Quality Content Writers Group

Just plain honesty
You got it in one, Cheryl,

Insurance is cover for something that might happen, unlike assurance which is cover for something that will happen (usually death).

Most insurance policies are so tightly written in jargon that nobody fully understands them. This means that whenever a claim is made under an insurance policy, there will be many ways in which the insured can be made to pay for the cover again and again and again - often ending up with nothing and sometimes ending up in debt.

Legal costs of 40+% of the benefit are a simple rip off. The thinking by the lawyers is simply that they have filled in the forms and gone through the formulaic process of presenting a claim so they can charge what they want. They also tend to think that any settlement is for their primary benefit - not for the claimant. This is for no other reason than that there are too many lawyers chasing too few potentially profitable cases so they screw the last ounce of 'juice' from the (winning) victim.

Many countries have a system of (free) legal costs audit which compare charges made by lawyers (and such) to ensure that there is no major over-charging going on over what are considered to be reasonable costs. American lawyers are not subject to this degree of supervision.

It is a sad fact that most insurance policy proceeds get gobbled up paying for legal opinion as to what the policy actually covers. Also, it is at the time of a claim that the initial application is inspected with a high powered magnifying glass to ensure that the client crossed all the 't's and dotted all the 'i's properly. There has long been controversy over this aspect of claims adjusters work.
Jan 4th 2008 13:31

Medical Billing/Coding/Insurance
I just can't believe that this woman who has been through so much is now facing this also. It should be illegal for them to do this to someone with permanent brain damage. She is obviously not in a position to understand what is happening. This to me is a clear cut case of taking advantage of the disabled.
Jan 4th 2008 14:25

Medical Billing/Coding/Insurance
Wait a minute Arthur.....did we just agree on something?????
Jan 4th 2008 14:27

Just plain honesty
Mark it up! Quick - before we forget!!!
Jan 4th 2008 15:23

Jean DAndrea

Retired
Unfortunately, insurance is a necessary evil. If the companies can get out
of paying, they will.
This poor woman should be allowed to keep her compensation.
Have these people not humanity or shame?

Jean
Jan 4th 2008 16:16

Reading the link has left me feeling totally nauseaous.

In spite of the legal verdict so far - Jim Shanks' comment says it all
"Sometimes I want to tell Wal-Mart, 'OK, you won on the principle. But just let us keep the money,'"

As Arthur rightly comments, many countries do have audit facilities to stop the excessive legal overcharging that many victims can suffer. Regrettably in the United States you dont seem to have any kind of protective legislation. And it is badly needed. (and that doesnt mean that life is a bed of roses outside the Stats by a long way - legal costs still prevent a lot of people from claiming their rights).

But the sickening part is that Walm Mart is ostensibly run by human beings and, in this case human beings who not only included the "reimbursement" clause but went ahead and are enforcing it. The insurance companies have long been guilty of abusing the "small print" in their policies. In England they had to make a special Insurance Companies Act in 1974 to stop some of the worst abuses, but they still have far too much power.

But now it appears that the Corporations are following their example and behaving just as inhumanly as the insurance companies - in fact worse, when you consider that the people they are suing are their own exemployees.
Jan 4th 2008 16:32

Medical Billing/Coding/Insurance
It is disgusting that the employer is helping this insurance company to abuse one of their own employees. As far as the legal side goes in these cases the victim is usually represented by a "contingency" lawyer. Which means the lawyer does not get paid unless he wins the case. A contingency lawyers standard fee runs somewhere between 35% 40% of the recovered settlement. Out of the lawyers percentage, usually court costs and incidentals are also paid.

In this case the woman won a good settlement to take care of her needs and the lawyers had it placed in a trust for her care. They did do what they were supposed to do. The insurance company however is showing their greed here. This woman paid premiums against the day she would need medical care and now because they had to actually pay they want back the money they paid which they had been collecting from her all along.

Not to mention the thousands of premiums that they are collecting in which claims are never made. How much more do they want? This woman is disabled and unable to ever work again! That little bit of money is ALL she has to provide for her. That is what sickens me.
Jan 4th 2008 16:53

I am curious to know the weight that public opinion has on these scandals, in the United States.

In some countries, the threat of media pressure is sufficient to get them to BEHAVE!. Has this caused a public outcry?
Jan 4th 2008 17:44

Medical Billing/Coding/Insurance
Most of these cases are kept very quiet. I would not have known about it myself except for our own Jeff(Peaceful)
Jan 4th 2008 17:51

Rae Steinbrink

Unfortunately, whoever is in charge of the trust, will now also have to pay new lawyers to handle this lawsuit so one way or another her "settlement" will be whittled down to nothing, she will be placed in a "medicare" facility and we, the taxpayers, will pay for her care! So much for the freedom to sue we have in the U.S. With respect, or lack there of, to Wal-Mart, for several reasons, I have ceased shopping there many years ago. Perhaps if we blog about this incident, send the link to our family members and friends...just somehow, get the word out, the public out-cry will cause some type of pressure on Wal-Mart?
Jan 4th 2008 19:15

That is a great idea Rae.

