Posted January 21, 2017 - Phillip C. Gilbert, Attorney at Law
If you watch mainstream television, then you are aware of the fact that many of the nation’s largest insurance companies have chosen to woo customers with funny commercials, i.e. Flo from Progressive, the “Mayhem” Allstate spokesman, Geico’s infamous gecko, etc., etc. The thing is, these ads have zero to do with the quality of the product that you receive, and we all want true “protection” in the unfortunate event that we’re involved in a car accident.
Something that absolutely is not funny is the disturbing fact that, when it comes to an insured’s own PIP claim, the large insurance companies seem to be requesting that the insured attend “Independent Medical Examinations” more often, and earlier on. As is discussed elsewhere on this website in more detail, “PIP” is the acronym used in the industry when discussing “Personal Injury Protection” coverage. PIP coverage is a first party coverage; meaning that our own insurance policies include this coverage (as opposed to being a coverage available through the policy covering another vehicle in those cases where a car accident is caused by someone else). This coverage is mandatory in Oregon (for automobiles, not motorcycles). It includes reimbursement of an insured’s medical care costs, for up to one year after the date of a car accident, and up to the amount of the policy coverage limit (Oregon law mandates that all policies issued in Oregon provide a minimum of $15,000.00). The coverage is available for care reasonably related to injuries suffered in a car accident.
In my experience (this is my 31st year in the industry, and I first worked for a very large insurance company and then law firms hired by insurance companies), the larger insurers are increasingly becoming more and more aggressive in challenging whether medical care that their own, premium-paying insured receives after a car accident, is needed (if the care in question is determined/claimed to not be reasonably necessary, the insurer will refuse to reimburse the insured’s medical care providers’ bills, leaving the insured personally on the hook to pay those bills). What happens in this scenario is that your own insurance company – the one that you have been paying hundreds (or more) of dollars a year to – requests that you attend an Independent Medical Examination; ostensibly for the purpose of having an allegedly “independent” physician examine you, and review your medical records, and thereby determine whether you need/needed medical care past a certain date. The dirty truth is that these examinations are almost never “independent.” The insurance companies tend to use the same batch of physicians over and over again and, guess what: it turns out that these physicians’ reports almost always end with the conclusion that the insured does not need any more medical care whereafter the insurance company refuses to pay your medical care providers’ bills. Some would describe this process as being a “racket.” Indeed, in many, many cases, the content of the “independent” physician’s report reads like dozens of other reports that they have generated. The punch line is often to the effect of: the person sustained a “soft tissue” injury and the medical research confirms that all such injuries completely resolve within 6 weeks; 3 months at the outside.
I will save a discussion of “soft tissue” injuries for another article but do want to add another word to the wise; referring to you, when you are injured in a car accident and require medical treatment for your injuries. Specifically, I would note that in my experience some of the insurance companies are relying upon “records reviews” in lieu of independent medical examinations. In a “records review,” a doctor is supplied with copies of the insured’s medical records and asked to comment on the reasonableness of their medical care. In essence, a records review is like an independent medical examination but without the examination. (USAA goes this route frequently). Predictably, the reviewing physicians seem to almost invariably conclude that the medical care in question is not needed, and the insurance company relies on that opinion to discontinue benefits. What I have noticed – in the trenches, if you will – is that the doctors that are used to perform these records review may have dubious qualifications. For example, last year we received such an opinion letter-coverage denial based upon the conclusions of an acupuncturist, from Colorado, whose own website revealed that they claimed to specialize in “facial rejuvenation” and “infertility.” This is but one example.
The upshot here is that even though your insurance company’s television commercials seek to assure you that they are on your side and will protect you well if and when you open a claim, in the vast majority of cases that is not in fact the case; and you’ll end up needing to lawyer-up.
Posted October 30, 2015 - James R. Gregory, Trial Attorney
Senate Bill 411
The legislature has passed, and the Governor has signed, a new piece of legislation that will change the auto insurance landscape in Oregon beginning January 1, 2016. The changes are significant, and have the potential to be life altering for injured Oregonians going forward.
