You Carry Insurance…Why?

The State of Ohio requires you to carry liability insurance in order to legally operate a motor vehicle. So in the land of good hands and good neighbors, critters and fancy commercials just what does your policy really provide? They all provide liability insurance as required by the state but that’s where the similarities end. Under Governor Taft’s administration the insurance industry was, in a sense, deregulated in Ohio. Protections required by law for you as the owner of the policy and your family members were removed. All policies start with some language to the effect that they will pay the legal liabilities you incur for operating a motor vehicle. The rest of the numerous pages of the policy are exceptions to this basic statement. They start by creating a “blanket of coverage” and then they punch holes in it. We now are seeing language in policies such as: there is no coverage for a bodily injury to any member of an insured family residing in the insured’s household. This creates a huge coverage hole for you and your family. It’s probably safe to say that the average person spends more time in the car with family members than they do anybody else. A family member is usually defined in policies as a person related to you by blood, marriage or adoption and living in the same household. So, for example, a husband and wife and their children are traveling in a car. The husband/father is driving and they stop and pick up a hitchhiker along the road and continue on their way. The father doesn’t see a red light, drives through the intersection and is clobbered by a tractor-trailer seriously injuring everybody in the car. The policy you paid for may not cover the wife/mother and the children because of this exclusion.

The hitchhiker, however, is covered. That would be the end of the story with some carriers. No coverage for your family members, the people you paid to protect. Some carriers would provide coverage, some carriers have taken a piece meal approach to it and will tell you their policy doesn’t cover it but in this situation they’ll help you out. This means they know they really should be covering the claim but since they were able to hoodwink you on the policy, they’re only going to pay a portion of your damages. We suggest you ask your agent specifically if your automobile policy will cover family members in your car if you cause the collision.

We suggest you get the answer in writing because sometimes we find agents are uninformed about all the changes that the insurance companies have put into the policy. Unfortunately, we see tragic situations like the one discussed in this article all too often. Find out who you are really insuring with your policy.

The New Federal Affordable Care Act

What it will do this year:

Allowing States to Cover More People on Medicaid

States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents.

Expanding Coverage for Early Retirees

Too often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents. Applications for employers to participate in the program were available June 1, 2010.

Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions

A Pre-Existing Condition Insurance Plan will provide new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state chooses not to do so, a plan will be established by the U.S. Department of Health and Human Services in that state. This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited.

Extending Coverage for Young Adults

Under the new law, young adults will be allowed to stay on their parent’s plan until they are 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Some insurers began implementing this practice early. Check with your insurance company or employer to see if you qualify. Effective for health plan years beginning on or after September 23, 2010.

Holding Insurance Companies Accountable for Unreasonable Rate Hikes

The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases to be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium increases may not be able to participate in the new health insurance Exchanges in 2014.

Rebuilding the Primary Care Workforce

Starting this year to strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants, including funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas.

Strengthening Community Health Centers

The law includes new funding to support the construction of and expansion of services at community health centers, allowing these centers to serve some 20 million new patients across the country.

Payments for Rural Health Care Providers

Presently, 68% of medically underserved communities across the nation are in rural areas, and these communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities.

Providing Small Business Health Insurance Tax Credits

Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit.

Relief for Four Million Seniors Who Hit the Medicare Prescription Drug “Donut Hole”

An estimated 4 million seniors will reach the gap in Medicare prescription drug coverage known as the “donut hole” this year. Each such senior will receive a $250 rebate.

Cracking Down on Health Care Fraud

Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in FY 2009 alone. The new law invests new resources and requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP.

Providing Free Preventive Care

Effective for health plan years beginning on or after September 23, 2010 – all new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.

A new $15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs that can help keep Americans healthy – from smoking cessation to combating obesity.

Putting Information Online

The law provides for an easy-to-use website where consumers can compare health insurance coverage options and pick the coverage that works for them.

Prohibiting Insurance Companies from Rescinding Coverage

In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal.

Appealing Insurance Company Decisions

The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.

Eliminating Lifetime Limits on Insurance Coverage

Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.

Regulating Annual Limits on Insurance Coverage

Under the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans.

As the law rolls into effect over the next four years, each year will have new provisions.

Pay Day Lending: Does it help or hinder? Pay Day Lending FAQ’s…You be the Judge!

