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What are my rights with my insurance company?

btkuhn — Fri, 23 Oct 2009 12:02:45 -0800

What are my rights with my insurance company? You are not my lawyer, but...

I am not looking for a legal opinion, but I'd like to find out what my rights are in a situation, and I don't know how. I have insurance coverage through my job with a major national insurer. I had to go for a long-term residential stay in the hospital to take care of some health problems. I knew that it was going to be expensive before going in, so I contacted my insurance company to make sure that the treatment was covered and at what rate it was covered. I was told that yes, the treatment was covered, and it was covered at 70% until my out-of-pocket max of $3000/year was reached.

So, after going through the treatment and getting my bill, I saw that it was covered as it should have been, except that when my out-of-pocket max was reached nothing different happened - I wasn't cut off at $3000 responsibility. I contacted my insurance co and was told that I must have been told the wrong thing before going in, and the type of treatment I underwent had no out of pocket max restrictions - ie I was responsible for 30% of the total cost, which works out to be about 35%.

I've had problems with insurance companies in the past, so I made sure to get written confirmation of my responsibility before going in for treatment. I have two email from customer service saying that my liability was capped at $3000, for the specific treatment I went for. I went through the appeals process with my insurance company and showed them these emails, and my appeals were denied, with no explanation except "sorry, you were told the wrong thing". I am currently appealing through my state insurance commission but I've heard things move very, very slowly.

My question is, what are my rights in this situation, legally? It seems pretty straightforward - the insurance company told me a treatment was covered, and then after I had it done they changed their tune and won't cover it. So they should be forced to pay for what they said they would. But I don't know how the law really works - perhaps insurance companies are allowed to lie to you (maybe customer service communications aren't legally binding), all that matters is the text of the policy itself? It turns out that the policy itself does not have a out of pocket max for this kind of treatment - this is written in the fine print of the 100+ page policy book, which I didn't have at the time of my treatment. All I had access to was a condensed policy booklet that did not mention this exclusion.

Can anyone comment on what my actual rights are in this situation, if any?

Paying out of pocket and preventing future involvement of car insurance co.

ecsh — Tue, 26 May 2009 14:57:29 -0800

If I pay out of pocket for repairs to another driver's car, is there a form I can ask him to sign to prevent later involvement of insurance companies? As I was backing slowly out of a parking space this afternoon, I bumped into another car. The other car was driving through the parking lot and not yet in a space.

The collision was so gentle that I didn't actually feel it, and the only damage to my car was a small crack in the paint on the corner of the rear bumper. The other car was a two-door model, and the only damage that we could see was a dent in the panel just behind the driver's door. The dent was about a foot across and looks like something that might easily pop out, but then there's the issue of repainting.

The other car belongs to the driver's brother; it is unquestionably still drivable and both the driver and owner live nearby. I admitted fault, but I pointed out that it was raining and that the other driver had not turned on his headlights, which certainly contributed to my failure to see his car. I'm in PA, where headlights are required when wipers are in use, and it was raining hard enough for that.

Given the headlight issue, I asked that the driver do me the favor of communicating to the owner that I am interested in paying out of pocket and not getting insurance companies involved. We exchanged contact and insurance information amicably, and the driver mentioned it was possible that his brother would decide to let the whole thing go (not that I'm pinning my hopes on this).

1. My guess is that repairs will run $200-400, and in this range I would rather pay out of pocket than report it to my insurance company and deal with increased premiums for years. Are these estimates reasonable?
2. I've never before been in a car accident where parties other than myself and a deer were involved. Is settling w/o involving insurance in any way illegal? If not, is there some standard form I could ask the owner to sign, when I hand over the check, to establish that the issue has been settled and prevent him from seeking money from my insurance company?
3. Would the driver need to sign the form mentioned above? I don't think there are any medical issues, but we did not discuss that explicitly.
4. If costs spiral out of control somehow, and I decide that I would rather have my insurance company cover the cost, how much of a delay in reporting the accident is acceptable?
5. The other car is 15 years old and worth $800-1200 according to KBB. It seems possible that the owner might prefer to have the cost of the repair in cash and either not repair the car or repair it when convenient (since the damage isn't a safety issue). Does offering to write him a check directly, either for the value of an estimate or for a mutually agreed upon amount, change any legal/insurance status?

