You Should Know: Beware the Insurance Company Three D’s

When you buy insurance, you’re buying security. In exchange for your hard-earned dollars, you trust the insurance company to be there when disaster strikes, to shoulder a potentially devastating financial burden. But too many insurance companies care more about profits than policyholders. They employ shady tactics to keep from paying legitimate claims, a practice we call The Three D’s.

If you’ve ever had to file an insurance claim, you know the frustration that seems baked right into the maze of endless forms and confusing small print. Companies that once lived up to their promise to “be on your side” when disaster strikes dramatically shifted business practices in the 1990s to meet Wall Street demands for short-term profits. The result is chronicled in the book Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It by distinguished Rutgers law professor Jay Feinman. Not surprisingly, insurance companies are recording astronomical profits. Here’s how it works:

Trick #1: Deny, Deny, Deny Claims

Insurance companies will outright deny that an accident occurred or that the policyholder was seriously injured. Some companies even offer gifts and bonuses to employees who deny claims and keep payments to a minimum. Arbitrary rules will crop up, often referencing provisions that do not exist or that contradict a previous statement. The hope is that denial after denial will defeat and deflate claimants, making them feel they have no choice but to throw in the towel.

Trick #2: Delay Paying as Long as Possible...
Even Until Death

Endless forms, arbitrary rules and a sea of fine print discourage claims.

You’ve jumped through all the hoops and the insurance company has agreed to pay the claim, so you can rest easy, right? Think again. Delaying payment is another common tactic to boost profits. Insurance companies have been known to send out incorrect forms and then blame claimants for the error, or set very short time limits on when a claim can be made after an accident, injury or illness. In cases involving elderly or gravely ill claimants, some insurance companies have even delayed payments in hopes that the customer dies before they have to pay.

Trick #3: Defend in Court

Following a denied claim or a delayed payment, insurance companies know they can further delay writing a check by defending their questionable tactics in court. Billions of dollars in profits and thousands of high-priced lawyers on the payroll means they are always ready for a trial. Insurance companies know that many of their customers may be afraid or unwilling to hire a lawyer, and they use that fear to convince claimants that a court battle would only end in an insurance company victory.

Getting Paid What You Deserve

Forcing a claimant to sue for benefits owed is one way insurance companies fail their customers.

What can a David do against these insurance company Goliaths? Here are some tips on what to do before, during and after making a claim to an insurance company:

• Pick a reputable company: It pays to do a little homework before you sign on the dotted line. Start with this list of best/worst insurers ranked on claim denials and bad-faith practices.
• Read your policy carefully: You should know exactly what is covered and what you need for an appeal in case your claim is denied.
• Double- and triple- check forms: An incorrectly filled-out form can be used by an insurance company to deny or delay claims. Past forms can even be used as a way to retroactively deny coverage. Be thorough and honest on every piece of paper you fill out.
• Do not cash the check right away: Insurance companies will send checks with very low offers, or pay premium refunds if they rescind your coverage. Cashing these checks can be legally interpreted as accepting their offers.
• Get everything in writing: If you need to fight your insurance company, you must be able to produce every bill, form and piece of correspondence.
• Reach out for help: An experienced plaintiff’s lawyer can guide you through your claims process and provide the firepower necessary to challenge the insurance company in court if necessary.

This article appeared in our July 2017 "You Should Know" e-newsletter.

You Should Know: Watchful Parents Can Prevent Playground Injuries

School’s out for summer, and kids are bursting to get outside and hit area playgrounds. No surprise then that June is a particularly dangerous month for playground injuries. Before you let those kiddos loose, learn how adults are the key to playground safety with tips on equipment, clothing and safe behavior.

Adult Supervision Is the Number One Way to Prevent Playground Injuries

Seventy-five percent of playground injuries take place on public playgrounds.

According to the Centers for Disease Control (CDC), at least 200,000 children age 14 or younger are treated in emergency rooms each year for playground-related injuries. More than 10 percent of these are traumatic brain injuries (TBIs), and the rate of TBIs is rising.

Because public playgrounds are numerous and easily accessible, most kids spend their time on these rather than private playgrounds. Thus, the largest percentage of playground injuries take place on public facilities. Monkey bars and climbing equipment are responsible for the highest number of injuries.

