The wrongs committed by insurance companies would surprise most people. A person pays his premiums and maybe has friendly conversation with their agent and they figure that when they make a claim, the claim will be properly paid. While most insurance claims are handled without the need for lawyers to be involved, there are too many instances of the insurance company trying to work against they insured/customer.
This is illustrated in an article from Argus Leader. The article is titled “Lawsuit Accuses Doctor Of Bias In Denying Injury Claim.”
The article tells us a woman who suffered a debilitating neck injury while at work has accused an insurance company who denied her benefits of hiring a doctor that it knew would dispute her injury claim.
Kristi Thompson alleges that National Union Fire Insurance Co. of Pittsburgh hired Dr. Paul Cederberg because Cederberg routinely finds in favor of insurance companies seeking to deny benefits.
Cederberg performed two examinations on Thompson in 2012 after she injured her neck at JC Penny in Brookings, where she worked as a manager in the jewelry department. Thompson’s head struck a counter top, causing the neck injury, according to her lawsuit.
National Union initially began paying Thompson under worker compensation insurance. But the company denied payments after Cederberg concluded that Thompson’s neck pain was from degenerative disk disease that existed before the at-work injury.
Thompson subsequently went through two surgeries to have the vertebrae in her neck fused.
Thompson filed a petition with the Department of Labor, and on Feb. 23, 2017, the department entered a decision determining that Thompson was entitled to past and future medical expenses as well as permanent and total disability benefits.
During the appeal, Thompson settled with National Union for $400,000, which was less than what she was owed. However, National Union, which is a subsidiary of American International Group, or AIG, failed to pay her medical expenses and to fund a Medicare Set Aside Agreement.
Thompson’s lawsuit accuses the insurance company of bad faith, including terminating her benefits without reason and “hiring a physician to conduct an adverse medical examination of Mrs. Thompson that defendant knew or should have known was biased in favor of insurance companies.”
Thompson’s lawyer said he is familiar with Cederberg from other cases. In those cases, Cederberg’s opinion has been used by insurance companies to deny benefits.
Cederberg did not return a message left at his office.
There has been growing scrutiny of insurance companies and their use of a handful of doctors who routinely provide favorable reports allowing insurers to deny benefits to those injured in accidents or at work. In 2016, the South Dakota Supreme Court ruled that the opinion of a doctor is not in and of itself a reasonable basis for denying claims. The ruling criticized insurance companies for using biased doctors in order to deny claims.
In Texas, there are similar rules. If someone feels the insurance company is using biased experts in order to justify denying a claim, an experienced Insurance Lawyer needs to be consulted.