Health Insurance Companies May Be Under Paying Claims

What happens if you are traveling and have to visit a hospital or doctor? Or what happens if you need to see a local doctor immediately who may not be in your health insurance company's “approved network of doctors?” You would expect your health insurance company to pay a reasonable amount towards those bills, wouldn’t you? But that doesn’t always happen.

Recent cases from across the country indicate health insurance companies may be significantly under paying out-of-network claims. This means consumers are unfairly left to pay the balance of these charges. In a recent Federal case, California based Health Net Inc. agreed to repay $215 million to its customers for using an out dated and lower than reasonable payment schedule for out-of-network claims. The company also agreed to spend $40 million to update its claims processing protocol to avoid this problem in the future.

DO YOU THINK YOU’VE BEEN THE VICTIM OF AN UNDERPAYMENT FOR AN OUT-OF-NETWORK CLAIM? Please call us or e-mail us at mcw2@moore-wolfe.com and put “underpayment” in the subject line. You may be entitled to a refund.

State Farm Must Pay Victim

A Mobile County jury ruled against State Farm and in favor of their insured in a civil trial that concluded on January 7th. Moore & Wolfe attorneys, Steve Moore and Karlos Finley, represented Francilla Ridgeway during the two day trial. Ms. Ridgeway was the victim of a serious motor vehicle collision that occured on Novemebr 14, 2006 near Chickasaw. The collision occured as she moved into an intersection with a green light and was hit by an Alabama State Trooper vehicle that was involved in a high speed chase. The jury concluded after only about an hour and a half of deliberation that State Farm owed their insured $100,000.

The trooper was pursuing Daniel Keith Gibson who, just seconds before the collision, had gone through the intersection at over 90 miles per hour and was headed directly towards a school zone just a block away. Ms. Ridgeway testified at trial that she did not see or hear the approaching trooper vehicle. When pressed on cross examination by State Farm's attorney, Ms. Ridgeway said she was distracted by Gibson's vehicle and when her light turned green she moved into the intersection but was looking down the road in the direction of the fleeing vehicle. That afternoon, Gibson led law enforcement officers on a high speed chase through Mobile, Saraland and Chickasaw. He admitted to speeds in excess of 140 miles per hour and said he attempted to ellude police because he, "didn't want another speeding ticket."

State Farm, who provided underinsured motorist coverage to Ms. Ridgeway, never offered her any of those benefits under the policy, claiming Daniel Keith Gibson was not at-fault in causing the collision which left Ms. Ridgeway with over $24,000 in medical bills. They maintained this position even though Mr. Gibson's insurance carrier had earlier paid his policy limits to Ms. Ridgeway. "Underinsured motorist coverage is a safety net that you pay a premium for," explained Steve Moore. "If you are injured through the fault of someone else and they don't have enough insurance to cover all of your damages, then you can use your underinsured motorist coverage to make up the difference," he explained.

Besides incurring over $24,000 in medical expenses, Ms. Ridgeway lost almost $8,000 in wages as she recovered from shoulder surgery necessitated by the collision. At trial, State Farm said the accident was not the fault of Mr. Gibson but rather the fault of Ms. Ridgeway, in closing argument State Farm's attorney even implied that Ms. Ridgeway lied under oath when she said she was not on her cell phone at the time of the collision as he suggested maybe she was distracted by talking on her cell phone.

"For over two years State Farm has refused to pay the benefits owed under this policy by continuously blaming Ms. Ridgeway for this accident. She was an innocent victim of Mr. Gibson's idiotic decison to run from the police," said Moore in closing argument. Ms. Ridgeway is a single mother of four with her oldest son in college at the University of South Alabama. She testified that every month for years and years she struggled to pay her insurance premiums to State Farm, which she said were about $70 per month. "At her income level she had to work about 10 hours every month just to cover her premiums and this is what she gets for her hard work," her attorneys told jurors in closing argument referencing State Farm's blaming her for the collision.

For additional information on this story visit the Mobile Register online.

