Wednesday, February 1, 2012
My client called, exasperated, and told me: "my auto insurance company called and told me they will not pay any of my auto accident bills after six weeks." Mind you, this was no fender bender. This was a broadside collision. The client was hit on the driver's side door and dragged through an intersection. The client had purchased $5000 of medical payments coverage with his "full coverage" auto policy and had paid a separate premium for that coverage.
But it was no doctor on the phone telling the client he should be "all better" after 6 weeks. It was an adjuster. She was not attempting to cut off the payment of bills to be mean or spiteful. Rather, it was simply their "company policy."
How can an insurance company magically devine that anyone in a crash who hasn't broken any bones should be fully recovered after 6 weeks? Simple. Spend millions on sophisticated software programs that input certain diagnosis "codes" and feed them into the fancy software algorithims. Voila. Out comes "data" that tells the adjuster how long their own insured should be treating with their medical providers for their injuries.
Why did many auto insurance companies sign on for sophisticated medical auditing software? Think $$$$. By creating and imposing artificial limits on medical payments coverage, they can save $350 or $700 or $1129 or whatever per claim. Now multiply that by millions of claims for medical payments and you get the point.
Never mind the fact that each person is different when it comes to recovering from muscle, ligament, tendon, and other "soft tissue" injuries. One person may not need even four weeks of treatment or therapy. Others, because of their health history, may need 10 or 12 or 14 weeks of treatment. One would think that someone--oh, I don't know, perhaps a PHYSICIAN comes to mind--should have a say so, maybe, in what treatment is necessary for that person's recovery?
That's what customarily happened before all the algorithims. Welcome to the new normal. Thankfully, many of these same companies will back down from their "policies" and re-evaluate their original position, but not without a fight from me and a threat to sue them for insurance "bad faith" in unreasonably delaying or denying payment of my client's bills.
They should give their computer program a name. Allstate's is called Colussus. I would propose Dr. Al. Al Gorithim.