The American Association for Justice issued a report this Wednesday naming the worst insurance companies for consumers in the US.  According to the report, “the rankings show a distinct pattern of insurance industry greed amongst 10 companies that refuse to pay just claims, employ hardball tactics against policyholders, reward executives with extravagant salaries, and raise premiums while hoarding excessive profits.”

The following companies were selected after a six-month review of information from court documents, SEC records, FBI records, state insurance department investigations/complaints, nationwide news accounts and testimony of former insurance agents.  Surprisingly, the companies in the “top five” are well-known and pretty popular choices among American consumers:

1. ALLSTATE - CEO, Thomas Wilson; 2007 compensation, $10.7 million; 2007 profits, $4.6 billion; assets: $156.4 billion. “According to investigations and documents Allstate was forced to make public, the company systematically placed profits over its own policyholders… The amount Allstate paid in claims dropped from 79 percent of its premium income in 1996 to just 58 percent 10 years later. In auto claims, payouts dropped from 63 percent to just 47 percent.

2. UNUM - CEO, Thomas Watjen; 2007 compensation, $7.3 million; 2007 profits, $679 million; assets, $52.4 billion. “Unum, one of the nation’s leading disability insurers, has long had a reputation for unfairly denying and delaying claims..”

3. AIG - CEO, Robert Willumstad; 2007 compensation for former CEO, 14.3 million; 2007 profits: $6.2 billion; assets, $1.06 trillion; “AIG executives have also come under fire for opportunistically seeking price increases during catastrophes. Now the company has been labeled ‘the new Enron’ because of charges of multibillion-dollar corporate fraud.”

4. STATE FARM - CEO: Edward B. Rust Jr.; 2007 compensation, $11.7 million; 2007 profits: $5.5 billion; assets, $181.4 billion. “In many cases, the company has gone to extreme lengths to avoid paying claims, including forging signatures on earthquake waivers after the deadly Northridge earthquake, and altering engineering reports regarding damage after Hurricane Katrina.”

5. CONSECO - CEO, C. James Prieur; 2007 compensation: $2.6 million; 2007 profits: $179.9 million; assets: $33.5 billion. “Conseco sells long-term-care policies, typically to the elderly. Unfortunately, Conseco uses the deteriorating health of its policyholders to its advantage because the company knows if it waits long enough to pay out claims, its customers will die.”

What’s not surprsing, however, is the fact that insurance representatives from the above mentioned companies have wasted no time attacking the trial lawyers behind the study.  A spokesman for Allstate told the press, “We’re not surprised we’re being targeted by the trial and personal injury lawyers because Allstate has always been at the forefront of the fight against insurance fraud and the effort to resist unreasonable demands made by lawyers.”

The sad part is that any person with insurance knows that you pay an arm and a leg for insurance “just incase,” but when an accident happens, its a nightmare to get what you deserve.  It doesn’t take a trial lawyer to point that out– although they are in the best position to make that allegation because they deal with insurance companies on a day to day basis. 

I don’t think consumers are buying this argument either. After all, its awfully hard to feel sorry for a CEO (such as Allstate’s Thomas Wilson), who racks in $10.7 million a year, while most people struggle just to pay their bill.

Related Information:

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On June 4, 2008, Walgreen’s drug store agreed to pay $35 million to settle a Medicare whistleblower lawsuit. In the suit, retail giant Walgreen’s was accused of substituting more expensive versions of three prescription drugs between 2001 and 2005 in an attempt to defraud the medicare system.

Pharmacist Bernard Listiza was credited for blowing the whistle on the fraud scheme and will receive $5 million as a reward for his cooperation.  This same pharmacist brought a similar suit against CVS Caremark Corporation in late 2006. 

In addition, individual states such as Indiana and Ohio have accused the pharmacy of making wholesale switches without physician involvement, which is a violation of numerous state regulations on pharmaceutical drugs.  The two states listed above recovered $161,000 and $28, 479 respectively from the Medicare settlement

Related Whistleblower and Medicaid Fraud Information:

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Medicare and Medicaid Fraud Whistleblower Laws

If you believe that a Medicare patient is being inappropriately discharged from a hospital or nursing home facility, you must file the following procedure from the Department of Health and Human Services to appeal the decision:

Steps to Appeal Your Discharge:

Step 1:  You must contact the Quality Improvement Organization (QIO) no later than your planned discharge date and before you leave the hospital.  If you do this, you will not have to pay for the services you receive during the appeal (except for charges like co-pays and deductibles).

• Here is the contact information for the QIO: (800) 624-4557 or tty 1-(877) 486-2048
• You can file a request for an appeal any day of the week.  Once you speak to someone or leave a message, your appeal has begun.
• Ask the hospital if you need help contacting the QIO.