Innocent Victim of High Speed Chase has to sue her own Insurance Carrier for Benefits

The Mobile Press Register recently reported on an interesting case pending in Mobile County involving a State Farm insured who was an innocent victim of a high speed chase. On November 14, 2006 Francilla Ridgeway was injured when a State Trooper vehicle collided with her vehicle at an intersection in Chickasaw, AL. Ms. Ridgeway entered the intersection on a green light and did not see or hear the approaching Trooper vehicle. The Trooper was engaged in a high speed pursuit of a fleeing motorist who had led law enforcement on a 30-40 minute high speed chase throughout the Mobile, Saraland and Chickasaw area. The fleeing motorist, Daniel Gibson, was driving a highly modified Ford Focus and admitted to traveiling in excess of 140 miles per hour and driving recklessly as he attempted to evade the pursuing law enforcement officers.

Ms. Ridgeway originally named Gibson as a defendant in the civil action claiming his negligence or wantonness caused the collision with the Trooper vehicle. Mr Gibson's insurance company paid their liability limits but the amount was insufficient to cover the full extent of Ms. Ridgeway's injuries. Under her policy with State Farm, Ms. Ridgeway has "underinsured" motorist coverage which provides additional benefits if an at-fault driver does not have enough liability coverage. State Farm denied Ms. Ridgeway's claim and never offered any underinsured motorist benefits to her claiming the collision was not Mr. Gibson's fault but rather Ms. Ridgeway's fault for not seeing the oncoming Trooper even though she entered the intersection with a green light.

Steve Moore, Ms. Ridgeway's attorney said he elected not to sue the Trooper involved in the incident because he did not believe he did anything wrong. "While some people may look at this situation and say the Trooper should have backed off from the pursuit or maybe he should have gone through the red light at a slower speed, I just felt legally the person who should be accountable is the person who caused this situation to begin with and that is Daniel Gibson." State Farm "stands in the shoes" of Mr. Gibson for any damages he may legally owe Ms. Ridgeway per the terms and conditions of the underinsured motorist provisions of their policy with Ms. Ridgeway. "They do not want to pay benefits that Ms. Ridgeway paid a premium for so they argue that the accident wasn't Mr. Gibson's fault and have forced their insured to litigate this case," said Moore.

The Mobile Press Register online at al.com has more on this story.

Warning About Holiday Drinking and Driving.

The National Highway Traffic Safety Administration (NHTSA) has released data showing that from 2002 to 2006, nearly 4 in 10 roadway fatalities in the last two weeks of December were related to alcohol use. NHTSA Acting Administrator David Kelly called drunk driving "one of the most serious, and preventable, dangers we face on our roadways," as he launched the administration's holiday crackdown on December 17.

NHTSA research shows that drivers aged 21-24 were most likely to be alcohol impaired when involved in a fatal car accident. Thirty-five percent of drivers in this age group were alcohol-impaired when their accident occurred, as opposed to 18 % of 15-20 year-olds and 29 % of 25-34 year-olds. In Alabama, this percentage is even higher, with 38 % of 21 to 24 year-olds being alcohol impaired when involved in a fatal accident.

This data also follows an NHTSA report earlier this year that restricting the drinking age to 21 has probably saved a total of nearly 4500 lives nationwide during the five year period from 2003 to 2007. This is in addition to the estimated 15,000 lives saved every year by seat belts. In Alabama alone it is estimated that seat belts save 400 lives a year, and that another 188 could be saved by full seatbelt use.

For more information about accidents involving impaired drivers, please click this link to the Moore & Wolfe MVA Resource Center.

Wolfe Article Published

The December edition of TRIAL will feature an article written by Mark Wolfe. TRIAL is a monthly legal journal for trial lawyers published by the American Association of Justice. Wolfe's article is a practical guideline for attorneys to better help their clients when responding to written discovery. This is the third article Wolfe has had published in a legal journal and he currently has another article under submission. Wolfe is a frequent speaker at Continuing Education Seminars for lawyers and says most of the articles he has had published or written come from seminar papers. "When you speak at a CLE seminar the topics are current and these topics often lend themselves to journal articles," said Wolfe.