A referendum backed by the payday-lending industry was presented as Issue 5 on the ballot during the 2009 elections.

The payday lending industry sought to overturn the rate cap portion of House Bill 545, the payday lending reform law signed by Governor Strickland in June.

Among other reforms, House Bill 545 reduces interest rates payday lenders can charge from 391 percent annual interest to 28 percent.

A majority NO vote on Issue 5 would allow payday lenders to continue charging a 391 percent annual interest rate. The fee for a $300, two-week loan would be $45.

A majority YES vote on Issue 5 would reduce interest rate charges to 28 percent. The fee for a $300, two-week loan would be $18.

Consumer protection advocates say the high-interest and short repayment business model traps borrowers in a debt cycle, requiring them to take out new loans to pay off old ones. They support a YES vote on Issue 5.

Here are some frequently asked questions and answers regarding this issue:

What does House Bill 545 do?

The most important provision caps the annual

interest that lenders can charge at 28%, down from the 391% allowed under the old law.

What prompted the Ohio General Assembly to pass the reform package?

There was growing evidence that payday loans did not solve short-term financial problems for Ohio borrowers. Instead, payday loans caused long-term financial entrapment.

Because of the deception employed by many lenders, and the structure of the loans, customers often found themselves in a long-term cycle of repeat borrowing and constant debt.

How many people in Ohio use payday lenders?

More than 300,000 Ohio payday borrowers were trapped in an unending debt cycle last year, according to the Ohio Coalition for Responsible Lending.

Has Ohio always allowed 391% interest?

No. In 1995, the Ohio legislature gave the payday lending industry a special deal on a product that was described as a two-week loan used for the occasional emergency. The interest rate and fees needed to be higher, lenders argued, because it was just a two-week loan. So the product was exempted from the state’s usury and small loan laws and was allowed to charge fees and interests which usually amount to a 391% APR.

What impact did the 1995 change have on the payday loan industry in Ohio?

The 1995 law allowed lenders to create their own demand. Borrowers moved from payday lender to payday lender to keep their loans from defaulting. Feeding on this pool of trapped borrowers, the number of lenders skyrocketed, going from 100 payday loan storefronts in 1996, to more than 1,600 today.

If the reform law stays in place, will the payday lenders disappear from Ohio?

The reform law does not eliminate jobs or force payday lenders to close their doors. The bill simply prevents lenders from charging 391% APR. Multiple product lenders, such as pawnshops, check cashers and Rent-a-Centers will continue regular operations. According to the Ohio Department of Commerce, hundreds of payday lenders are taking the legal steps to continue operating under the new law, suggesting many think they still can make money in Ohio without trapping their clients.

The District of Columbia recently capped payday loan rates at 24%, where more people turned to credit unions that offer short-term loans at much lower rates than payday lenders, according to a July 26 report in the Washington Post.

Who wants to repeal the new law?

To date, the national payday lender trade association is the only donor supporting the repeal effort.

Do most people use the payday loan for an emergency, then get their financial house in order?

The typical payday borrower takes out 11 to 12 loans per year when accounting for multi-shop borrowing. Once borrowers begin the payday lending process, it’s often hard to close out the original loan, and they typically wind up involved in the product repeatedly for up 18 to 24 months.

An expert hired by the payday loan industry, Pat Cirillo of the Cypress Research Group, confirmed the statistic when she testified on behalf of the payday lending industry.

Rescission: Is it legal or illegal?

Rescission is the practice in which an insurance company cancels an insurance policy after a claim for benefits has been made. The insurance company then conducts what is called “post claims underwriting where the insurance application

is reviewed (often long after it has issued the policy) in order to find undisclosed or incorrect information, which it then uses as a reason to cancel the policy. This usually occurs when an expensive claim is made on the policy.

Legitimate reasons for rescinding a policy (may) include inaccurate or incomplete information, misleading, misrepresentation, omissions, failure to disclose a pre-existing medical condition, and lying or concealing information about your medical history.

Insurance companies have long engaged in the practice of rescission where they investigate policyholders shortly after they have been diagnosed with life-threatening illnesses.

In one particular instance in 2002 Jerome Mitchell, a 17 year old college freshman from South Carolina, learned he had contracted HIV. In his favour, he thought, he had health insurance. However, shortly after his diagnosis, his insurance carrier Fortis – now Assurant – cancelled his policy.

