Unbelievable......

[jonmulzer]

http://online.wsj.com/article/SB1195...hps_us_pageone

How can anyone, who takes any part in this whatsoever, sleep at night? Seriously.

[cgallery]

+10 on that, I couldn't agree more.

I feel terrible for her and her husband.

[LCHIEN]

my 2 cents
The WSJ article is very well done as are most WSJ articles.

I can certainly feel for the family
I can certainly understand the logic behind the subrogation issues, the health plan wants to recover money if it can to keep health care costs low, when someone is at fault for the injuries. Thie benefits both the insurance co and the insured (thru lower premiums).

However in this case the issue really seems to be two fold:
1. the insurance settlement from the trucking company was not enough to pay the woman for her medical costs as well as her suffering and resultant needs
2. the health insurance co. went after the easy money.

The tucking company had a liability insurance cap of $1Million; they paid the family $200K for him and $700K for her. Clearly her injuries cost over $670K in med care plus a new house and ongoing costs or care. Should she not own the trucking company now? A 700K settlement seems low in retrospect.

Another interesting aspect of this might be this scenario:
Suppose she were at fault in the accident, either 50% or 100% because she was driving. There might be no truck co insurance settlement. Health insurance would cover her intial health care, but then they would be left essentially as they are now - no settlement money left. Is there any insurance that protects us from our own stupidity?

Finally observation: legals costs have evdently eaten a huge amount in a not very big pot... the intial settlement included $200+ K for their lawyers,netting the family only $417K of the 700K settlement.

[jonmulzer]

I can certainly understand the logic behind the subrogation issues, the health plan wants to recover money if it can to keep health care costs low, when someone is at fault for the injuries. Thie benefits both the insurance co and the insured (thru lower premiums).

Here we disagree. The healthcare system in this country is wildly profitable and corrupt (IMHO) at the upper levels. Health insurance companies have been outed so many times denying coverage and care to many people, for whatever reason they can. I look upon any insurance out there with suspicion. Their whole objective is to get you to pay as much money as they possibly can, while giving you back as little as they possibly can. The only people who are not making a killing are the GOOD doctors.

[BobSch]

Just another reason I never shop at WallyWorld.

[jonmulzer]

Sadly, it is not just Wally World. It is the health insurance company that did this. You better check your own policy eh?

[cgallery]

Should she not own the trucking company now? A 700K settlement seems low in retrospect.

I agree. I suppose it is possible that the trucking company is small and not worth much of anything.

But what bothers me MOST is that the woman's attorney didn't get in front of this. Given the worst-case scenario, the right time for the attorney to contact the health insurance company was BEFORE a settlement, not wait for the health insurance company to decide what to do AFTER the settlement.

"Hello, I represent the injured in a personal injury case against the trucking company. We're considering taking a settlement for 900k, but we're stuck on subrogation. If you'd consider limiting your damages to something reasonable, we may proceed. Otherwise, we will have to go to trial, but in that case we (and you) may get nothing."

It wouldn't hurt, BTW, to have this meeting w/ the attorney for the health insurance company in person, with the injured present.

Hindsight is 20-20. But that doesn't mean we're blind the rest of the time for God's sake.

[182much]

What a shame

I find fault with the attorney for Walmart.
The lawyers these days are more interested in the $$$, than what is right. My step-son once said he wanted to go to college to be a lawyer. My response was I'd kick his a**. How could someone sleep at night after screwing some one, or getting a guilty person off?

[jseklund]

Like most of the people on this board, my gut reaction is, "Insurance companies suck".

However, after looking into this further, and actually thinking about it- I have to side with Wal-Mart. I agree that this is a tragic situation, and I agree that it is sad. However, you have to look at what the woman had done before the accident to protect herself.

1. She had a health insurance policy.

The health insurance policy PAID her bills. Then, in a legal suit, the person responsible PAID her bills (that had already been paid). Obviously, if the person responsible is responsible, then the insurance policy shouldn't be paying, right? I mean, if I hit you in a car accident, and I'm at fault- should I pay (or more accurately, my insurance)? Or should you pay (or your insurance)?

The fact is, we are duped by the style of writing in this article- we believe she has a right to collect a sum that will allow her to live for the rest of her life without worries. This is a nice thought, but not reality. She had a right to have her medical bills paid (she had an agreement). The court, however, decided that someone else was at fault, and then they paid.

In other words, the money was for the payment of her medical bills, not for funding her future. That is where other forms of insurance (not health insurance) comes into play. If she did not have this insurance, and the judge did not award any judgement for this- that is not the health insurance company's fault. Why should all of the other insured employees of Wal-Mart pay for the tragic accident that did not effect them?

What this article should really state is, "Make sure you are adequately insured." "Plan for the future, and have contingencies."