Wolfe will serve as a moderator at a CLE seminar in Birmingham on December 12th and he is the moderator and a speaker for the South Alabama Trial Lawyers Association's Winter CLE on December 19th. In January he will be a speaker at the Alabama Association for Justice's Mid-Winter Conference.

M&W Charity Wine Tasting 2008

On October 26th, M&W held its third annual charity wine tasting. This year's beneficiary was the Mobile Bar Association's Volunteer Lawyers Program (pro bono program). The event raised over $10,500. The Volunteer Lawyers Program (VLP) is one of the top free legal service programs in the United States and assists hundreds of clients each year with civil legal matters. After Hurricane Ivan in 2004 and Hurricane Katrina in 2005, the VLP assisted thousands of victims with property and title issues so they could secure government assistance. Over 50% of the Mobile Bar Association attorneys donate their time to the VLP each year. The funds raised from this year's event will go towards office supplies and various incidental operational expenses. The event was held at the Bakery Cafe and Market at 1104 Dauphin Street in mid-town Mobile.

In 2006 the proceeds from the first M&W Charity Wine Tasting helped build a playground in mid-town Mobile at Central Presbyterian Church for use by children of residents of the Family Promise Network and summer camp participants. In 2007 the proceeds from the M&W Charity Wine Tasting went to buy computers and school supplies for the USA Children's and Women's Hospital Class Act program. That program provides full time teachers to children in the hospital so they can maintain school attendance credit and keep up with their classwork while in the hospital. In 2009 the beneficiary will be Victory Health Partners which provides low cost medical services to people without health insurance.

A special thanks to our friends at Russell Thompson Butler & Houston CPAs and Cormier Chiropractic and Physical Therapy for again being platinum sponsors for this year's event.

Where to Vote

With the election just a week away, many voters may not be familiar with where they go to vote. The link below can help you find your polling place.

http://www.alabamavotes.gov/

M&W Atty Steve Moore Secures $32 Million Judgment

M&W attorney, Steve Moore, recently secured a $32 million judgment against an at-fault driver who has been charged with DUI related to the crash. The victim, a 50 year old woman, suffered severe life altering injuries and requires constant medical attention. The women and her husband understand the judgment will probably never be collected but asked Steve to consider prosecuting the civil claim in hopes it will send a message to others in the community about the dangers of driving under the influence. "I applaud their courage and desire to try and make something positive occur from this terrible event," said Moore. The judgment, which includes $8 million for compensatory damages and $24 million in punitive damages, will now be recorded against the defendant. Read more on this story on al.com.

This is not the first time the attorneys at M&W have undertaken to help victims of DUI drivers at no charge. In 2001 they helped the family of 4 year Joia White, and other victims, obtain a $3 million judgment against a DUI driver who ran a red light and crashed into the vehicle occupied by Joia and her family. Joia and her grandfather were killed in the collision and her 4 siblings had multiple injuries and hundreds of thousands of dollars in medical bills. The firm also handled that case at no charge. Since then, the back cover of the law firm's Victim's Handbook has been dedicated to the memory of Joia White with a reminder of the dangers of driving under the influence.

Knox Boteler on Law Call

M&W attorney, Knox Boteler, will be the featured guest on Law Call on Sunday night October 11th. The 30 minute show will focus on traffic accidents and related insurance claims. The show will air immediately following the Sunday night football game on WPMI - NBC-15. "Knox's years of experience in the area of motor vehicle collisions and insurance claims, makes him an excellent guest for this topic," said Mike Rush the program's host. Please mark your calender and tune in on Sunday night, Oct. 11th. Advance questions can be sent to jkb@moore-wolfe.com

Ju$tice for $ale in Alabama?

Interesting Article from the Anniston Star.