Please don't tell me that I shouldn't have admitted fault. I think that it mostly was my fault, and paying a few hundred dollars out of pocket is no hardship. I would just rather avoid the insurance hike.

Is my company's wellness program legal?

Anonymous — Wed, 25 Mar 2009 15:31:05 -0800

Is my company's new, highly Orwellian, wellness program legal? How can I get them to stop? Posting anonymously to avoid employer retribution if I end my making a complaint.

My spouse and I are insured by her employer's health care plan. Recently, she was informed about a new wellness program they are implementing. The plan is called voluntary but it seems anything but. If you refuse to enroll, $90/month is deducted from your paycheck. If you enroll, you have two choices: the "no monitoring" plan which costs $65/month and the "monthly monitoring" plan with costs $30/month. Under terms of the monthly monitoring plan, you agree to health screenings of weight, cholesterol, diabetes, smoking, etc. every 30 days. If you have a negative screening, such as your weight going up instead of down, your rate climbs to $65/month until corrected.

In general, I have no problem with wellness programs, and all for healthy living. However, I don't like the fact that they are penalizing people who don't want to participate, and I don't like the idea of anyone being forced to pay "fat fees." I did a little research on the EEOC site and came up with this:

"The Equal Employment Opportunity Commission (EEOC) has offered employers some guidance with regard to the ADA's restrictions on medical inquiries and examinations. Under the guidelines, an employer may conduct medical examinations and activities that are part of a voluntary wellness and health screening program. Therefore, offering employees the opportunity to voluntarily participate in health screening programs for high blood pressure and cholesterol monitoring are not likely to violate the ADA, as long as there is no penalty (economic or otherwise) for not participating. Employers must treat any information acquired as a confidential medical record. (source: http://hr.blr.com/whitepapers.aspx?id=19254)"

We have no other access to health insurance, so switching plans isn't an option. I know you're not a lawyer, and you're not my lawyer. But I'd be interested in opinions as to whether this program is legal. And if not, I would also appreciate any tips people may have for how to get the employer to change the program. We live in Georgia, if that helps.

Throw away email address: illegalprogrammefi@gmail.com

Source for Medical Malpractice Insurance Quotes for Doctors/Hospitals?

Quarter Pincher — Mon, 16 Mar 2009 18:28:59 -0800

Do you know of any reasonably credible sources that list the premiums and deductibles that hospitals/doctors (of any kind, but largely medical surgeons for intensive-care/emergency/surgical hospitals) pay for medical malpractice insurance? I'm researching figures for a malpractice reform idea. The idea is based on a rumor that medical malpractice insurance is an absurdly burdensome expense for hospitals/doctors who must pay it in order to legitimately practice. If there were a way to eliminate that particular burden, the massive periodic (monthly/etc) savings would gradually equal lesser medical expenses for Billy and Susie down the line.

My idea was to eliminate the need for malpractice insurance by enacting legislation requiring the hospital in question to add the malpracticed-against as simply a new employee, paid out of the standard payroll expenses, at a comfort-offering rate (variable according to terms of the suit and local standards of living) instead of having to lop over this giant sum (and pay insurance for the dark cloud of a giant sum to loom over them, waiting to be dished out). Does this idea hold much water?

Should I report an accident to my insurance company even if there was no harm done?

tipthepizzaguy — Fri, 03 Oct 2008 20:03:40 -0800

A little kid ran in front of my car in a parking lot and I hit him. He was not hurt and there was no damage to my car. The boy's mother apologized and told me everything was okay. We did not exchange any information. After I drove away she called the police and filed a bogus report. What to do? Thankfully there was a witness and his report to the police matches mine. I don't believe I'll be in any legal trouble. The officer I spoke to said the woman and her story were both "a little off."