“Underinsured motorist” coverage is an important part of any auto insurance policy. If you are seriously injured through the fault of another driver, and their liability insurance is inadequate to cover your damages, your own UIM policy takes over. However, under current law, your UIM will only pay to the extent that your purchased coverage exceeds the coverage of the at fault driver. In other words, if the other driver has $25,000 in coverage, and your UIM policy likewise provides $25,000, your policy pays nothing. This counter-intuitive result has finally been changed.
Under the new law, using the above example, the injured driver’s UIM policy would be available to compensate for damages over $25,000. The UIM coverage will “stack” on top of the at-fault driver’s coverage, making $50,000 available. For someone facing medical bills and lost wages resulting from a serious accident, this will make a big difference.
PIP, or “personal injury protection,” is Oregon’s version of “no fault” auto coverage, and is a mandatory part of all auto policies in the state. If you are injured in an accident, your own PIP coverage takes care of the initial medical bills and wage loss, regardless of who is at fault. If the other driver is later deemed responsible for your injuries, your insurance company is entitled to reimbursement from whatever settlement you eventually recover. This reduces the amount of money available to the injured person.
Under current law, PIP reimbursement is not available until all the injured driver’s economic damages are compensated. Unfortunately, non-economic damages are often a big part of an auto accident claim, but PIP is reimbursed before non-economics are paid. Under the new law, there will be no PIP reimbursement until ALL the injured person’s damages are taken into account. This will allow injured Oregonians to receive fair compensation for their injuries, and put their PIP carriers behind them in line for funds which are often inadequate to cover all their losses.
How to Take Advantage of the Changes
In order to benefit from the new law, it is essential that your auto policies are either new, or renewed after January 1, 2016. It may be a good time to switch carriers altogether in the new year, as studies have shown loyal insurance customers are often penalized for that loyalty with higher rates.
The changes embodied in SB 411 are too important to ignore. . .make plans to renew or get a new auto policy as close to January 1st as possible.
Posted September 30, 2015 - James R. Gregory, Trial Attorney
The Oregonian reported today that highway fatalities have risen 31% in the past year, according to the Department of Transportation. Pedestrian and motorcycle deaths have experienced the sharpest increases, at 64 and 15 percent, respectively.
While DOT officials declined to speculate on the reasons for the upswing, the cause is likely growth in miles driven, as we reported earlier this year. As motorists venture into unfamiliar territory, especially on rural roads, accidents increase dramatically.
Phillip C. Gilbert & Associates would like to remind you to be vigilant as you enjoy fall driving. Avoid distractions, keep your concentration up, and exercise caution on unfamiliar roads.
Posted September 21, 2015 - James R. Gregory, Trial Attorney
The Los Angeles Times is reporting that German automaker Volkswagen added programming to the ECUs of a half million diesel vehicles, with the express purpose of cheating on U.S. emissions tests. In a show of cynicism that would even make your bitter uncle blush, VW engineered their engine management software to detect when a typical emissions test was being run, and drastically (and temporarily) reduce emissions for the test. In normal driving, the VW/Audi “Clean Diesels” belch out 40 times allowable NO emissions.
Massive fines are clearly in the offing for VW, as well as a public relations disaster that could harm the market for diesel cars for decades. Additionally, there can be no doubt that the resale values of effected vehicles will plummet, as the environmentally conscious ditch their Teutonic polluters for hybrids. Can you say diminished value?
* * UPDATE * *
The “clean diesel” link above is now returning a predictable “404” error, as VW apparently thought better than to leave it hanging in the breezes of the Interwebz. However, thanks to the Wayback Machine, the page can be enjoyed in its full glory RIGHT HERE.
Posted September 18, 2015 - James R. Gregory, Trial Attorney
In May of last year, the New York Times eloquently reported on how an ignition switch fault destroyed an unknown number of lives and lead to a recall of over two million vehicles. Per that Times article, GM withheld information from families and government investigators about the defect, leading one innocent driver to be charged with homicide related to the death of her boyfriend.
Yesterday, GM announced that it will spend as much as $900 million in settlement of a criminal case brought by the U.S. Department of Justice in connection with its horrific conduct in the case. This sum will be in addition to $575 million in civil settlements with private parties.