He was told that without treatment his HIV would become full-blown AIDS within a year or two and he would die within two years after that. At this, he took legal action and hired an attorney.

In 2004, a jury in Florence County, South Carolina, ordered Assurant Health to pay Mitchell $15 million for wrongfully revoking his policy. And in September 2009, the South Carolina Supreme Court upheld the lower court’s verdict but reduced the amount to $10 million.

This win against Assurant, allowed Mitchell to not only get justice for himself but it helped expose wrongdoing on the part of Assurant. It took being sued before his insurance carrier would restore coverage, approximately 22 months later.

It was discovered that Assurant was targeting policyholders with HIV. A computer program and algorithm triggered an automatic fraud investigation for every policyholder recently diagnosed with HIV, as the company searched for any pretext to revoke their policy. In addition, for some time Assurant had been making recommendations for rescission and without good-faith investigation, acting on them. They had pre-programmed its computer to recognize the billing codes for expensive health conditions, which would trigger an automatic fraud investigation by its cost containment division whenever the code was recognized.

It was obvious that Assurant was focusing on claims that carried a high cost for treating the illnesses in question. But Don Hamm, the CEO of Assurant, defended the company stating that rescission is a necessary tool to hold the cost of premiums down for other policyholders and one of many protections supporting the affordability and viability of individual health insurance in the United States under our present system. But isn’t the purpose of health insurance to protect policyholders if they are or when they become ill so they can seek and receive the medical attention they need? The envelope has been pushed by insurance companies and they’ve come close to crossing legal boundaries, and in some cases have stepped over them, to prioritise profits over the care, rights, and interest of their customers. In doing so, they demonstrate a lack of regard for the health and safety of those of whom they are suppose to serve by, in some instances, gambling with their lives such as in the Mitchell case.

Hamm further stated that those who had their policies rescinded had attempted to intentionally mislead the company and that there are times when they discovered an applicant did not provide complete or accurate medical information when they underwrote the risk.

On the contrary, state, federal and congressional investigators and consumer advocates said that in only a small percentage of cases were there people who had their health insurance cancelled for a legitimate reason.

Based on an investigation by the House Energy and Commerce Committee (as well as earlier ones) found that thousands of vulnerable and seriously ill policyholders have had their coverage canceled by many of the nation’s largest insurance companies without any legal basis. The congressional committee found that three insurance companies alone saved at least $300 million over five years from rescission. One of those three companies was Assurant.

Recently, insurers have revoked policyholder’s policies for less serious medical conditions such as diabetes, depression, and high blood pressure because of the lifetime of care and bills that generally follow with treating these conditions.

Mitchell is one example of many who have won the battle against unlawful rescissions rendered by health insurance companies but there are still far too many others who have lost the battle because they didn’t fight, didn’t realize the had legal footing or lost their lives because they lost the only insurance that could help them fight for their lives.

For this reason, rescission proves to be a very serious issue. It is a growing concern primarily because insurance companies revoke policies for the very reasons policyholders need coverage – when they are sick and need health care. Insurers are comfortable with accepting payments in the form of premiums but do not want to cover their policyholders for the purpose they pay to be insured. They don’t want to spend money taking care of those they insure when they need healthcare coverage the most.

Sadly, there are still others (millions) who can’t get healthcare insurance because of pre-existing conditions. Who will cover them? How will they get the care they need to treat their conditions? To be continued….

Sometimes you have to get a little gum on your shoes.

We currently represent a client who was on his way to work in the morning and who stopped behind a school bus picking up children. Our client was rear-ended by a teenager traveling at a high rate of speed. The teenager’s car, which was destroyed, completely collapsed the rear end of our client’s vehicle, and forced it into the back of the school bus. Our client sustained spinal disc herniations ultimately requiring back surgery.

The teenager was only insured for a total liability limit of $25,000.00.

His carrier turned that over, leaving us with an underinsured motorist claim to pursue with our client’s insurance company. Fortunately, our client had underinsured motorist coverage on the day of the collision in an amount that would fully compensate him for his injuries. As part of the process of pursuing his claim, we requested that the claim be arbitrated with his insurance company pursuant to the terms of the policy. If done correctly, arbitration goes faster, costs the parties less, and spares the clients the emotional roller coaster, loss of earnings, and hard work involved in a trial.

