Tag Archives: Independent
Why This Lawyer Says You Should Buy Car Insurance From An Independent Broker
Why This Lawyer Says You Should Buy Car Insurance From An Independent Broker
I don’t sell car insurance, but as a lawyer practicing in the field of personal injury I frequently see people suffer because they have the wrong insurance coverage. Often, this happens because they purchased directly from an insurance company instead of an independent broker.
Many of my clients who have been seriously hurt in a car accident were struck by someone who had no insurance or only the minimum liability insurance coverage, which is ,000 in New York and much less in many other states. Unfortunately, many of my clients were sold insurance policies with liability limits of 0,000 or 0,000, but were not sold matching uninsured and underinsured coverage.
Just this week, yet another new client had this problem. My client was a pedestrian crossing the street when she was struck by a car which fled the scene. The driver was caught shortly after leaving the accident, but the owner of the car only has the New York State minimum liability insurance of ,000 and my client has serious injuries consisting of many broken bones including a fractured arm, leg and skull.
My client owns a car with liability insurance limits of 0,000, but she purchased the insurance from GEICO whose salesperson didn’t sell her underinsured coverage. GEICO does not use independent insurance brokers, but sells insurance directly to consumers through in-house sales agents.
For a small fee, my client could have purchased underinsured coverage of 0,000 which would have allowed her to recover 0,000 for her injuries instead of ,000. Ironically, she did not need the 0,000 liability coverage to protect her assets. However, since you cannot buy underinsured coverage higher than your liability coverage, I would have advised her to purchase 0,000 liability coverage for the sole purpose of being able to purchase 0,000 underinsured coverage.
I have had many clients in this situation who lost their jobs because of serious injuries and incurred substantial debt. If they had matching underinsured coverage, the additional money available to pay their claim would would be a big help to pay their bills and get their life back together.
Underinsured motorist coverage will pay you money from your own automobile insurance policy if you have been hurt in a car accident by someone who was negligent for causing your injury and who had less liability insurance coverage than you did. Uninsured motorist coverage will pay you when the other car did not have any insurance coverage or the identity of the other car is unknown.
Underinsured and uninsured coverage is inexpensive and usually available in limits that match your liability insurance coverage. It is not available in amounts greater than your liability insurance coverage.
Underinsured and uninsured coverage is so important that a couple of states now require coverage limits matching your liability insurance limits, unless you decline the coverage in writing. Several years ago, I suggested to several New York State senators that they enact a similar law in New York.
I have also seen many clients who were not sold the maximum medical payments insurance, which costs me only .01 per month on my car insurance policy. This is particularly important for people who do not have a good health insurance policy. It is also beneficial for passengers who do not have health insurance.
Why should you buy car insurance through an independent insurance broker? The courts have defined the reason. There have been several “malpractice” lawsuits against insurance companies for failure to offer underinsured and uninsured motorists coverage limits matching the liability limits. However, when the insurance company sells directly to consumers, these cases have gone in favor of the insurance companies. The courts found that when a consumer buys insurance directly from an insurance company, rather than an insurance broker, the consumer is only buying insurance and is not paying for advice.
When you buy auto insurance from an independent insurance broker who represents several different insurance companies, you get the advantage of an insurance professional who can evaluate your needs and advise you accordingly. Additionally, only an independent insurance broker can provide you with a choice of insurance companies and premiums, so you get the best coverage at the lowest price.
Whether you buy your car insurance directly from an insurance company or through an independent insurance broker, always make sure that you purchase matching uninsured and underinsured motorist coverage and the maximum medical payment benefits.
Getting the Most Out of Your IRO (Independent Review Organization)
Getting the Most Out of Your IRO (Independent Review Organization)
Working with an Independent Review Organization (IRO) is a bit like working with your physician. How do you know you’re going to get the treatment to fix your ailment? Is the treatment covered by my insurance? How long do I have to wait for treatment? Have I given the doctor all of the information he or she needs to make the right care decision?
When requesting an independent medical review, careful consideration needs to be given to focusing on the specific issue(s) you’re trying to resolve. Understanding what questions to ask in the first place will help keep costs at a minimum by ensuring your IRO is reviewing the proper records and facts and correctly delivering decisions on the issues at hand – the first time.
It’s easy to confuse the issue of medical necessity of a procedure with the issue of whether or not a patient qualifies for that procedure according to your plan language. For example, say Mary Smith’s doctor has referred her to a chiropractor for back pain treatment but the plan language on her policy does not cover chiropractic services – no exceptions. Regardless of medical necessity or the doctor’s referral, the treatment would and should be denied. The IRO reviewer must be informed as to which issue you are trying to address up front.
Experimental and investigation treatments also pose a problem. Given constantly evolving technology, drugs and treatment protocols, it’s often difficult to keep up with what’s been approved as scientifically accepted treatment by the medical community and what’s still considered experimental procedure. Knowing that the plan exclusions always take precedence over inclusions can save a lot of time in the review process. The plan language definition of experimental/investigational is central to the decision.
Following are some tips designed to make it easier for you to work with your IRO and ensure meaningful outcomes for both the patients and your business every time:
Make sure you isolate the specific issue you are trying to address before you develop your questions, such as standard of care, medical necessity, experimental/investigational and/or plan language interpretation.
Develop a list of questions that must be answered with a definitive and substantiated reason.
Make sure you include all relevant chart documents and plan language that are needed to provide a definitive response.
If you have exhausted your efforts to get the records you need for a review, a “no” response from your IRO may be just the stimulus needed to prompt the record holder to release the full documents.
Understand that it’s your IRO’s responsibility to call with questions or clarifications on independent medical review requests before they begin. Make sure your IRO understands who to call and the best time of day that person can be reached.