Phillip C. Gilbert & Associates applaud the Justice Department as well as lawyers for GM’s victims for bringing the company’s malfeasance to light, and securing recompense for those injured.
Posted September 11, 2015 - James R. Gregory, Trial Attorney
According to a recent article in the Oregonian, a study just completed by Allstate Insurance shows that Portland drivers have more automobile collisions than all but seven of the nation’s largest 200 cities.
Allstate statistical research showed that Portland drivers are involved in auto accidents once every 6.9 years, contrasted to the national average of once in a ten year span. Allstate, like most carriers, takes these types of statistics into account when evaluating risk and setting rates, so we might expect a bump in premiums as a consequence of our apparently poor driving.
Also of interest is the fact that Portland drivers experience over 18 “hard braking events” per 1,000 miles driven, again above the national average of 16 such incidents.
We’d like to remind our fellow nor’westerners of the two second rule, which helps drivers maintain safer following distances. This, in turn, reduces instances of panic braking, and rear-end accidents as well.
Posted August 10, 2015 - James R. Gregory, Trial Attorney
We are pleased to announce that firm founder Phillip C. Gilbert has been named to the rolls of “Super Lawyers” for 2015. This marks the third consecutive year Mr. Gilbert has been chosen for this prestigious and exclusive award.
Super Lawyers is a rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievement. The selection process includes independent research, peer nominations and peer evaluations.
Posted August 4, 2015 - James R. Gregory, Trial Attorney
According to figures published by the United States Department of Transportation, miles driven on American roads are surging, recovering rapidly from a 2009 low. While this phenomenon can certainly be interpreted as good news in terms of the overall economy as well as fuel prices, it also signals an increase in traffic accidents and injuries.
Historically, when driving increases, not only the number but the severity of automobile crashes increase as well. This results from an upswing in the number of people driving on unfamiliar roads at highway speeds. Insurers are feeling the pinch from this phenomenon, due to a rising number of claims as well as the rising costs of repairing today’s complex vehicles. Allstate, for example, recently reported a 38% drop in revenue this quarter, compared to Q2 last year, and its stock prices dropped as a result.
We would like to remind you to take extra care when you hit the open road this summer, and keep your family safe, happy and healthy.
* * UPDATE * *
In response to the loss of revenue suffered by Allstate and reported above, the company will be holding out their good hands for a rate increase, along with instituting cost cutting measures and potentially selling customer data in an effort to make ends meet.
Posted July 31, 2015 - James R. Gregory, Trial Attorney
According to an article in this week’s Oregonian, a Washington woman has filed suit in Multnomah County against Fred Meyer for a serious mistake in filling her prescription. The lawsuit alleges that Anna Bell went to the Burlingame location of Freddy’s to pick up fertility pills. What she got instead was a powerful anti-depressant called Clomipramine, an older compound with a long list of adverse side effects.
Ms. Bell is seeking just over a half million dollars in damages, including past and future medical expenses, lost income, and life impact damages.
The error appears to flow from a similarity in spelling between clomipramine and the correct drug clomiphene, and comes on the heels of a 2012 survey of “chain” pharmacy employees which intimated that large retailers such as Fred Meyer have created a work environment inviting such problems.
Posted July 24, 2015 - James R. Gregory, Trial Attorney
Ride-sharing pioneer Uber, a recent entrant to the Portland car-for-hire market, has posted a website urging people to “Save Uber Oregon!” The site encourages Uber supporters to “tell the state leaders to stop holding Oregon back” and oppose two house bills “that would end ride sharing in Oregon.”
Strangely absent from Uber’s plea are any details about the contents of HB 2995 and HB 2237, which would require the company to provide modest insurance coverage to drivers while they are logged onto the Uber service and seeking passengers. Uber maintains it should provide coverage only while its drivers are carrying its customers, which creates a dangerous gap in protection – personal auto insurance would likely deny payment for accidents during this “interim” period, because actively seeking paid fares is a commercial activity.
The legislature is attempting to force Uber to provide coverage of $50,000 per person and $100,000 per incident, which is a meager sum indeed compared to the $500,000 minimum mandated for traditional cab companies.