The insurance company refused our call for arbitration and wanted to force our client to go to trial or else accept their low offer. They based their refusal on a recent “endorsement” they said they had filed with the Department of Ohio Insurance and claim they sent to him. Ohio law requires all endorsements for this type of policy to be filed and accepted by the Ohio Department of Insurance prior to being used by the company and sent to their insured.

We didn’t take their word for it. Instead, we went down to the Ohio Department of Insurance archives and combed through hundreds of filings and thousands of pages on computer and microfiche. Nowhere did we find the “endorsement” they said they had filed with the Ohio Department of Insurance.

At that point their story changed. They admitted they had never filed this particular “endorsement”, but argued they had filed one an awful lot like it and so argued they had complied with the law.

The insurance company also admitted this other “endorsement” was not a part of our client’s insurance policy. Yes, we had to go to court on this even with their admissions.

In court, both sides briefed the issue. On their side was a bizarre hope that the court would cross its eyes, blur these two documents together, and come up with a validly filed endorsement binding on our clients. On our side was the law. We argued that the plain language of the statutes in effect in Ohio since the 1950s required them to file this endorsement and that if they were seeking to impose the other endorsement on our clients, they should have included it in the policy.

Fortunately, the court agreed with us and ordered the case to arbitration. Unfortunately, the insurance company appealed and the case is presently before the 9th District Court of Appeals. Stay tuned.

The Incredible Shrinking Umbrella

The year was 1973. Some of the biggest hits on TV were Kojak, M.A.S.H., and The Waltons. Movie tickets cost $1.75 each. Gas was 40 cents a gallon, and a stamp was 8 cents.

Obviously, all those prices have gone up quite a bit in the last 37 years. But one very important number hasn’t budged since 1973: the state minimum insurance requirement in Ohio, which has been frozen at $12,500 per person. Insurance is meant to “cover” you, and there’s a reason one of the largest insurance companies, Travelers, chose an umbrella as their symbol. Insurance is meant to cover you in the event of a loss, but in Ohio this umbrella has been shrinking every year.

Now certainly, in the last several decades the amount of money you pay for insurance has gone up… and up… and up some more. But this absolute minimum protection has not changed despite the concerted efforts of consumer advocates in recent years.

A 1973 dollar is worth about $4.85 today. [So in the early ’70’s our state set the floor – the absolute minimum coverage needed to protect our citizens – at $12,500.00. Due to inflation, this has eroded to the equivalent buying power of about $2,500.00.] Just to keep pace with inflation, the state minimum limits should accordingly be at least $60,000.00. (This doesn’t even factor in the spiraling cost of medical care.) Drivers with state minimum limits tend to be younger, higher risk drivers. Higher risk drivers are those drivers that are the most likely to cause an accident injuring you or your loved ones. The current bill to finally fix this situation is House Bill 23 which is before the legislature in Columbus. The insurance industry is a powerful force, but legislators respond to their constituents. Email your state senator and representative and tell them to support increasing the state minimum auto limits. You can find your legislators at http://www.legislature.state.oh.us/.

Bills have been introduced repeatedly over the last 10 to 15 years to raise those limits more in line with the rest of the country and with the reality of current prices. But the insurance industry fights this bill every time, claiming they will have to raise rates drastically to provide that level of coverage. Forgive us, but we think this is a pretty walleyed way of looking at things. As insurance consumers, we are constantly hit with increased rates most of which have nothing to do with our own claim history but have to do with increased cost of claims, etc. So the insurance companies get the benefit of increased premium dollars every year and yet this state minimum has not increased a penny in over three decades.

If the state minimum hasn’t changed, the question policyholders should be asking is where are the monies we pay in inflated premiums going? Insurance companies have raised premiums of their policyholders with out increasing their risk regarding the amount they might have to pay under the coverage.

The only way to protect yourself from this shrinking coverage is to make sure you and your loved ones are covered by uninsured/underinsured motorist limits much higher than the state minimum. As a rule of thumb, uninsured/underinsured motorist coverage is the most important insurance coverage to you and you should have as much as you can afford on your policy. Talk to your agent; you’d be surprised how affordable it can be to increase this vital protection.

