e., other person or entity) in tort law. Third party cases may fall into categories such as traffic accidents, slip & fall incidents, defective products, defective equipment or the exposure to toxic substances and any number of other situations.

If a worker suffers a significant injury, it is highly probable that they will not receive sufficient funds from a workers' compensation claim because workers’ compensation claims are not based upon fault whereas tort claims are based on fault and include monetary compensation for pain and suffering.  Therefore, pursuing claims against a negligent third party is critical to ensure maximum compensation for injuries or death.

           Every on-the-job injury should be evaluated by an experienced attorney to determine if a third party claim exists.

The personal injury component of a workers’ compensation claim is oftentimes overlooked.  Here are just a few examples of such cases that my office has successfully handled (all clients were on-the-job but we also sued a third party on their behalf):

·         Male bus driver rear-ended by automobile.  He suffered a knee injury which required arthroscopic surgery. Significant confidential settlement.

·         Female building maintenance person who slipped due to wet carpets when exiting the elevator of her office building.  At the time of the incident, a carpet cleaning company (third party) was cleaning the carpet and failed to post signs warning of the dangerous condition.  Serious knee injuries. Large 6-figure settlement against the carpet cleaning company.

·         U.S. Postal Worker who was in Los Angeles on business suffered severe burns to his left foot due to the hotel’s providing scalding hot water to the shower.  The client almost lost his leg due to complications.  Significant settlement against the hotel.

·         Male law firm investigator was rear-ended while in the field. He suffered injuries sufficient to require him to undergo neck and back surgeries. Policy limit settlement against the driver of the offending vehicle.

·         Female Cal-Trans worker was in a lift changing a street light when an the top of an 18-wheeler grazed the bottom of her bucket, throwing her several feet out of the bucket. She hung in the air by her safety belts.  The worker suffered severe physical and emotional injuries as a result. Significant 6-figure settlement against the trucking company.

The attorney handling the third party portion of the claim must work closely with the workers’ compensation attorney as well as with the workers’ compensation insurance carrier because of the unique legal issues presented in these situations.

If you have suffered a work related injury and have reason to believe that a third-party may bear some liability, please call or e-mail me to discuss your legal rights.

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The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

If you have suffered a Personal Injury, Call for a Free Consultation

State Farm Sued for Sham "Independent" Medical Exams

New York Personal Injury Lawyer Eric Turkewitz Reports The Following in his Blog:

State Farm Hit With Civil RICO Claim Over Sham Medical Exams

State Farm has been sued for racketeering in New York with a claim that it conspired with "Independent Medical Exam" companies and medical practitioners to produce fraudulent and sham medical reports. The suit, filed January 30th in the Eastern District of New York, is brought under the Racketeer Influenced Corrupt Organization Act (RICO). (This story has not been previously reported.)

State Farm acted in concert with "IME" companies and doctors to furnish fraudulent and boilerplate reports, according to the suit. The objective was to procure "scientifically dishonest reports in order to terminate benefits." The Complaint is here: McGee-v-StateFarm-RICO-Complaint.pdf

Of particular interest is that the plaintiff is not an injured accident victim that was wrongfully deprived of insurance benefits, but John McGee, a physician practicing rehabilitative medicine. The physiatrist asserts that claims submitted to State Farm are being wrongfully denied, thus depriving him of the revenue he should be receiving for the treatment he rendered. He alleges that "sham" examinations were done by the defendants to procure false findings so as to cut off the benefits, resulting in the claims he submitted being denied.

The Complaint alleges that State Farm and the other defendants communicated that the evaluations and reports must deny that its insureds needed future treatment and that there was a lack of medical necessity for prior treatment. The Complaint goes on to state that State Farm engaged the other defendants with the expectation that reports received would be favorable to the insurance carrier, and to the detriment of the insured.

McGee states that "State Farm made it known to the other defendants that if they did not provide sufficient denials within the evaluation reports then State Farm would not use their IME services."

The defendant "IME" companies are Independent Physical Exam Referrals, Inc., and Metro Medical Services, LLC.

