Pre-Existing Condition And Health Insurance

Fort Worth insurance attorneys will get calls from people who have been denied benefits by their insurance company because the insurance company claims the person has a pre-existing condition. KSAT recently posted an article about this practice. Here is what the article tells us.
The KSAT 12 Defenders uncovered a little-known fact that insurance companies consider a person’s weight when awarding settlement monies for accident claims.
Maria Vasquez was in a wreck caused by the other driver in May 2013 and found out State Farm is considering her weight while deciding how much to award her in damages.
Vasquez is 5 feet 3 inches tall and weighs 180 pounds and Vasquez does not consider herself extremely overweight. “I would say average to be honest,” Vasquez said. “I’m average.”
She and her fiancé were hit at an intersection on the Northwest Side by a driver who ran a red light. They suffered cuts, bruises and whiplash and their car was totaled.
In settling the case her lawyer, Adam Cortez, found out the insurance company was offering to settle with her for less money because her weight was a factor.
Cortez said the claims adjuster was holding back a few thousand dollars and he was trying to figure out why.
“(The claims adjuster) blurted out, ‘well your client’s overweight. And I did say what the hell does my client’s weight have to do with this claim. ‘Well overweight people don’t heal as fast.'”
Cortez disputed that reason and has yet to settle the claim. “That is absolutely preposterous and I said you have no medical evidence to support that and you won’t find a doctor to say that,” Cortez said. “This was the first time I ever learned that they factor in weight and so it raises the obvious question, how long has this been going on? How many people for so many years have been denied thousands of dollars that they needed in damages for no reason other than the fact that they were overweight.”
A letter from State Farm confirmed that.
Claim Representative Janet Lorenz-Floyd wrote: “Ms. Vasquez’s pre-existing condition, including her height and weight, was considered in our evaluation.
“However, as outlined in our previous correspondence, was not the primary cause for our range of value.”
Vasquez is angry and said insurance companies should not take money from those who are not the perfect body type.
“You’re 5-3 and weighing 115 pounds, unless you’re in that category then you’re not going to be getting taken care of if you’re in an accident,” Vasquez said. “I’m active with my two year old, I take care of the park, I work anywhere from 10 to 12 hours a day at my job. It’s not a problem for me.”
State Farm would not make a statement about the accident because the case is still in litigation and for privacy issues, but spokeswoman Patti Kelly wrote in an email that the company is being fair: “If someone files a bodily injury claim against another person, they make their health history and pre-existing conditions pertinent to the evaluation of the value of the claim. State Farm’s obligation is to evaluate and pay what we owe. We evaluate claims fairly every day.”
The Defenders asked Michael Barry with the The Insurance Information Institute whether considering factors such as a victim’s weight is common practice.
In an email he wrote: “Auto insurers, upon receipt of a bodily injury (BI) claim, review the claimant’s health history to determine which injuries can be directly attributed to the accident.
The auto insurer becomes aware of the claimant’s general health status, which may include weight, in this way. But the insurer’s payout to the claimant is based exclusively on the medical expenses arising out of the accident.
Based on the correspondence you shared with us, it appears as though State Farm covered all of the reasonable and customary medical expenses they were legally obligated to pay.”
Vasquez disagrees and wants people to know weight can be used against accident victims. This case has not been resolved and a lawsuit could be filed.
Cortez said he has never seen anything like this in 23 years of practicing law and that if across the nation insurance companies are giving less money to overweight accident victims, “‘it’s a travesty.'”