Why We Need Trial Lawyers

The alleged need for “tort reform” has become a refrain in American political life. Yet for all the demonizing of trial lawyers, the reality is that product-liability litigation has become an ever more important means of keeping consumers safe.

Case in point: the current Toyota Motor Corp. recalls, with their attendant revelations of corporate obfuscation. This is only the most recent situation in which lethal defects have gone uncorrected for years at least in part because of insufficient government oversight.

In model after model, as we’ve now learned, car owner complaints were either minimized or ignored altogether by Toyota and by the regulatory agencies that were supposed to police the company. In one review of federal records, the Los Angeles Times found 2,600 complaints of sudden acceleration from 2000 to 2010 by Toyota and Lexus owners. And according to CBS, recently released internal company documents indicate that as far back as 2005 Toyota was tracing its sudden acceleration problem to its software-not to floor mats.

Yet for nearly a decade, neither Toyota nor federal regulators aggressively addressed the problem. Toyota is now likely to face a rising tide of class action lawsuits as consumers look to their historic fallback: the courts.

Regulation is crucial to the creation of a level playing field for consumers, particularly in this era of growing corporate power. But regulation alone has never been enough. Federal agencies such as the Food and Drug Administration (FDA), the Consumer Product Safety Commission and the National Highway Traffic Safety Administration have long been swamped by large workloads. And lobbyists are adept at weakening and fending off regulations.

The laissez-faire policies of the Bush administration only further weakened regulatory agencies by cutting funding and personnel, since such agencies were viewed as an impediment to private-sector growth. Government watchdogs soon found themselves so overwhelmed and undermanned that they could scarcely do their jobs.

Consider the FDA. By the mid-2000s, the FDA’s caseload extended to more than 11,000 existing drugs, some 100 new drugs a year, and a breadth of products from food to vaccines to medical devices that comprise approximately 25% of all consumer spending.

Resources were stretched so thin that a 2006 report on drug safety by the Institute of Medicine

of the National Academies found that the FDA simply couldn’t ensure the safety of new prescription drugs. The reasons given? Inadequate funds, cultural and structural problems, and “unclear and insufficient regulatory authorities.”

The FDA is just one example. Until April 2009, federal motor vehicle safety standards were so weak that many vehicles could comply and still sustain severe roof collapse from a force equivalent to a 5 mph parking lot collision. Similarly, drivers and passengers are far too frequently ejected in rear-end collisions because the minimum standard for automobile seatback strength is so low that many folding lawn chairs can pass the test.

The recession threatens to further starve the agencies responsible for consumer safety, even as the tough economic climate subjects manufacturers to brutal competition and discourages them from investing in product safety on their own.

As a result, consumers are increasingly left with the courts not only to compensate them when the regulatory system fails to protect them, but also to deter manufacturers from cutting corners in the future.

Product liability lawsuits have played a crucial role in ensuring public safety, encouraging-and sometimes compelling-manufacturers to put safety first. A 1988 survey of 264 CEOS of manufacturing companies found that a third had improved their product lines as a result of the threat of litigation, 35% had improved product safety, and 47% had improved warnings to consumers.

At the same time, such lawsuits have provided important assistance to agencies overseeing product safety. Litigation involving defective products has increased access by regulators and

the public to critical safety information about particular products. This has resulted in stronger regulations, safer new products, and the removal of dangerous products from the market. Just

last year, in Wyeth v. Levine, the Supreme Court noted that state tort suits “can serve as a catalyst” for regulatory action.

Litigation has not only advanced public safety, but has encouraged improvement in products almost too numerous to mention: air bags, seat belts, child safety seats, tires, minivan doors,

hot water vaporizers, children’s pajamas, farm machinery, firearms, building materials, tobacco products, intra-uterine contraceptive devices, tampons, sleeping pills, anti-depressants, pain medication, appetite suppressants and many more. Toyota is just another sign of how much work remains to be done.

Strong product liability laws remain vital to public health and safety-no matter how passionate the political debate on tort reform.

-Tagged from the February 24, 2010 issue of The Wall Street Journal, column written by Mark Robinson and Kevin Calcagnie

Upset with your health insurance premiums? That’s just half the story

Sometimes we find ourselves representing a client whom we represented in a personal injury claim 10 or 15 years ago.  These clients are invariably amazed at the shear number and complexity of additional insurance wrinkles that have sprung up over the intervening years.  One of the most irritating recent wrinkles involves health insurance. 