According to the website of Independent, they play no role in the production of the report:

We have addressed the "independent" part of the examinations by requiring all reports to be independently processed by the medical provider, typed and forwarded on their own stationary. IPER does not participate in the production of the reports, thus ensuring an arms length transaction for our clients. IPER reviews all reports by a registered nurse only to ensure that essential components of the report are present and that your questions are answered. The medical opinions rendered are those of the examining physician and based upon his/her clinical assessment and review of medical records.

This description, however, is directly at odds with the allegations of the complaint, which states that "boilerplate medical evaluation reports" are used. That may be an easy thing to prove if identical language is used in many different reports.

Whether these companies are like Integrated Risk Services Inc. -- a company I wrote about Tuesday that specifically states it doesn't want information favorable to the plaintiff included -- remains to be seen. (See: How to Fool a Jury (Is It Insurance Fraud?))

Another part of the Complaint alleges that State Farm pays an excessive fee to the IME company for the doctor's services, and that the money is then shared with the IME company or a kick-back is given to non-medical personnel. The complaint sets forth (in paragraph 19) that felonies have been committed with respect to the sharing of medical fees with non-medical personnel.

Thanks to my anonymous tipster for the heads up.

The plaintiff is represented by Bruce Rosenberg of Bellmore, New York.

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Related Links:

Chicago Personal Injury Lawyer Gary McCallister's Injuryboard discusses this and other related issues

Tipsheet: Independent Medical Exam

Wikipedia: Independent Medical Examination

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

Related Links:

Chicago Personal Injury Lawyer Gary McCallister's Injuryboard discusses this and other related issues

Tipsheet: Independent Medical Exam

Wikipedia: Independent Medical Examination

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Rear-Ended By Drunk Driver: Leads to Surgery, Large Settlement

How horrific it was for my client, Mrs. F., an innocent woman legally slowing down for a stop to be suddenly, and without warning, be rear-ended by a drunk driver.  Otherwise in great health, this lovely lady's life was turned asunder by the flagrant disregard of a guy who was more concerned with his afternoon cocktails than the safety of other people on the road on which he drove.

The physical impact to Mrs. F's car was so severe that it was deemed a total loss.  In particular, the insurance company felt that it would cost more to repair her car than the $30,000 that it would cost to replace it! 

Mrs. F., was so seriously injured that she required neck surgery to remove and replace the discs in her cervical spine at two different levels in an effort to relieve the symptoms of the herniated discs in her neck.  The herniations were deemed to have been caused by this accident.

Medical Bills: Over $100,000.  The drunk driver's insurance policy had a limit of $25,000 which was paid very quickly to Mrs. F.  However, what to do when her medical bills and pain and suffering far exceeded the drunk's policy limits?  Fortunately, Mrs. F. was savvy enough to have Uninsured Motorist Coverage which is also known as Underinsured Motorist Coverage with a limit of $500,000.  Simply put, Mrs. F's insurance policy "stepped into the shoes" of the drunk driver and treated this case as though they were insuring the drunk driver. 

Our office prepared a detailed settlement demand package which included all of the details of the accident, injuries, treatment (and all relevant medical reports, surgical reports, treatment reports) and what Mrs. F could now expect in her future.  With that in mind, we demanded the entire $500,000 from Mrs. F's insurance own company under the provisions of her Uninsured/Underinsured Motorist Policy.  Due to the severity of the injuries, her insurance company tendered the entire $500,000 less a credit for the $25,000 that she received from the drunk driver's insurance carrier.

I routinely advise my clients that it is imperative that they carry as much automobile insurance as they can afford -- and very importantly, Uninsured Motorist Coverage.  I hope that what happened to Mrs. F. never happens to you but, in the event that it does, it is best to be covered to the greatest extent possible.  In another posting I will discuss Medical Payments Coverage.

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Auto Insurers Play Hardball in Minor Crash Claims - CNN Expose

CNN has done an incredible expose on the tactics and strategies of major insurance carriers whose strategy is to deny, delay and defend claims where a person is, through no fault of his/her own, injured in a minor collision.  The strategy is to make initial offers far below your medical bills which forces you into the court system.  At that point, the auto insurers make it so expensive to litigate the matter that injured persons and their lawyers will be dissuaded from pursuing legitimate claims. 

In 2006, Business Week published an in depth article about Allstate's practices entitled In Tough Hands at Allstate  wherein they cite many of the tactics described in David Berardinelli's groundbreaking book From Good Hands to Boxing Gloves,

Are you in good hands with Allstate?  Quoting from the CNN article, "Playing off Allstate's signature slogan, one document recommends the insurer put boxing gloves on its "good hands" for those who insist on going to court."