Corporate money and courts
By Robert Leslie PalmerSpecial to The Star
09-28-2008

In electing the next Alabama Supreme Court justice, Alabamians should bear in mind the Dutch proverb that "promises make debt, and debt makes promises," for it is now virtually impossible to run for judicial office in this state without acquiring substantial political "debt."
Alabama ranks at the very top in the cost of judicial campaigns, which commonly exceed a million dollars. If we think that all of that money has no effect on the quality of justice, then we are only deluding ourselves.
But how did this come about? Last December, a Harper's Magazine article, "The Best Justice Money Can Buy," observed that it was Karl Rove who "put the Supreme Court elections in Alabama 'on the map' in national political terms." The article then detailed how in 1992, Rove masterminded a strategy by which the Republican party seized control of the Alabama Supreme Court.
That strategy involved substantial infusions of cash into judicial campaigns by corporate interests. According to the non-profit organization, Justice at Stake, Alabama Supreme Court candidates raised $54 million between 1993 and 2006, the highest total in the nation. As a result, 16 years later all but one of the nine Alabama Supreme Court justices is a Republican.
Despite the near complete domination of Alabama Supreme Court elections by corporate interests, the cash spigot is still running. More important, the flow of corporate money has had a demonstrable effect on the quality of justice. In the fall 2008 Alabama Association for Justice Journal, an article, "Is There Any Hope?", has removed the rhetoric from the struggle between corporate interests and trial lawyers by painstakingly detailing objective facts rather than subjective opinion.
For example, the article demonstrates that in the past five years, the court has either reversed or reversed in part nearly four times as many jury verdicts as it has affirmed, and that there is an astonishing correlation between the percentage of campaign contributions received from corporate interests and votes to reverse a jury verdict.
Thus, by methodically detailing fundraising and election results, individual justice's votes on plaintiffs' damage verdicts, and the degree to which campaign contributions correlate with judicial decision-making, the article demonstrates objectively and authoritatively that all that corporate money has "made it harder for civil plaintiffs in Alabama to get and keep jury verdicts" compensating them for their injuries. In short, the article lifts the Court's skirt to reveal the red boots of a brazen streetwalker.
A wise person once admonished us that the "accomplice to the crime of corruption is frequently our own indifference." If we remain indifferent to the wholesale purchase of our highest court by corporate interests, then we will all be accomplices to every unjust decision that the court renders.
It is in this context that we must consider the campaign contributions in this year's only Supreme Court race. To date, Greg Shaw has raised $591,269 from 188 contributors, for an average of $3,145 per contribution. In sharp contrast, Deborah Bell Paseur has raised $521,009 from 1,417 contributors, for an average of $367 per contribution. Thus, even though Paseur raised just 88 percent of the total contributions that Shaw raised, the number of her contributors outnumbers Shaw's 7.5 to 1.
Shaw was able to exceed Paseur's total campaign contributions only because his campaign contributions on average are nearly 9 times as large Paseur's. In short, Shaw has raised more cash from decidedly fewer sources.
More disturbing, however, is the degree to which Shaw's contributions come from political action committees. In contrast to Paseur's campaign contributions, less than 11 percent of which come from PACs, a whopping 95 percent of Shaw's campaign contributions come from PACs. And if that is not enough to make you ill, a full 62 percent of Shaw's contributions come from PACs run by one person, Thomas Dart, a lobbyist for the Automobile Dealers Association of Alabama. Every time you watch a commercial or read an ad for Shaw, remember that the pitch is being made by car dealers.
Unlike Shaw, Paseur has collected campaign contributions primarily from individuals rather than PACs, and half of her contributors are women. When couples are included, the number rises above 61 percent.
Alabama, you should vote for Shaw only if you truly believe that juries — composed of ordinary citizens like you — are wrong more than 80 percent of the time, and that the Alabama Supreme Court needs one more justice whose sympathies lie with corporations rather than people. You should vote for Shaw only if you are comfortable buying your next Supreme Court justice from a used car salesman.
But if instead you can see the plain facts before you, and if you are concerned that corporate money threatens the sanctity of our judicial system, then you should stand up for an independent judiciary and vote for Deborah Bell Paseur.