But despite the risks, we know kids love playgrounds and benefit from the exercise and social interaction. The good news: Adults can play a key role in keeping kids safe on their favorite playgrounds with these tips and resources:

Keep Your Kids Safe With These Tips

• Areas underneath the equipment, known as fall surfaces, should be made of soft material such as wood chips, mulch, sand or rubber.
• Inspect equipment for any piece (especially metal) that may be hot from the sun.
• Watch for hazards or protrusions like bolts, hooks, stumps or rocks that could trip or cut children.
• Look for neglected maintenance, such as rusty or broken equipment.
• Make sure kids wear safe clothing. No loose scarves or hoodies with drawstrings, as these can become a strangulation hazard if entangled with equipment. Shoes should be comfortable for play and protect feet, like sneakers. Tie long hair back as well.
• Make sure there are strong and sturdy guardrails to prevent falls.
• Your children should be using age-appropriate equipment. Read all playground signs for warnings and instructions.
• Most importantly, the best way to prevent injuries is parental supervision. Talk to your kids about appropriate playground behavior before you visit the playground and watch them while you’re there.

More Resources for Safe Playgrounds

To ensure your local playground is safe, the National Recreations and Parks Association has a network of Certified Playground Safety Inspectors (CPSI). The CPSI certification program provides comprehensive and up-to-date training on playground safety issues, including hazard identification, equipment specifications, surfacing requirements and risk management methods. To find your local CPSI, click here.

A thorough playground safety checklist and ranking tool, created by the National Program for Playground Safety, can be found here. If you see safety hazards or poorly maintained equipment, reach out to the owner as soon as possible. In most cases, this will be a school or park district. 

Keeping our kids safe while out on the playground is an issue we can all get behind, and one that benefits the community as a whole. So let’s all get out there and have some fun!

This article appeared in our June 2017 "You Should Know" e-newsletter.

You Should Know: Pedestrians Pay the Price for Distracted Driving

Bikers, Walkers Threatened By Increase In Distracted Driving

April showers have given way to May flowers, encouraging walkers and bicyclists to get out and enjoy the weather. Long walks and leisurely bike rides can be a perfect way to soak up the sun, but busy streets with distracted drivers can be an accident waiting to wreck a lovely day. Unfortunately, when drivers are distracted, pedestrians and bikers often pay the price. This month, you should know how to keep yourself safe while you enjoy the spring season.

Use marked crosswalks: Eighty-two percent of pedestrian deaths occur outside the crosswalk.

More Cars, More Walkers and Bikes, More Distractions = Higher Traffic Deaths

According to the Governors Highway Safety Association (GHSA), almost 6,000 pedestrians were killed in 2016 in traffic accidents. In 2015, more than 800 bicyclists lost their lives in motor vehicle-involved crashes. Pedestrian deaths shot up 10 percent between 2014 and 2015, bicyclist deaths by 13 percent – both more than any other category of traffic-related fatalities, according to National Highway Traffic Safety Administration (NHTSA). 

The cause of this deadly trend has been greatly debated, with different groups pointing to a stronger economy and hence more cars on the road, more people walking to work or for recreation, and distraction due to the skyrocketing use of smartphone technology. Meanwhile, most efforts to prevent distraction are focused on motor vehicle drivers and passengers rather than pedestrians and bicyclists.

Teens Account for 25 Percent Increase in Pedestrian Deaths Over Past Five Years

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Bicycle fatalities have risen sharply for adults (especially men) 20 years or older since 1975. Click for larger image.

Even if a person is not behind a wheel, they can be at risk if walking while talking on a cell phone or listening to music through headphones. Among kids, teens account for 50 percent of all pedestrian deaths in the United States, and unintentional pedestrian traffic injuries are the fifth leading cause of fatalities for ages 5 to 19. Older teens have accounted for a staggering 25 percent increase in pedestrian injuries in the past five years. Over half of all adults have been involved in a distracted walking encounter.

Tips To Stay Safe

Walking or bicycling are healthy for both people and the environment. Perhaps that is why we’ve seen a 60 percent increase in commuter biking during the past decade. But while bicycle deaths among children have thankfully decreased by 88 percent since 1975, deaths among bicyclists age 20 and older have more than tripled. Here are a few safety tips to keep in mind that will increase your chances of arriving safely at your destination, whether on foot or by pedal!