[AAJIII]

I don't usually reply to these threads because the knowledge base on this site is very large and usually right on.

As a former litigation claims person for an insurance company I will say that the lawyer for the woman should be sued under his Errors and Ommisions policy(Malpractice).

In New Jersey under a workers comp claim, part of the negoations and settlement are the medical bills paid by the workers comp carrier. They have to be repaid by any settlement the claimant receives.

The womans atty never took the time or maybe did not care enough about his client to either get all the facts or if he knew them to act on the repayment clause.

There are many ways to get settlements that exceed the policy limits of the insured vehicle. One is to attach the assets of the company.

Al

[JSUPreston]

jseklund is exactly right in this case. I nearly went through the same thing several years ago with a doctor making a big mistake in giving my wife certain medications. After 3 or 4 years of constant hospitalizations, I thought about suing for malpractice. I talked with legal counsel here at my office, which happens to be the insurace "company" for employees of the State of Alabama (we are self insured). He told me that the insurance board (a.k.a. the "company" previously mentioned) would get everything back that was paid, and we might have enough leftovers to say we got something. We decided because of that and other reasons not to sue.

Basically the article is tricking people into feeling sorry for the victim. The insurance company is only getting back what is rightfully theirs...the trucking company should have paid all her expenses, therefore the insurance company is getting reimbursement for what they paid out.

I feel badly for this family, but they are not being wronged by Wal-Mart or the insurance company in this case. IMHO: It's just liberal media trying to create a stink.

[Caddis295]

My thoughts .......

After a long thought and as a knee jerk response of anger with Wal-Mart and the insurance agency, I have to side with the insurance company.

She had health care insurance. The insurance company paid, reaffirmed the families obligation of settlement reimbursement of any legal windfall. And now it has escalated to this very one sided article. I blame the lawyer.......

The lawer should have done his home work. He did not perform the commission of his duties with his clients best interest at heart. I read in another post that the family should sue the lawer, and I concur to this idea.

Unfortunately, we as a society have allowed the legal system to become the hungry beast it is presently. By allowing every idiot to sue over the most miniscule fault.

There are many reasons health care costs are astronomical. Uninsured patients are the #1 reason. How about malpractice insurance costs or pay outs. Can you blame the insurance companys intent to reconcile any funds possible? In defense of the the health care insurance companies, they did what was in the best interest of their customers.......that means YOU.

My heart goes out to the family, along with my prayers.

[jonmulzer]

I feel badly for this family, but they are not being wronged by Wal-Mart or the insurance company in this case. IMHO: It's just liberal media trying to create a stink.

Liberal? It is the Wall Street Journal. Bought and paid for the same man who owns Fox News, and you call them liberal??

[cgallery]

I realize the insurance company should get their bucks back, but the lady should get enough money for pain, suffering, and continuing her care. That is why I think her attorney did her wrong in settling for too little money.

However, like I also said, perhaps there wasn't any more. Maybe "trucking company" is two trucks and two drivers. I'd be surprised that a trucking company of any significant size would have a one million dollar limit on their policy. ****, I have a one million dollar limit on my policy for my personal car and I don't even think that is enough given the cost of healthcare.

Finally, I still think her attorney could have struck a deal w/ the insurance company to let her keep more of the money before even proceeding with action. At that point the insurance company has nothing to lose, so they may agree to 25 cents on the dollar.

Perhaps her attorney realized it was a slam-dunk case, and that his 1/3 commission was protected from subrogation. So he pockets the 200+ thousand dollars and screw the client. Mentioning the possibility that she may get nothing in the end means the $200k walks out of his office. Just my opinion.

[ejs1097]

The Walmart lawyers aren't at fault here, they are simply making sure the agreed upon rules are followed. Is a cop at fault for giving you a ticket when you are speeding?

Insurance Companies also don't suck. The theory hurts at times though. Insurance, health, car, home, etc. is another name for Legal Socialized Gambling. You are pay someone else a fee to pay your bills if situation arises. The insurance company is hoping they get enough people to do this that the most people don't submit claims. Then they use their payments to pay claims for other people. That's it. Insurance companies don't have a magical money grove on site to be kind hearted people and help others. And they can't operate to lose money but they also need to abide by the contracts they have. In this case they did.

This case is tough because they won a settlement totalling more then the medical bills and the insurance company with this contract has the right to be reimbursed. But after the plaintiff lawyer took 'his' share what was leftover was less the the medical bills and the family seems stuck to pay the difference. They ended up worse off by collecting a settlement. I see the real problem here is the contract the plaintiff's had with their lawyer. Not everyone is smart enough to consider these aspects, especially at hard and emotional times, but should the lawyer's cut been taken after the insurance was reimbursed?