Cheryl - If you add Shanks & Walmart to the Title of your blog here - you can blog YOUR blog! and that is something else that can be found

i was reading on the internet since i posted. There is some stuff there - but not enough. it appeared in the Wall Street Journal too. But the more the better. This lady is not going to get well when we get bored.

I guess if we comment on the other existing blogs too, that gets them more attention.
Jan 4th 2008 19:20

Just plain honesty
It appears that no matter what happens to Mrs Shanks, employers in America have carte blanche to ignore any reasonable degree of care towards their employees since they are now virtually guaranteed that any health costs will be covered, as a priority, from any settlement. (In other words, they already had insufficient third party insurance cover to protect their employees and now have no reason to even maintain that level.)

As I have read and understood the reports, Mrs Shanks was incapable of handling any cash of her own and was, therefor, NOT paid any of the award. The award was paid to court appointed, professional trustees. While trust accounts are a sort of limbo for cash, in any civilised country they are inviolable. The benefit allocated to the beneficiary is calculated on a day to day basis and, effectively, the award becomes an ad hoc pension with the trustees ensuring no abuse of the fund by the beneficiary or by the holding entity. Claims (in civilised countries, anyway) are not entertained against a trust until the benficiary dies.

The tax breaks for employee care, in America, seem to be very generous but no allowance has been made for the tax relief WalMart received in respect of Mrs Shanks in their claim. Also, the award seems to be quite clearly for the 'future' well being and comfort of Mrs Shanks but the Walmart claim appears to have over-turned or modified (quite arbitrarily) a ruling by a Judge (or a panel of Judges).

It seems to me that the case of Mrs Shanks is shocking enough but it must be the tip of a very substantial ice berg.

It is quite likely that the lump sum settlement was arrived at using life assurance tables and forcasts of future interest rates to ensure that the sum was large enough to cover the life expectancy of Mrs Shanks - in future, why would anybody bother trying to work it out?

One aspect that has not seemed to have received much interest is the poor cover of the truck that did the damage in the first place - why aren't the owners being sued as well?

What is WalMart's liability in respect of the place in which the accident happened? Why doesn't their public and employee liability insurance cover the expenses they claim to have suffered?

I can see it now.

The annual review of the company insurance cover wil end with the Chairman's statement that ..... "because we are covered by the individual private policies of our employees and our victims, we have decided that the executive bonus pool this year will be increased by a million dollars and the insurance premiums reduced accordingly".

You couldn't make it up!

I'm glad I live in a civilised country.
Jan 5th 2008 12:22

Medical Billing/Coding/Insurance
The initial $700,000 was with the trucking company. That is what Walmart and the insurers are after the money which the trucking company paid for their own liability. This is not money Walmart paid out but money they are looking to acquire.

The opening for Walmart to do this was in the fine print of the insurance policy. So the question should be why are Walmart employees paying for this insurance in the first place since the coverage is not covering them. It's more like corporate approved loan-sharking!
Jan 5th 2008 13:56

Just plain honesty
Hi, Cheryl,

I see your point but from an outsider's point of view it appears that WalMart could not sue the truck owners at the same time as Mrs Shanks because they, the truck owners, were hopelessly under-insured.

I'm quite sure that if Walmart had been able to join with Mrs Shanks in a joint suit and if the cover of the truck owners had been at a sensible level, the truck owner's third party cover would have ALSO repaid WalMart.

It appears that WalMart, themselves, did not have sufficient third party cover to protect employees who had accidents on their property so, although the liability seems to have been settled as far as the truck owners are concerned, the liability (and responsibility) of WalMart to protect and ensure the well being of their employees while on WalMart property has been radically diminished.

The only time I have ever seen subrogation in action has been 'knock for knock' settlements in non-injurious car accidents - and that is quite common but, in those cases, there are two insurance companies settling between themselves. A totally different scenario, I think you will agree.
Jan 6th 2008 05:48

Medical Billing/Coding/Insurance
I think the key here is that Walmart had "no grounds" to sue the trucking company because they were not the injured party, Mrs Shanks was. Mrs Shanks had legal grounds to sue. Walmabt was not involved as a party to the accident. So the insurance policy has a clause that allows them to sue employees that receive personal injury settlements.

And again the BIG question here is why are we paying for insurance when it's not covering us. This is a case of what we call "double dipping" Getting paid on both ends.
Jan 6th 2008 07:25