(See previous commentary on this subject from the Anniston Star.)

Legally Speaking

The latest edition of Legally Speaking is now available on-line. This quarter's edition includes bio information on Karlos Finley (M&W's newest attorney), traffic safety, a recent case history and events at the firm. Legally Speaking has been published every quarter for the last 10 years by M&W and is dedicated to promoting important information for consumers and injury victims. It also reports on important traffic safety news. To be added to the regular mailing list please contact Mark Wolfe at mcw2@moore-wolfe.com.

Finley and Wolfe Attend ALA Banquet

On Sept 19 and 20th Karlos Finley and Mark Wolfe attended the Alabama Lawyer Association's (ALA) annual seminar and banquet. The ALA was established in 1971 to assist African-American attorneys in Alabama. This year's event celebrated 35 years of service. At the evening banquet ceremony, which was held at the Renaissance Ross Bridge Golf and Spa Resort in Hoover, Alabama, Karlos was installed as the Southeast Regional coordinator for ALA. Long time attorney and civil rights activist Demetrius Newton also received a life time achievement award and Judge John England was honored for his continuous legal and judicial service for Alabamians. M&W were proud to be sponsors for this year's event.

From the Birmingham News; 9-18-08

The race for the Alabama Supreme Court has reached $1.1 million in contributions
Thursday, September 18, 2008
ERIC VELASCO
News staff writer

Political action committees have substantially underwritten Greg Shaw's campaign for Alabama Supreme Court, while hundreds of women contributed to Deborah Bell Paseur, campaign disclosure forms show.
The two candidates for an open seat on the state's highest court passed $1.1 million in combined fundraising since campaigning began. They have collectively spent $968,000.
Shaw, a Republican, reported raising nearly $468,000 in cash and other sources between June 7 and Sept. 4, according to his latest disclosure form, posted Wednesday. He also reported spending more than $440,000 in that period, 81 percent of which was for advertising.
Paseur, a Democrat, reported raising nearly $257,000 in cash and in-kind services between June 3 and Sept. 12, according to disclosure forms sent this week to the state Secretary of State's Office. She spent more than $282,000, 58 percent of which went for ads.
Both candidates filed ahead of Monday's deadline for reporting this summer's contributions and spending. It is the only Supreme Court race on the Nov. 4 ballot.
PACs gave $439,000 in cash and in-kind services during the current reporting period to Shaw, a judge on the Alabama Court of Criminal Appeals. PACs provided 94 percent of his intake since June.
Nearly half of that PAC money came from the Alabama Civil Justice Reform Committee, traditionally the largest contributor to Republican judicial candidates. It is run by Thomas Dart, a lobbyist for the Automobile Dealers Association of Alabama.
Three other PACs run by Dart - Lawsuit Reform, Pro Business and Automobile Dealers Association - contributed a total of $75,000 to Shaw. Dart's PACs provided 62 percent of Shaw's contributions this summer, disclosure forms show.
Shaw has collected nearly $600,000 in cash, in-kind and other sources since his campaign began, 95 percent from PACs. Total spending for his entire campaign is just above $519,000.
Half of the contributors to Paseur's campaign this summer were women, her disclosure forms show. When couples are included, the number is above 61 percent.
Individual contributors provided nearly $206,000 since June to the retired Lauderdale County District Court judge, almost 85 percent of her total money in that period.
Less than 15 percent of Paseur's contributions came from PACs. Of the $37,000 she received from political action committees, $25,000 came from the state Democratic Party Executive Committee.
Paseur has received nearly $538,000 in cash and in-kind contributions since her campaign began. Women dominate the overall contributor list. Less than 11 percent of her money has come from PACs.
Paseur's total spending since her campaign started is almost $449,000.
In Alabama, the most expensive state in the nation to run for Supreme Court, million-dollar judicial campaigns are routine. The $7.7 million race for chief justice in 2006 was the second-most expensive judicial campaign in U.S. history.