• Look left, right and left again before crossing the street
• Make eye contact with drivers of oncoming vehicles to make sure they see you
• Be aware of drivers even when you’re in a crosswalk; vehicles have blind spots
• Don’t wear headphones while walking or biking
• Never use a cell phone or other electronic device while walking or biking
• If your view is blocked, move to a place where you can see oncoming traffic
• Never rely on a car to stop
• Only cross at designated crosswalks (82 percent of pedestrian fatalities occur outside crosswalks)
• Wear bright and/or reflective clothing, especially at night
• Always wear a helmet while biking
• Walk in groups, if possible
• Follow all traffic laws and road signs, and signal to turn

This article appeared in our May 2017 "You Should Know" e-newsletter.

You Should Know: Motorcycle Injuries, Insurance and Prevention

Americans love motorcycles: the wide-open road, the sense of freedom, the “Born to Be Wild” spirit of rebellion. Perhaps you are thinking about a biking adventure as well this summer? You wouldn’t be alone. According to numerous government and industry sources, motorcycle ridership in the United States is at an all-time high, especially among older riders.

Fatalities Continue to Rise Among Older Riders

Common sense tells us that motorcycling is simply more dangerous than driving a car. Aside from four wheels over two, cars are equipped with numerous safety features, including seat belts, air bags and a surrounding structure that protects occupants in a crash. Motorcycles are also less visible to other drivers, and require more mental and physical skill to operate safely. Finally, motorcyclists are more vulnerable to bad weather and hazardous road conditions.

While the overall number of motorcycle injuries and deaths declined slightly in 2013 and 2014, fatal accidents among older riders continue to rise. Riders 50 and older accounted for 3 percent of motorcycle fatalities in 1982, 13 percent in 1997 and 36 percent in 2014, according to the Insurance Institute for Highway Safety. Aside from the inherent dangers of motorcycling, riding without a helmet, while intoxicated or speeding are often cited as contributing factors as well.

Insurance May Not Cover Personal Injury

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Click to expand this Fool's Gear, Cool Gear infographic.

After strapping on your helmet, the next best protection you can have in case of a motorcycle accident is insurance. While all 50 states require minimum insurance coverage to operate a motorcycle, be aware that the minimums may not adequately protect you in a serious accident. Like any type of insurance, how much you'll need will depend on many different factors, including the type of bike you own, how often you ride, your marital status, your personal assets and your budget.

Liability covers bodily injury and property damage that you may cause to others involved in an accident. Other coverages include uninsured or underinsured motorist, which covers personal injury and damages caused by the driver of another vehicle who either does not have insurance or does not have sufficient coverage; collision, which covers physical damage to the motorcycle involved in a crash with an object, tree or another vehicle; comprehensive, which covers a loss from non-collision sources, such as theft, vandalism, fire or hail; and in states where applicable, medical payments or personal injury protection (PIP), which covers physical injuries to the rider and passenger.

Beyond liability, your first priority should be the coverages that pay you – and your passenger – for medical treatment, lost wages and other damages. These include uninsured/underinsured and PIP. Note, however, that the risks associated with motorcycling often make it very expensive to increase these coverages. In some cases, for example, PIP may not even be available, or may be so expensive that it is out of reach for most individuals. As when purchasing any type of insurance, seek the advice of a qualified advisor and carefully review policies from several different insurers.

Preventing Motorcycle Accidents – Tips for Riders and Drivers

To help combat the growing safety issues with motorcycles, the Motorcycle Safety Foundation has set out to improve safety through education, training and licensing. Since 1974, over 7.5 million motorcyclists have taken MSF training courses. 

The Foundation offers the following tips for riders and drivers (download) to help prevent motorcycle accidents.

For Riders:

• Be Properly Trained and Licensed – Half of all riders have never taken a proper safety class. If you take the Motorcycle Safety Foundation’s Basic Rider Course, some states will waive the written portion of the motorcycle endorsement test.
• Wear a Helmet – The facts are irrefutable: Helmets prevent fatalities an estimated 37 percent of the time for motorcycle drivers, and 41 percent of the time for passengers in motorcycle accidents, according to the NHTSA. And aside from being smart, wearing a helmet the law in 19 states and the District of Columbia.
• Fool's Gear, Cool Gear – What you wear can make it easier for drivers to see you and better protect you in a crash. 
• Never Drink and Drive – In 2013, 28 percent of cycling fatalities involved riders who were legally intoxicated.
• Ride Within Your Skill Limits and Obey Traffic Laws – Don’t ride faster or farther than your abilities will allow.
• Be a Lifelong Learner – Take advanced courses to brush up on the basics and keep improving your skills.