For those of us who have paid health insurance premiums for a number of years, we have seen years of double-digit percent increases in our premiums.  Thousands of dollars of our income go toward paying a health insurance company for the sole reason that it pay our medical bills.  And once a premium dollar is paid, you never get it back.  Your premiums are non-refundable.

But the rules just keep getting better for the health insurance companies.  If they pay a medical bill on your behalf, as required by the policy you’re paying for, most of them will now leave no stone unturned in a search to get that money paid back out of any injury claim you may have.  The end result is that any recovery you’re pursuing against a wrongdoer could be completely gobbled up by your health insurance company – to repay them… for bills… you paid them premiums… to pay in the first place! 

And don’t bother asking them for your premiums back – remember? Those are non-refundable. 

All of this is head-spinning, wrong, and yet perfectly legal.  In fact, the Ohio Supreme Court recently strengthened the insurance companies’ rights even further.  Question:  If an insurance company collects your hard-earned dollars to provide you insurance, pays your bills as a result, and then gets all of that money back at your expense, is that insurance anymore?

It gets worse.  We all know that different folks are insured at different premium levels, depending on factors such as age, health, number of dependents, etc.  All of these factors are considered in the underwriting process that ultimately determines how much premium you have to pay for your policy.  Insurance executives have testified under oath that the possibility of getting their money back in an injury claim is not factored into underwriting.  If it were, it would certainly reduce premium to some degree.  Because any money recovered as part of  a victims legal action is not considered during underwriting; it represents a complete windfall to the insurance companies.  They charge a full premium based on normal risk factors.  When a claim is made, if they’re “fortunate” enough to identify an auto insurance policy to get money from instead for medical bills that they are contracted to pay, it’s  pure windfall profit.

While this is all a big boost to the bottom line of the insurance company, it comes at your expense.  As an example, if there were $50,000 available to pay you for your injury claim but your health insurance company paid $60,000 for your medical bills, you are literally looking at a situation in which, on paper, you as the injured person get nothing.  Now at this point, most of the health  insurance companies will offer to reduce their lien and “only” recover one-third to one-half of the $50,000 available.  In so doing, they portray themselves as good Samaritans taking a hit on your behalf.  (Remember, this is all pure profit to them). 

Most clients we talk to about this get pretty worked up.  Well, so do we.  The ultimate irony is that this issue hurts the most seriously injured the worst.  Those whose lives have been forever altered by permanent injuries, and who have experienced hundreds of thousands of dollars in medical treatments, are the same ones who face the prospect of losing hundreds of thousands of dollars of their claim only to be turned over to an insurance company to boost its bottom line. 

Fortunately, the law requires insurance companies to take certain affirmative steps to secure these rights, and  we have had success demonstrating that the insurance companies have not done everything they were required to do.  This boils down to half gum-shoe detective work and half legal scholarship.  We have to make sure we have the correct policy and that the insurance company has actually written into the policy necessary language to even accomplish this.

Especially on permanent injury or catastrophic loss cases, this issue can be as important as all other issues combined.  We have had cases where liability was clear, injuries were permanent,  insurance coverage was limited to $100,000, and the at-fault insurance carrier promptly offered those limits… to the health insurance company!  The fight then becomes doing everything we can to put every dollar possible in our client’s pocket.

This fight is not for the faint of heart, and it is aggravating for us to be the bearer of bad news when we so strongly disagree with this policy.  However, we have found success, and we find it personally fulfilling, to battle back these liens in defense of our client.

Know Your Lawyers: What they do & what they don’t

The law firm of Willis & Willis is not a general practice law firm. We concentrate our efforts on representing individuals who’ve been injured physically and/or financially by someone else’s wrongdoing. Attorney Mark Willis is licensed to practice before all state courts in Ohio and West Virginia. Attorney Todd Willis is licensed to practice before all state courts in Ohio and Pennsylvania. Both are also licensed to practice in the United States federal courts. Mark Willis has been practicing law for over 22 years and Todd Willis for 11. Together they have represented thousands of injured individuals at all levels of the judicial system. In recognition of his expertise in representing injured individuals Mark Willis has been asked to represent the American Association for Justice on issues in other states. In addition to representing individuals, both Mark and Todd have been asked to represent the Ohio Association for Justice on issues pending in this state, including issues pending before the Ohio Supreme Court and in legislative committee hearings. Both Mark and Todd have been recruited to teach other lawyers in continuing legal education seminars on various topics related to representing injured individuals. Both Mark and Todd have served as the president of the Summit County Association for Justice. Mark Willis has served on the board of Ohio’s Association for Justice and was instrumental in beginning a section dedicated to helping injured consumers. Todd Willis has also served on the board of Ohio’s Association for Justice and served as the section chair relating to representing injured consumers.  