What I am worried about is my insurance. Should I report this incident to my insurance company? Should I file a claim even though there was no damage? Is there anything else I need to do to cover my ass in case she sues or files her own insurance claim?

Help my boy take home a Camaro!

konolia — Wed, 19 Mar 2008 07:57:48 -0800

So, my son bought a car off Ebay. He's in Colorado, the car is in Maryland. He will be flying to Maryland to pick up the car on Spring Break and driving back-but there's one little problem... ...Colorado won't give him temp tags because the car is in Maryland and Maryland won't give him temp tags because he is not a Maryland
resident. So....how can he get the car legal to drive back to USAFA with it? He is presently calling the insurance people to see what they suggest but meanwhile I thought the hive mind might have some ideas. (The car is a refurbished Camaro, and this is kinda his graduation present to himself-so if I'm not chewing him out for buying off of ebay, let's not go there here either. )

ongoing billing issues w/ doc...

keith0718 — Tue, 04 Mar 2008 13:00:56 -0800

I'm having ongoing billing issues with a doctor and it's time I seek resolution with a third party. Where should I go? This is in response to this previously asked question. The situation is still not resolved. Basically, there is a large discrepancy between what the doc charged me and the info he's given me to charge my insurance. I've done pretty much all I can and now it's time to take the matter to the next level. Which would be what, exactly?

selling vehicle without title

diode — Wed, 27 Feb 2008 16:07:49 -0800

I've got a vehicle whose title is in the process of being transferred to me. I've got to do the reregistration by mail from Oregon to California. I've had an offer on the vehicle. The potential purchasers say a bill of sale and them putting the vehicle on their insurance is sufficient to let them drive legally. They also mentioned a temporary registration, which I've never heard of. Is this a bad idea, or a practical one to get the car sold now. I've got a vehicle in my possession that belonged to a deceased relative. I'm a resident of Oregon, the car title is in California. I've sent the title and paperwork down to the California DMV in Sacramento and of course there is some glitch that means the paperwork will have to come back to me and then get resent down there.

In the meantime, a couple have made an offer on this vehicle, a good one. Since the title is in limbo at the moment, they are saying we can do a bill of sale, then they put the vehicle under their insurance and I transfer the title when I get the paperwork completed.

I'm not clear on the potential downsides of this. Given that they look like solid citizens and will pay with a cashier's check, so it's not an issue of money, what happens if they get into a wreck? The vehicle title is soon to be in my name, then I have to re-register it in Oregon, then sign it over to them. That's probably at least another three weeks minimum if nothing goes awry.

While the paperwork is getting completed, they'll have the vehicle. My worst fear would be that if they got into a smashup, the title would point to me and I'd be named in a suit. Is that a reasonable fear or am I just being too paranoid?

It would be nice to have the car sold now. It's a Pontiac Aztek, 2001, with only 18,121 miles on it. There's no problem waiting though until the title is completely clear before doing this if that's the best course of action.

Doctor won't give me info to file w/ insurance.

keith0718 — Wed, 26 Sep 2007 15:30:55 -0800

What can I do if my doctor will not give me the information I need to file with my insurance? I used the telecounseling services of a reputable psychotherapist in a different state for about 8 months. At the preliminary session I made a point to inquire about insurance. The counselor told me that while he doesn't file for his patients he had "no problem" giving me the information to do so myself. With that I went a head with the counseling. After a few months my wife and I solicited the counselor by email for the to-date information that we may file with the insurance. Our requests were initially ignored, then pacified over the next few months. After we got pretty firm about the matter we received a seemingly sincere apology by the counselor wherein he took full responsibility for neglecting to follow through on the matter (incidentally during our last counseling session). We got the said information in the mail a couple weeks later. A few weeks after that we decided to crunch the numbers, whereupon we discovered that there was a huge discrepancy between the amount the counselor billed us, and the information he gave us to bill the insurance. Only about half of the sessions were included in the insurance information (which translates to about $1000 I could--but won't be able to--get reimbursed from my insurance. I promptly wrote a firm yet polite email to the counselor (apologizing for bothering him with this again) and explained the discrepancy...complete with a detailed itemization. That was almost three weeks ago and we've heard nothing. What should I do? Do patients have a legal right to correct information with which to bill insurance?