Step 2: You will receive a detailed notice from the hospital or your Medicare Advantage or other Medicare managed care plan (if you belong to one) that explains the reasons they think  you are ready to be discharged.

Step 3: The QIO will ask for your opinion.  You or your representative need to be available to speak with the QIO if requested.  You or your representative may give the QIO a written statement, but you are not required to do so.

Step 4: The QIO will review your medical records and other important information about your case.

Step 5: The QIO will notify you of its decision within 1 day after it receives all necessary information.

• if the QIO finds that you are not ready to be discharged, Medicare will continue to cover your hospital services
• If the QIO finds that you are ready to be discharged, Medicare will continue to cover your services until noon of the day after the QIO notifies you of it’s decision.

IF YOU MISS THE DEADLINE TO APPEAL, YOU HAVE OTHER APPEAL RIGHTS:

• You can still ask the QIO or your plan (if you belong to one) for a review of your case:
  o If you have Original Medicare: Call the QIO listed above
  o If you belong to a Medicare Advantage Plan or other Medicare managed care plan: Call your plan.
• If you plan to stay in the hospital, the hospital may charge you for any services you receive after your planned discharge date.

For additional information, call 1-800-Medicare (663-4227) or TTY: 1-877-486-2048

Related Information:

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It’s that time of year again when children are outside, unsuspectingly playing near cars in the driveway or street.  Surprisingly, parked or slow moving cars are two of the greatest dangers facing our children in the summer months.  In 2007 alone, 725 children were injured or killed as a result of non-traffic or non-crash car accidents.

To prevent your child from sustaining a car related injury, I would encourage you to discuss the following safety precautions with your children and their friends:

KIDS AND CARS recommendations to keep children safe include:

1. Walk around and behind a vehicle prior to moving it.
2. Know where your kids are. Make children move away from your vehicle to a place where they are in full view before moving the car and know that another adult is properly supervising children before moving your vehicle.
3. Teach children that “parked” vehicles might move. Let them know that they can see the vehicle; but the driver might not be able to see them.
4. Consider installing cross view mirrors, audible collision detectors, rear view video camera and/or some type of back up detection device.
5. Measure the size of your blind zone (area) behind the vehicle(s) you drive. A 5-foot-1-inch driver in a pickup truck can have a rear blind zone of approximately 8 feet wide by 50 feet long.
6. Be aware that steep inclines and large SUV’s, vans and trucks add to the difficulty of seeing behind a vehicle.
7. Hold children’s hand firmly when leaving the vehicle.
8. Teach your children to never play in, around or behind a vehicle and always set the emergency brake.
9. Keep toys and other sports equipment off the driveway.
10. Homeowners should trim landscaping around the driveway to ensure they can see the sidewalk, street and pedestrians clearly when backing out of their driveway. Pedestrians also need to be able to see a vehicle pulling out of the driveway.
11. Never leave children alone in or around cars; not even for a minute.
12. Keep vehicles locked at all times; even in the garage or driveway and always set your parking brake.
13. Keys and/or remote openers should never be left within reach of children.
14. Make sure all child passengers have left the car after it is parked.
15. Be especially careful about keeping children safe in and around cars during busy times, schedule changes and periods of crisis or holidays.

These precautions can save lives.

For additional information, visit the KIDS AND CARS web site at www.KidsAndCars.org

Related Information:

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The Consumer Product Safety Commission (in conjunction with Stanley Furniture) has issed a recall for 2nd Nature Built To Grow cribs due to a potential entrapment hazard.  Consumers have been asked to stop using this product immediately, as infants may get stuck in a gap between the crib and the mattress when used on the medium setting.

The cribs subject to this recall were sold in furniture and department stores between March 2006 and December 2007 for approximately $1100.  The specific model and serial numbers covered by the recall include:

     353-14-220-L-01, 353-14-220-L-02, 353-14-220-L-03, 353-14-220-L-04, 353-14-220-L-05, 353-14-     220-L-06, 353-14-220-L-07, 353-14-220-L-08, 353-14-220-L-101, and 353-14-220-L-103.

These serial numbers are located on the headboard of the crib.  Please note that the recall does not include cribs sold after December 2007.

Stanley furniture is offering a free headboard replacement for any crib subject to the recall.  For additional information, contact Stanley Furniture toll-free at (888) 839-6822 between 8 a.m. and 5 p.m. ET Monday through Friday, or visit the company’s web site at www.youngamerica.com

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Learning how to spot a bedsore is the best way to help a loved one living in an elder care or rehabilitation facility.  If not treated properly, bedsores can be fatal.  At the very least they are painful and may slow the patient’s recovery process by weeks, if not months.

Furthermore, bedsores are almost always an indication of neglect from the nursing home staff.  That is why you must familiarize your self with the signs and symptoms of a bedsore so you can take immediate action in the case of nursing home abuse.