Judge Deborah Bell for Ala Supreme Court

No she doesn't have a Hollywood celebrity doing her voice overs in her comercials like her opponent, but she's a great person and a top notch Judge who will be a blessing to our State as a Justice on the Alabama Supreme Court. Please watch this clip.

http://www.youtube.com/judgedeborahbell

gREAT liNK abOUT In$urance Company Rule$

Sad, but true. Watch and laugh.....until you have a claim!

http://www.youtube.com/watch?v=bVpX5fUvPlg


Mark

At the Firm

AT THE FIRM -

Wolfe Selected as Member of Academy of Trial Advocacy (ATA). (The following is an excerpt from the ATA news release) Alabama Attorney Selected for Membership in Academy of Trial Advocacy. The Academy of Trial Advocacy (ATA) is pleased to announce that Gulf Coast attorney Mark Wolfe has become a member of the organization. The organization is limited to 1000 members and Wolfe is only the second lawyer in Alabama to qualify for membership. The ATA members are lawyers who represent consumer and injury victims. Not only are members required to have extensive litigation and trial experience, but they also must have had articles published in legal journals, taught continuing education courses for other lawyers in the area of trial advocacy, handled significant or important appellate issues, been involved in public education activities regarding the legal system and been active in charitable activities. John Leighton, a Miami attorney who is the chairman of ATA, said the organization wants lawyers who have demonstrated skill in the courtroom but also excelled in other areas such as public service, teaching, writing and advocating issues on behalf of consumers and injury victims. "Simply put, ATA looks for the best of the best. We want members who are deeply committed to protecting the rights of consumers and injury victims," said Leighton. Wolfe, who was nominated for membership by New Jersey attorney, Larry Simon and sponsored by fellow Alabama lawyer Greg Cusimano of Gadsden, said ATA membership appealed to him for several reasons. "The main thing I liked was the ATA has no membership fees or dues. Day in and day out we receive material from one group or another who want you to buy your way into a super name or title. This is not the case with the ATA," he said. "Also, when I looked at the criteria for membership I realized this organization was looking for people who not only have courtroom and trial experience but who are truly committed to helping the people who we represent. I am very proud to be a member of ATA and I look forward to continuing to help consumers and injury victims in our area," he said. Wolfe is a partner in the law firm of Moore & Wolfe located in Mobile, Alabama. The firm’s primary area of practice is auto-negligence and wrongful death claims and cases.

M&W Lawyers Participate in Medical Seminar. On August 8th, Steve, Mark and Knox participated in a national medical seminar for chiropractic physicians held in Orange Beach, AL. They were part of a panel discussion on medical records and documentation for auto-negligence claims. Wolfe also reviewed his recent paper on computer assisted claim evaluation programs. Those programs are being utilized by more and more liability insurance companies when evaluating auto-negligence claims.

Third Annual M&W Charity Wine Tasting is Sunday, October 26, 2008. The event will go from 2:00 to 5:00 and again be at the Bakery Café at 1104 Dauphin Street. This year’s beneficiary is the Mobile Bar Association Volunteer Lawyer Program (VLP). The program has been providing quality pro bono legal assistance to the low income citizens of Mobile County in civil matters for over 23 years. Over 50% of the Mobile Bar Association members volunteer their time to help with this important program. He program is recognized as the most effective pro bono program in the State and one of the best in the country.
In the past two years the M&W Charity Wine Tasting has raised almost $20,000 for area charity projects. In 2006, the proceeds went to help build a community playground at Central Presbyterian Church in midtown. In 2007, the proceeds went to the ClassAct Program at USA Children’s & Women’s Hospital. The program provides teachers and class rooms at the hospital so patients can stay current with school assignments and receive attendance credit. For more information or to download ticket order forms visit the News page of the M&W web site: www.moore-wolfe.com or call 251 433-7766.