Story Highlights

• State Farm, Allstate employ consultant's strategy, CNN research finds
• Theme of strategy is "deny, delay, defend," former employee says
• Companies convince juries that claims are fraudulent
• Insurers, institute deny treating claimants unfairly

You can download the text of the article by clicking here.

e-mail me at lowell@steigerlaw.com

www.steigerlaw.com

Lowell Steiger, Attorney at Law (323) 852-1100

Health Insurance: Retroactive Cancellation by Blue Shield to Be Heard by Appeals Court

The following is an article that appeared in the May 7, 2007 Los Angeles Times reporting that an appeals court is hearing a case regarding Blue Shield retroactively cancelling the medical insurance policy of a self-employed machinist who was badly injured in an auto accident.  The article reports that the case could affect hundreds of suits challenging such cancellations as illegal and unfair.

LOS ANGELES TIMES
INSURANCE
Halted health coverage suit may be far-reaching
An appeals court will weigh Blue Shield's retroactive cancellation of a car-crash patient.

By Lisa Girion
Times Staff Writer

May 7, 2007

A 2001 car accident that left Steven Hailey badly injured was the beginning of his continuing medical and financial calamity.

While Hailey was still recovering in his Cypress home and with medical bills topping $450,000, Blue Shield of California suddenly canceled his coverage. That forced the former self-employed machinist to wait so long for surgery to repair an injured urethra, he says in a lawsuit against Blue Shield, that his bladder stopped working. Since then, he has depended on an implanted catheter that drains his urine into a bag strapped to his body.

Now, Hailey says, he and his wife, Cindy, can't afford the care he needs because Blue Shield began garnisheeing her wages to recoup more than $104,000 it had paid for Steven's medical care before canceling him.

The outcome of the Haileys' case against Blue Shield could change the way insurers do business in California and influence reform efforts by state regulators and lawmakers. As the first case of its kind to reach an appellate court in California, it will test the legality of retroactive health policy cancellations, a controversial industrywide practice that has driven canceled consumers into debt and forced them to forgo needed medical treatment.

Blue Shield contends it was within its rights to cancel the Haileys because they failed to disclose Steven's true weight and full medical history when the couple applied for coverage nearly seven years ago.

Blue Shield says it would not have covered Steven in the first place had it known that his weight was 285 pounds, not the 240 listed on the application, or that he had been treated for headaches, hypertension and other conditions.

The Haileys say that Cindy made an honest mistake when she filled out the application and that state law bans the rescission of health coverage without evidence that the policyholder intentionally misrepresented his or her medical history. Blue Shield disagrees, saying the law allows it to cancel policies for any misrepresentation, even inadvertent ones.

Whatever the 4th District Court of Appeal in Santa Ana decides could affect hundreds of suits challenging such cancellations as illegal and unfair.

Such retroactive rescissions have come under scrutiny in recent months because of the hardships they create for patients. A Los Angeles Times article detailed the turmoil of a Murrieta family whose daughter had an aggressive cancer-like tumor, a Riverside couple who sold their home to pay off medical debts and a Van Nuys small-business owner who was maxing out credit cards to get therapy for his disabled infant twins.

State regulators recently levied a $1-million fine against Blue Cross of California, the state's biggest health insurer, over retroactive cancellations. Regulators say they are investigating other carriers, including Blue Shield.

But regulatory actions have failed to stop the cancellations, and none of the lawsuits has resolved the dispute over whether such actions violate the law. The Orange County court is poised to do that.

Noting the "broad public interest" in the test case, the appellate court invited consumer advocates, regulators and industry representatives to weigh in, an unusual move suggesting that the panel sees more at stake than just the case at hand. The court asked for briefs on the law and public policy "against improper health policy cancellations and post-claims underwriting."

"They want to know: How big is this problem?" said Amy Bach, executive director of United Policyholders, a nonprofit organization based in San Francisco, which plans to submit a brief. "Clearly, the court is smelling something bigger."

Blue Shield is one of the state's largest sellers of individual policies, the type of coverage at issue. Unlike with employment-based group coverage, which is issued to all group members regardless of health, carriers in California and some other states are allowed to reject applicants for individual policies based on their medical histories.