The Mayo Clinic offers the following description of pressure sores, as well as prominent areas that a bedsore may form:

Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization dedicated to the prevention and treatment of pressure sores, has defined each stage as follows:

• Stage I. Initially, a pressure sore appears as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.
• Stage II. At this point, some skin loss has already occurred — either in the epidermis, the outermost layer of skin, in the dermis, the skin’s deeper layer, or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration. If treated promptly, stage II sores usually heal fairly quickly.
• Stage III. By the time a pressure ulcer reaches this stage, the damage has extended to the tissue below the skin, creating a deep, crater-like wound.
• Stage IV. In the most serious and advanced stage, a large-scale loss of skin occurs, along with damage to muscle, bone, and even supporting structures such as tendons and joints. Stage IV wounds are extremely difficult to heal and can lead to lethal infections.

If you use a wheelchair, you’re most likely to develop a pressure sore on:

• Your tailbone or buttocks
• Your shoulder blades and spine
• The backs of your arms and legs where they rest against the chair

When you’re bed-bound, pressure sores can occur in any of these areas:

• The back or sides of your head
• The rims of your ears
• Your shoulders or shoulder blades
• Your hipbones, lower back or tailbone
• The backs or sides of your knees, heels, ankles and toes

Alternatively, if you have read the previous bedsore information and believe that you or a loved one may have been the victim of nursing home neglect, call (856) 833-0600 in New Jersey or (215) 567-2380 in the Philadelphia metro area.  You can also contact a nursing home neglect and elder abuse attorney by filing out the case evaluation form on the left side of the page.   A legal professional will contact you within 12 hours to discuss your case.

A scathing report issued by the Asbury Press reveals that New Jersey day care centers are among the nation’s worst regarding proper inspections/safety personnel, slow response times and releasing violations to the public.

According to the report, New Jersey has only 27 inspectors to watch over 4,290 public day care centers.  However, this figure does not include the thousands of private day care centers operating within the state. 

In addition, the report found that New Jersey inspectors take an average of 7.4 days to respond a complaint that falls just shy of child abuse.  The report further states that 61 New Jersey day cares have over 33 violations each and account for 26% of reported incidents.

Linda K. Smith, Executive Director of the National Association of Child Care Resource and Referral Agencies, has called on the State of New Jersey to clean up their act regarding child safety.  “If there is going to be an error made, the error needs to be in favor of the safety of the child.  These children cannot speak for themselves,” warns Smith. 

When choosing a day care, I would encourage families to personally interview members of the facility, as well as other parents who use the same day care.  Ask the parents how often their child comes home with unexplained cuts, bruises or injuries and how forthcoming the facility is when an accident happens.

Alternatively. if your child has been injured or abused at a New Jersey day care center, you may have legal rights against the facility.  To immediately speak with an NJ personal injury and accident attorney, call (856) 833-0600 or fill out the case evaluation form on the left side of the page for a free consultation.

Related New Jersey Legal Information:

Medical Malpractice in New Jersey

Defective Products in New Jersey

Birth Injuries or Birth Defects in New Jersey Hosptials

ATV, Quad or Yamaha Rhino Accidents in New Jersey

The World Health Organization (WHO) has taken a stand this week against unnecessary medical complications that occur in the operating room.  In response to the increasing occurrence of medical mistakes and subsequent medical malpractice suits, the WHO has issued a list of simple safety checks aimed at reducing surgical death and complications.

An example of the recommendations issued by the WHO are as follows:

1. All members of a surgical team are to identify themselves and state out loud exactly what type of surgery is to be preformed on the patient;
2. Members of the surgical team should physically mark the site of surgery and incision to avoid operating on the wrong body part or patient;
3. Administer antibiotics within 60 minutes of making an incision;
4. Verify drug allergies before prescribing medication;
5. Insert two intravenous lines for operations with substantial blood loss; and
6. Count all sponges and needles to ensure surgical instruments are not left in the body.

The full article and complete list of recommendations can be found on the New York Time’s website.

Related Information:

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According to the State Board of Medical Examiners, New Jersey surgeon Santusht Perera, removed his patient’s wrong lung and lied to cover up the mistake.

The real kicker to this story is that Dr. Perera only received a six (6) month suspension and $81,000 fine for what the board determined was “gross negligence” on the part of the surgeon.

The surgery in question was originally meant to remove a tumor in the patient’s left lung.  However, a portion of the right lung was removed by mistake, thus leaving the tumor to remain in the body.  The surgeon then lied to the patient and told him that it was really his right lung that contained a life-threatening tumor and changed the charts to also reflect this information. 

Further investigation into the matter revealed that no such tumor existed in the right lung.  The doctor simply did not check the chart or pay attention to the details of the planned surgery.

Sadly, Dr. Perera can file an appeal for early restoration of his medical license in December of 2008. 

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Medical Malpractice Facts and Lawsuit Information

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