Our philosophy has always been to represent clients one at a time, in a custom-tailored process, to maximize the benefits for each client. We have consciously rejected the approach some lawyers have taken in recent years, which embraces solicitations, mass mailings and advertising while reducing the practice of law to assembly-line claims adjusting. Our motto is we take care of our clients and our clients will take care of us. We strive to earn each client’s trust and our goal is to obtain the best possible outcome for each client. As a result, almost all of our clients come to us as a referral from another client, another lawyer, or a judge.

Recent Legal Decisions Received by the Attorneys at Willis & Willis Co.

Have you ever received paperwork from your insurance company telling how they’ve changed your policy? Have you ever wondered why insurance companies have the right to just change their coverage at any time? If you and I entered into an agreement where I would pay you $100.00 to paint my barn, I cannot unilaterally just change my mind in the middle of the job and tell you I’m only going to pay you $50.00.

Why is it that insurance companies have the right to change coverage whenever they feel like it? We recently had a client who had auto insurance coverage with a major insurance company. (You’ve seen their ads on T.V.) They sent him paperwork changing his policy. This particular change clearly affected his rights under the policy as it pertained to injuries he sustained in a collision. Ohio has statutory regulations, enforced by the Ohio Department of Insurance, specifying how insurance companies can modify their policies. Through extensive research through the records at the Ohio Department of Insurance in Columbus we were able to establish that the insurance company had not followed the legally required procedures to change the policy language. The court ruled in our client’s favor finding that the original policy language governed. This case involved our firm spending significant time and energy chasing down a long-shot lead to better advocate for our client. 

In a case where a woman was killed when she was struck by a vehicle on private property, we were successful in establishing that the vehicle’s driver’s insurance provided coverage for funeral expenses and medical bills. Allstate Insurance Company insured the driver and argued that she should not have been considered an insured under their policy. The language, however, of the Allstate policy and the existing case law established that she was in fact an insured. The court ruled in our client’s favor.         

In the same case, American Family insured the woman who was killed. We were successful in arguing that American Family provided coverage to her family. American Family argued they did not owe coverage to the family members. The court ruled in the family’s favor citing the language used by American Family in their policy and found that the total $325,000 limits in coverage was applicable. 

In another case, a client purchased a used car from a dealer with a 30-day warranty and the car immediately experienced problems that the dealer couldn’t or didn’t repair. After many repair attempts, our client left the vehicle at the dealership and demanded her money back since the dealer could not get the vehicle to run properly. The dealership refused to refund her money but turned around and sold the car to someone else.  The court agreed with us and held that the dealership’s actions violated several provisions of Ohio’s Consumer Sales Practices Act. The court awarded our client all of her money back plus her damages. This amount was tripled per the statute, as the Defendant had engaged in the wrongful conduct knowingly, and our client recovered her attorney fees. All of this totaled $58,000.00.

   We recently tried a rear-end automobile collision wherein the plaintiff claimed permanent and significant neck injuries and the defense claimed that it was a mild collision causing hardly any damage to the vehicle let alone to the driver. Our client turned down an insurance company offer of $20,000.00. The jury only awarded $11,015.00.

   We recently arbitrated a case where our client was injured in a multi-car rear-end collision while on the job. Our client had significant shoulder injuries and Worker’s Compensation paid her medical bills and lost wages. We were successful in getting the main defendant’s insurance company to pay their limits of $50,000.00 to our client. We then pursued an underinsured motorist claim under our client’s insurance policy and forced the case to arbitration. Our client’s insurer claimed the $50,000.00 already paid was all the claim was worth. The arbitration panel awarded an additional $32,500.00. We were also successful in negotiating a reduction of the amount of money Worker’s Compensation wanted returned.