Blue Shield says it was conducting a routine and legal claims review when it discovered that the couple's application had purportedly shaved 45 pounds off Steven's weight and failed to disclose his health history. The health plan says it immediately mailed the couple a letter rescinding coverage.

But the letter didn't reach the Haileys before a vendor showed up at their Cypress home and repossessed Steven's wheelchair and adjustable hospital bed.

The Haileys, both now 45, declined to discuss the case on a lawyer's advice. But in court documents, they accuse Blue Shield of launching a secret investigation while Steven was hospitalized to search for an excuse to dump them and avoid paying his bills.

The Haileys say they never tried to conceal anything. In a sworn deposition, Cindy testified that she was confused by the application and mistakenly thought it was seeking only her medical history.

Consumer advocates say the forms routinely trip up people such as Cindy because they use a single set of medical history questions for all family members.

"I've seen that happen repeatedly," said William Shernoff, a Claremont lawyer who represents policyholders but not the Haileys.

The error is so common, Shernoff said, that he is trying to persuade insurers to use separate medical questionnaires for each member of a family seeking coverage.

The Haileys don't fit the profile of people who insurers typically say have an incentive to lie about preexisting conditions to obtain coverage. They could have gotten guaranteed group coverage through Cindy's employer.

They said they turned to Blue Shield because a physician Cindy wanted to continue seeing was not in her employer's health plan. The physician was in Blue Shield's network, so, in November 2000, she filled out the application, listing only her treatment for a digestive condition.

Blue Shield issued coverage in December. Steven was injured in March 2001. The carrier rescinded coverage in June.

Blue Shield says its application's request for information on all applicants was clear. The carrier also says the law allows insurers to take applications at face value. Anything else would be unworkable, said John LeBlanc, a lawyer for Blue Shield.

"If the company were required to investigate every response on an application, despite what the applicant says … the burden would be placed on the insurance company to investigate everything," he said.

Cindy Ehnes, director of the California Department of Managed Health Care, which regulates health plans, recently sided with consumers, saying a 1993 state law clearly bars insurers from rescinding policies unless they can prove a policyholder engaged in "willful misrepresentation" on an application.

Ehnes' office plans to file a friend-of-the-court brief at the Haileys' request and is drafting regulations aimed at curbing cancellations. Her proposal is expected to require carriers, among other things, to develop clear and simple applications and to limit how much medical history they ask applicants to accurately remember.

Ruling without trial in the Haileys' lawsuit against Blue Shield, Orange County Superior Court Judge Corey Cramin upheld the cancellation in 2005 and ordered the couple to repay the carrier $104,192 — the amount the carrier says it spent on Steven's care before dropping him.

Before the accident, Steven owned and operated a small plant that made hydraulic presses for the ceramics industry. The disruption in coverage forced him to wait several months longer than his physician desired for the operation to repair his urethra, the Haileys say.

Often in pain and unable to work, Steven and his wife moved to Broken Arrow, Okla., to be closer to relatives who help care for him.

Blue Shield obtained an order from an Oklahoma judge to garnishee Cindy's wages from her job as a staffing manager for a temporary employment agency. Blue Shield's cut — $680 a month — reduced her monthly take-home pay to $1,714 and, the Haileys say, made it impossible to pay for all the medical care and therapy that Steven needs.

They "are barely hanging on," Michael Nutter, one of their lawyers, wrote, urging the Orange County appellate court to stop the garnishment. Blue Shield argued that if the couple was so hard up, they could file for bankruptcy.

The appellate court sided with the Haileys in December, issuing a temporary halt to the garnishment.

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lisa.girion@latimes.com

lowell@steigerlaw.com

www.steigerlaw.com

Personal Injury Law

Insurance Company Claims Tactics - Are You Really In Good Hands? Anderson Cooper

Anderson Cooper of CNN did a great piece on insurance company tactics.  Fascinating reading exposing the negative tactics of insurance companies: Deny, defend, delay and save BILLIONS in claims payouts.  Click here, read and try not to become enraged as you see how the insurance companies systematically deny injured people their due.  Personal Injury Law attorneys have been fighting this for years.

You can read the Rough Transcript here.

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