The other day Mike Bullard was talking about a recent
accident he had on his motorcycle on his radio show. I’ve provided a video of that segment of his
show below. What isn’t covered in the
taped segment is Bullard’s description of his interaction with his
insurer. That can be heard on the podcast of the show (November 16, 2012).
Fortunately as you can hear from his story he did not
sustain serious injuries. What you can hear on the podcast is a description of
how the adjuster assigned to his file provided him with paper work to begin
treatment under the MIG. Bullard refused
indicating he didn’t think his injuries were minor and he was waiting for his
doctor to report back on his MRI. As a
result of his refusal to accept treatment under the MIG, he received a letter
from the adjuster indicating that his physiotherapy treatment was being denied..
His doctor did finally report that, in fact, his knee is in pretty bad shape and
he has a torn ACL and two tears in the meniscus.
I raise this story because from time to time I hear similar
ones. I don’t know how frequently it
occurs but it does happen. This was an
insured that had returned to work two days after his accident and had refused
other services.
The MIG was developed predominantly to deal with whiplash
injuries in addition to minor strains and sprains. Torn knee ligaments probably do not fall
under minor injury definition but I’m not in a position to make a determination. Sometimes adjusters are too quick to classify
an injury without fully considering all the medical evidence.
When a health care provider exaggerates a diagnosis he or
she undermines the integrity of the auto insurance system. Similarly an
adjuster that inappropriately directs claims into the MIG undermines the
system. Both situations increase demand
for dispute resolution services and delay access to appropriate rehabilitation
services. It is more than 2 years since
the SABS minor injury definition was introduced and although disputes that have
yet to be resolved regarding the definition, there should be a better
understanding of what falls under the definition.
RE: "Sometimes adjusters are too quick to classify an injury without fully considering all the medical evidence."
ReplyDeleteMr. Handler,
Do you think it might also be true that sometimes the insurer IME/IE vendors are also to quick to paint injured claimants as exaggerators and fakers and that this too "increases demand for dispute resolution services and delays access to appropriate rehabilitation services"?
Brian
Speaking from personal experience, almost TWO YEARS after someone side-swiped me on the Highway (who was also charged with careless driving), I'm still battling Insurance for rehab outside of MIG (Minor Injury Guidelines) ... even though they have proof through an MRI and X-rays of injuries sustained, as well as confirmation of Neurological issues from the concussion I suffered! My injuries have severely impacted my income, the debts are piling up, and frankly the Insurance company doesn't seem to give a damn! The Insurance Company pretty much tells people they're lying - even with medical proof being provided. Why are people basically being forced to take on a Lawyer in order to get the coverage that we pay for? All the medical proof proves that my injuries are real ... why is that not good enough for them?!!
ReplyDeleteMaybe I need to 'hire' someone who's an expert in scamming Insurance Companies in order to have a legitimate claim covered ... really??!!?? RIDICULOUS!!