Legalities after Bicycle Accident?

suedehead — Fri, 07 Sep 2007 13:41:50 -0800

I got hit by a car on a bicycle while carrying a laptop. Bicycle & laptop are busted, but thankfully I'm not. What do I do now, legally speaking? I was riding my bike uptown on an avenue on a green light. A livery cab coming uptown on the same avenue turned to his left, across the avenue, to enter a eastbound street. I saw him coming and tried to brake to avoid him; he was going pretty fast and didn't brake in time, and he hit me on my left, his front/right. I flipped over and landed on my back.

There were quite a few people around, who started calling the police and an ambulance. The police came and got the driver's license number, et cetera, and I went in the ambulance to the ER, where I got checked out and they told me that I'd probably be okay for now. Fortunately, I was wearing a helmet and a messenger bag, and so I don't have any harsh bruises or scrapes. My neck/head seem okay for now.

Problem is: My bike wheels are bent, a pedal is bent, the handlebars are bent sideways, et cetera. On top of that, I had my laptop in my messenger bag. The laptop's LCD screen is cracked, and my laptop won't boot up past the Apple login screen. I went to the police, they gave me an accident report, but told me that they couldn't include any information about any valuables I had in a police accident report.

All I want is to have my bike, my laptop, and any medical fees resulting from this to be covered. I do have medical insurance. I don't think that it was my fault - I was going slower than the cars, it was my green light, I have the right of way because he was turning left, and if the livery cab wasn't going so fast he would have been able to stop in time.

1) What should I do next?
2) How do I prove that the accident caused the damage to my laptop?
3) Should I just contact the driver's insurance company and try to settle it that way? Will they cover my medical fees/bike/laptop?
4) Should I try to find a lawyer specializing in these cases? (I'm in NYC.)
5) The police report doesn't have any info about witnesses - should I try to find one?
6) Does the fact that the car was a livery cab change anything/make anything difficult?

I'm just very confused and frazzled - nobody I've talked to has been able to answer these questions. Thanks!

Can I tell my doctor I smoke weed?

Anonymous — Tue, 04 Sep 2007 20:41:53 -0800

Are there any potential downsides to telling one's doctor that he uses marijuana? I'm thinking about it getting in my records and being used against me for insurance purposes or possibly getting out. How confidential is this sort of thing?

is legal insurance a good idea or is it not worth the money?

krautland — Fri, 18 Aug 2006 14:21:17 -0800

is legal insurance a good idea or is it not worth the money? this is a question about legal insurance plans. you might have seen them around, aragdirect.com offers what they call comprehensive coverage, so does hyatt legal plans and a few others. but are they worth the $400 annually (or $35 per month)?

let's face it, we do live in a litigation happy country. I myself would be happy to retain council every time I felt wronged (I am especially thinking of all the cable and phone companies in this world) but retaining council involves considerable cost and effort, which is why I never do. I feel it's only a matter of time until someone swipes my photos off flickr or sues me because of something in my blog and I would like to be prepared to respond without having to come up with ten grand out of nowhere in no time. having just dealt with id-theft myself, the idea of having someone on standby is even more intriguing. but do these plans work or are they another empty promise?

