Articles Posted in Medical

Med-Pay is suppose to be an easy way to get medical bills paid when someone is injured in an automobile accident. As most insurance lawyers can tell you, that is not always the case. The San Antonio Express-News published an article on January 6, 2016, dealing with the way USAA, based in San Antonio, treats its customers when it comes to Med-Pay benefits in their policies. The article is titled, Med Pay Lawsuits Dog USAA.

San Antonio’s USAA continues to be dogged by lawsuits that allege it uses a “cost containment scheme” to delay, deny or reduce medical payouts to customers injured in auto accidents.

USAA has been vigorously defending such cases for more than a decade, though the number of lawsuits couldn’t be determined.

Dallas area attorneys need to know actions that can be taken to fight hospital over charging uninsured patients. The Washington Post published an article in June that named 50 hospitals that charge uninsured more than ten times the cost of care. Three of those were in the Dallas / Fort Worth area. Here is what the article says.

All but one of the facilities are owned by for-profit entities. The hospitals with the highest markups are not in pricey neighborhoods or big cities, where the market might explain the higher prices.

Topping the list is North Okaloosa Medical Center, a 110-bed facility in the Florida Panhandle about an hour outside of Pensacola. Uninsured patients are charged 12.6 times the actual cost of patient care.

Dallas insurance lawyers need to understand how medical payments (Med Pay) coverage works in auto insurance policies.

Med Pay is an optional coverage in an auto policy. Unlike personal injury protection (PIP) or uninsured motorist (UM), it is not a required coverage.

Under this coverage, the insurance company agrees to pay “reasonable expenses incurred for necessary medical and funeral services because of bodily injury caused by accident and sustained by a covered person.” This insurance agreement uses the term “caused by accident” as opposed to the more specific phrase “auto accident” used in the liability insurance agreement. Essentially this means that any injury that occurs that is related to the use of the auto is going to be covered.

Most homeowners in Grand Prairie, Arlington, Irving, Fort Worth, Dallas, Duncanville, De Soto, Cedar Hill, Mansfield, and other Dallas County and Tarrant County cites will have a policy of insurance on their home. Most of the time that homeowners policy is going to have a medical payments coverage in the policy.

Medical payments coverage will usually provide payments for “reasonable and necessary” medical expenses up to the limits of the coverage which is usually $1,000 to $5,000. It is coverage that should pay medical bills without regards to who is at fault for the injuries sustained.

Here is a case dealing with the coverage. The case is styled, Cynthia Farris, as next friend of Vidal de Jesus Farias, a minor v. Allstate Insurance Company and Allstate Property and Casualty Insurance Company. This opinion was issued by the Corpus Christi Court of Appeals on June 2, 2011.

Here is one for people in Weatherford, Grand Prairie, Fort Worth, Dallas, Aledo, Richardson, Garland, Mesquite, Irving, and anywhere else in Texas to know. It regards insurance settlements and hospital liens.

This is an opnion issued on March 17, 2011, by the Texas Court of Appeals, First District, Houston. The style of the case is, Memorial Hermann Hospital System v. Progressive County Mutual Insurance Company.

In this case, Progressive settled a claim brought against one of its insureds arising out of injuries in a car accident. Memorial filed a hospital lien for the cost of medical treatment to the injured person half an hour before Progressive issued the settlement check. Under the Texas Hospital Lien Law, a hospital “has a lien on a cause of action or claim of an individual who receives hospital services for injuries caused by an accident that is attibuted to the negligence of another person.” Texas Property Coce, Section 55.002. To secure the lien, Section 55.005 requires the hospital file notice with the county clerk before payments to the entitled party. The statute also declares that the county clerk “shall index the record in the name of the injured individual.”

Young athletes in Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, Irving, Cleburne, Mesquite, Garland, Weatherford, and other places in Texas, usually have some sort of insurance coverage in case they get injured when involved in school sporting events. But exactly what does this coverage provide?

A student athlete in Clark County School District in Nevada, is finding the answer to be “not enough.” This is in an article published by the Las Vegas Sun and written by Steve Green. The article, titled, “High School Football Injury Sparks Lawsuit Over Insurance Coverage” was published on December 1, 2010. The athlete is LaQuan Phillips, who was a Green Valley High School football player who got injured in a game on September 5, 2008. Phillips suffered a spinal injury and has incurred more than $195,000 in medical expenses, which does not include future medical expenses and rehabilitation recommended by his medical providers. This figure also does not include compensation for Phillips pain and suffering and/or lost quality of life.

The insurance policy at issue in this case was issued by National Union Fire Insurance Company of Pittsburg, Pa. The policy is issued to the school district and is suppose to cover student athletes, cheerleaders and students in non-sports extracurricular activities and provides up to $2.5 million in coverage.

It does not matter whether you live in little ole Weatherford, Texas, or some of the bigger communities like Dallas, Fort Worth, Arlington, or Grand Prairie. Health insurance is a concern of everybody.

A recent lawsuit in Colorado illustrates the anger that can be taken out against an insurance company that does one of its insureds wrong. The article is in the Denver Post. The title of the article is “Canceled Insurance Leads To $37 Million Verdict For Woman.”

A jury in the city and county of Boulder returned a verdict of $37 million to a woman whose health insurance policy was canceled after she was seriously injured in a car accident.