Physicians Going Broke?

**Jim Kyle** · 01-13-2012, 01:24 PM

Originally Posted by Midtowner

And sitting where I do, on the opposite side of the insurance equation, some of the games played by insurance adjusters and their companies are pretty bad as well. Insurance companies are out there to make a profit. They do so by paying injured folks as little as they can.

That's as bad a generalization as claiming that all attorneys are shysters. Granted, such insurance companies do exist. But during her first several years as an adjuster, my wife worked for a company that realized not all claims were zero-sum games, and thus sought win-win solutions. She was proudest of one case involving a quadriplegic injury that she settled by negotiating a structured settlement that provided long-term security for the victim, giving him more than he had originally asked for, and doing so with no attorney involved -- so that the victim received the entire settlement. When both sides are honest, there's no need for an adversarial relationship.

Later, at another company, she had to deal primarily with workmen's comp cases, and there almost all of those that came in were more than a trifle fraudulent. One in particular that sticks in my mind involved a worker who was drawing 100% permanent total disability from his first claim, another 100% permanent total from a later injury on another job, and claiming yet a third such finding from a third job. If he was actually permanently and totally disabled by the first injury, how did he manage to get the later two jobs? That company, faced with such claimants in most of their business, adopted the policy of paying as little as possible while fighting the claims all the way.

From time to time, I review my own insurance coverage and get quotes from firms other than my current carriers. One of the things I look for when evaluating their proposals is their attitude toward both their policy holders, and their claimants. I try to stay with the firms that seem to seek such win-win conditions.

I'm not defending the insurance industry as a class. It has as many bad apples in its barrel as does the bar. Such blacklisting as you report by a malpractice insurer ought to be outlawed; the only valid reasons for denying coverage to an applicant should be their records of previous claims -- and even then, only if they had been found liable. Since anyone can file a claim no matter how little grounds exist for it, a simple claim count wouldn't be right.

I suspect that you're a plaintiff's attorney. It would be interesting to hear what a defense attorney would say about the situation; I'm sure there would be some differences! (EDIT--Just saw that PennyQuilts has already done so! And I agree with her, 100%)

**PennyQuilts** · 01-13-2012, 01:28 PM

I suspect that you're a plaintiff's attorney. It would be interesting to hear what a defense attorney would say about the situation; I'm sure there would be some differences!

You betcha.

**HewenttoJared** · 01-13-2012, 01:43 PM

Originally Posted by Jim Kyle

That's as bad a generalization as claiming that all attorneys are shysters. Granted, such insurance companies do exist. But during her first several years as an adjuster, my wife worked for a company that realized not all claims were zero-sum games, and thus sought win-win solutions. She was proudest of one case involving a quadriplegic injury that she settled by negotiating a structured settlement that provided long-term security for the victim, giving him more than he had originally asked for, and doing so with no attorney involved -- so that the victim received the entire settlement. When both sides are honest, there's no need for an adversarial relationship.

Later, at another company, she had to deal primarily with workmen's comp cases, and there almost all of those that came in were more than a trifle fraudulent. One in particular that sticks in my mind involved a worker who was drawing 100% permanent total disability from his first claim, another 100% permanent total from a later injury on another job, and claiming yet a third such finding from a third job. If he was actually permanently and totally disabled by the first injury, how did he manage to get the later two jobs? That company, faced with such claimants in most of their business, adopted the policy of paying as little as possible while fighting the claims all the way.

From time to time, I review my own insurance coverage and get quotes from firms other than my current carriers. One of the things I look for when evaluating their proposals is their attitude toward both their policy holders, and their claimants. I try to stay with the firms that seem to seek such win-win conditions.

I'm not defending the insurance industry as a class. It has as many bad apples in its barrel as does the bar. Such blacklisting as you report by a malpractice insurer ought to be outlawed; the only valid reasons for denying coverage to an applicant should be their records of previous claims -- and even then, only if they had been found liable. Since anyone can file a claim no matter how little grounds exist for it, a simple claim count wouldn't be right.

I suspect that you're a plaintiff's attorney. It would be interesting to hear what a defense attorney would say about the situation; I'm sure there would be some differences! (EDIT--Just saw that PennyQuilts has already done so! And I agree with her, 100%)

You have the luxury of making a choice about your carrier. Many, many people get no such choice and are stuck with companies that treat them like cattle. Even the "good" companies you are choosing are still for-profit enterprises with a vested interest in building a reputation, true or not, as a company that cares about their customer's well-being.

If you want to know their actual motivations try comparing their medical loss ratios to the state's equivalent. If their motivation is to help people then they should be similar. They probably aren't.