Foot-sore in Mississippi

Anonymous — Thu, 20 Jul 2006 06:45:49 -0800

I was arrested and convicted for DUI in Mississippi over 3 years ago. I have not driven since (small town, good friends, I live close to work), and now I am wanting to get my license back. . . . Concerning SR22 insurance--am I effectively "grandfathered in" from needing it? You have to carry SR22 for three years following a DUI if you are to hold a MS driver's license. As I have not driven since the arrest, do I now still need to get SR22 insurance and keep it for three more years, or am I "clean," insurance-wise? and yes, I know the DUI is still very much on my record.

i will, now, drive 55

luriete — Tue, 11 Jul 2006 09:31:59 -0800

I got an extremely expensive traffic ticket (my first! and $632!) for doing 97 in a 75 on a lonely stretch of road outside of Lovelock, Nevada. I paid the ticket, and asked the court (and the ticketing officer, at that point) about traffic school; they both said that the points wouldn't transfer to California or go on my record, but as far as traffic school to lower insurance went, it was between me and my insurance company, and they'd get in touch with me. However, can't I do something pre-emptively to keep this from going on my insurance record? Or am I screwed? I paid the fine in mid-June, just before it was due (took a little while to save the money); the ticket was issued in mid-May.

How to keep people from suing my start-up business

acoutu — Fri, 23 Sep 2005 11:08:20 -0800

BusinessLiabilityFilter -- Do we need product liability insurance for our start-up mail order business that sells repackaged craft supplies to kids? My husband and I are looking at starting a business that offers craft kits for kids by subscription. We'd take basic supplies -- a few pipecleaners, string, paper, stickers, sandpaper, whatever -- and provide instructions for making a craft. These supplies can be purchased at any craft or dollar store or even Wal-Mart. We wonder if we create a liability for ourselves, such as if a kid stabs herself with a pipecleaner. We were planning to include a note that says parents are best able to determine age appropriateness of crafts -- and we're gearing our kits to four- to eight-year-olds. If we are potentially liable, we want to know the best way to protect ourselves -- incorporation, insurance or something else. We're in Canada, but would sell 90%+ to US customers, if that helps. Thanks.

You're in good hands.

itchie — Tue, 30 Aug 2005 19:41:57 -0800

In an Allstate commercial I have seen, the narrator tells a tale of a car that smashes into a house. The narrator continues to explain that the family got sued by the driver of the car. Can any lawyer-types out there explain to me how this is legally possible? To me (someone completely unaffiliated with anything having to do with the law), this seems odd - how can it be possibly legal for the driver of the car to sue the family, although they had no wrongdoing? I can't find the commercial online, and I'm pretty sure that's what was said in the commercial. If I'm wrong on any accounts, please correct me accordingly. Thank you in advance.

Liabilities for loaning/renting out a car

wildblueyonder — Fri, 13 May 2005 10:10:52 -0800

What legal issues exist for loaning out or perhaps even renting out a car that you own? I have a vehicle that I may not be using for a few months. I've considered trying to rent its use for a low price or perhaps even simply lending it for free to someone in need. I'm concerned about liability issues, however. Am I, as the owner, responsible for damage/injury caused by the vehicle if someone else is driving it?

Can requiring a loanee to carry insurance or having them sign something indicating responsibility cover me?

Or would I just want to make sure I've got liability on the car myself, no matter what?

Insurance Company Woes

sophist — Tue, 26 Apr 2005 19:29:49 -0800

I am being sued for damages related to an auto accident. The lawyer from the insurance firm is representing my case. Should I get my own lawyer? About six years ago I hit a pedestrian while driving. At the time I was a minor on my parents' insurance. Due to the conditions (raining, at night) and situation (pedestrian running across 4 lane highway, no lighting) I was obsolved of criminal charges by the police at the time. Later on the guy decided to sue me for damages in civil court. It has escalated and is definitely going to trial. They are asking for $500,000, $250,000 of which is covered by my insurance. The insurance lawyer seems nonchalant but the insurance company has not settled and trial date has been posted for next month. Should I get my own lawyer to represent my interests, rather than those of the company? Any other insights on the situation would be appreciated.