For Drivers:

• Watch for Motorcyclists – Motorcycles are smaller than other vehicles and often harder to see. In 42 percent of the fatal motorcycle accidents reported in 2013, a vehicle made a left turn in front of an oncoming motorcycle.
• Focus on Driving – Motorcyclists are easy to miss even when you are paying attention. Studies show that distracted drivers simply don't see certain objects like signs, motorcyclists and pedestrians. Hang up the cell phone or mobile device.
• Give Motorcyclists Enough Room – Maintain a safe distance between your car and a motorcycle and don’t change lanes too close. What would be a minor fender bender between two cars could easily be fatal to a motorcyclist.
• Use Your Turn Signals – For everyone’s safety, use your turn signals. It is also the law.
• Keep Trash in the Car – Road debris can kill a rider. And don't throw cigarette butts out of your car, either.

 This article appeared in our July 2016 "You Should Know" e-newsletter. 

You Should Know: The Latest on Marijuana and Driving

A patchwork of state laws define marijuana intoxication.

Marijuana and Driving

Studies analyzing the effects of driving under the influence of marijuana have been marked by contradictory research and imprecise measurement. Two major studies published by the National Highway Traffic Safety Administration (NHTSA) in February 2015 shed new light on a topic of increasing concern as 24 states have legalized marijuana (four states and the District of Columbia for recreational use, the rest for medicinal use). According to a recent article in Timemagazine, another five states could follow suit this year.

NHTSA’s first report confirmed predictions that legalization might lead to more stoned drivers. In a 2013-14 roadside survey of more than 9,000 drivers, 12.6 percent tested positive for THC (the principal psychoactive ingredient in marijuana,) compared to 8.6 percent in 2007 – a 47 percent increase. The percentage of drivers at or above the legal limit for alcohol was 8.3 percent, down 80 percent since a 1973 NHTSA roadside survey.

But here’s where the story takes an unexpected turn. The second NHTSA report focused on crash risk in what the agency described as the “first large-scale study in the United States to include drugs other than alcohol.” Data was collected from more than 3,000 crash-involved drivers and compared to 6,000 drivers not involved in crashes. While drivers who tested positive for THC were 25 percent more likely to be involved in a crash, other factors like age, gender, ethnicity and blood alcohol concentration were considered more likely the culprit than the presence of drugs. NHTSA researchers didn't mince words, writing: “Caution should be exercised in assuming that drug presence implies driver impairment.”

Meanwhile, the number of traffic fatalities involving marijuana-stoned drivers has increased in Washington and Colorado since both states legalized the recreational use of the drug, according to two recent reports. The percentage of drivers who used pot within hours of a fatal crash in Washington nearly doubled from 2013 to 2014, according to a just-published AAA study. A similar increase was recorded in Colorado with 10 percent of drivers in fatal accidents testing positive for marijuana in 2011 versus 5.9 percent in 2009.

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OK, So What’s “Under the Influence”?

Findings from these studies underscore another important point in this discussion: Measuring impairment in a person using marijuana isn’t comparable to blood alcohol concentration. “Most psychoactive drugs are chemically complex molecules, whose absorption, action and elimination from the body are difficult to predict,” NHTSA writes, "and considerable differences exist between individuals with regard to the rates at which these processes occur. Alcohol, in comparison, is more predictable.” Some marijuana users can have measurable amounts of THC in their bodies days or even weeks after using the drug, long after any psychoactive effects remain.

The uncertainty surrounding the intoxicating effects of marijuana is reflected in the patchwork of state laws defining driving “under the influence” of drugs. Some states follow a zero tolerance standard, making it illegal to have any presence of THC or other illegal drugs in your body while driving. Others set a legal THC limit expressed in nanograms (one-billionth of a gram) per milliliter of blood. In others, impairment is inferred based on the circumstances rather than defined by blood THC levels.

To review the laws on marijuana and driving in your state, click here.

What’s Next?

Of course, no one is suggesting that people should “blaze one and go for a joyride whenever the whimsy strikes,” wrote a New York Times reporter after reviewing the NHTSA study. There is plenty of evidence to show that marijuana use impairs driving skills. And as all these studies make clear, we need more research on the effects of marijuana and driving, along with better equipment for detecting and measuring marijuana-related impairment. It is also clear that the science of intoxication surrounding marijuana is different than that of alcohol and may demand a more nuanced response by policymakers, law enforcement and court officers. In other words, stay tuned for more on this evolving topic.

 This article appeared in our June 2016 "You Should Know" e-newsletter. 

You Should Know: Our Growing Awareness of Traumatic Brain Injury

The movie Concussion opens with the story of “Iron Mike” Webster. Fifteen years as a center in the NFL for the Pittsburgh Steelers had earned him stardom and four Super Bowl rings, but also a host of behavioral and memory problems in his later years. Pittsburgh’s hometown hero gave away or lost all of his money (he couldn't remember which), would often slip into a catatonic state, and eventually became homeless, living out the last years of his life in his truck.

After Webster died at the age of 50 from a heart attack, a young Nigerian forensic pathologist named Bennet Omalu (played by Will Smith) performed the autopsy for the county coroner’s office. Omalu had heard the stories about how Webster had essentially gone crazy in his later years and wanted to know why. After months of studying Webster’s brain, he discovered signs of a new disease marked by severe brain damage. He named it chronic traumatic encephalopathy (CTE) and published a paper that linked the new disease to the repeated concussions suffered by Webster while playing football.

While the NFL rejected Omalu’s report that Webster and other NFL players suffered CTE as a result of playing football, the genie was out of the bottle, so to speak. Several subsequent studies of NFL veterans and other athletes vindicated Omalu’s research and ignited a firestorm of concern and discussion about sports-related concussions. Eventually we would learn that even a single mild TBI can more than double the risk of early-onset dementia.

The Big Denial

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Anatomy of an Impact (click to expand)

For years, the NFL ignored extensive medical evidence until finally acknowledging in 2009 that repeated head injures can cause brain damage. Litigation has played an important role in forcing the NFL (and other organizations) to address this growing crisis and change head injury protocol, as documented in this extensive report from the American Association for Justice. Attorneys and Dr. Bennet Omalu joined forces with the family of Mike Webster and other past NFL players to sue the NFL for disregarding medical research and not doing more to prevent TBIs. During this lawsuit, it was revealed that the NFL ignored its own actuarial research showing an estimated one-third of its former players would suffer from brain damage caused by TBIs.

The NFL eventually settled for $765 million, causing a ripple effect throughout the sports world. Many professional, college and high school sports programs have changed concussion protocols and rules of play as a result, and insurance companies have followed suit by requiring stricter adherence to proper procedures for TBI care. The NFL even started its own brain bank to study the brains of former players with the hopes of creating new measures that will combat the possibility of brain damage or CTE. NFL data released ahead of Super Bowl 50 showed that concussions were down 25% this season, mostly due to changes in technique by the players.

The Story Closer to Home

Football is lead cause of head injuries for high schoolers.

In 2006, high schooler Zackery Lystedt went back out on the football field after suffering a concussion earlier in the game. After being struck in the head again, Zackery collapsed with what proved to be a debilitating brain injury. In 2009, his home state of Washington passed the Lystedt Law. This legislation requires annual mandatory training for athletes, parents and coaches. It also requires the immediate removal from sporting events and practices of any athlete suspected of having suffered a concussion until cleared for return by a medical professional. Since Washington took action, every state except Wyoming has enacted a “When in Doubt, Sit Them Out” law. Compliance to these guidelines has increased from 50% in 2007 to 80% in 2013.

That’s the good news. The bad news is that very few states have enforcement mechanisms to make sure these laws are being followed, and only six states require parental notification of a child’s TBI. So for parents, athletes and coaches, vigilance is still the first line of defense. Know the signs and protocol for dealing with TBI (review here) and don’t delay seeking medical attention. Note that many other contact sports cause head injuries, as outlined in the chart above, not just football. Automobile crashes and other blunt trauma to the head account for many times more.

 This article appeared in our February 2016 "You Should Know" e-newsletter.