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Accidents Happen But Insurance Companies are Created

I have always enjoyed reading, watching, and listening to various recounts of historical information on a wide range of topics. Wikipedia is a scary resource given the ease of access and also in creating of the history online. However, for broad strokes and a general overview it has proven quite resourceful.

  • Did you know that insurance has been around in some form since humans have gathered together in communities, or societies?
  • The form of insurance as we know it culminated as a result of the mercantile trade along treacherous rivers and oceans where the chance of loss was great, thus if a merchant received a loan on the shipment they would pay the lender additional monies to cancel the loan if the shipment was lost or stolen.
  • Did you know the first insurance company in America was created here in CharlestonSouth Carolina?

I won’t bore you anymore with history but just as we have advanced as humans, so to have our societies (at least in most parts of the world), and thus our businesses, or economies.

As stated in one of many lessons learned in Sun Tzu’s, Art of War:

It is said that if you know your enemies and know yourself, you will not be imperilled in a hundred battles; if you do not know your enemies but do know yourself, you will win one and lose one; if you do not know your enemies nor yourself, you will be imperilled in every single battle.

Therefore, I try to learn as much as I can about insurance companies and convey that knowledge the best I can to clients that come in with questions.  Those questions mainly consist of:

  • trying to understand how their insurance company can treat them so poorly after they have religiously paid their premiums without ever having an insurance claim;
  • trying to understand how the insurance company of the negligent, ignorant, or omitting party, will not provide them a fair amount for the injuries, troubles, and ordeals they have experienced through no fault of their own; and/or
  • why the insurance company will not call them back or appreciate what they have had to experience and instead treats them disrespectfully or with disdain.

Well, it is very simple. It’s about money. The money insurance companies want to save by minimizing the payout on your injury, property, and/or life insurance claim. Simply stated insurance companies make money two ways:

  1. Through underwriting, the process by which insurers select the risks to insure and decide how much in premiums to charge for accepting those risks;
  2. By investingthe premiums they collect from insured parties.

The whole insurance business model is summed up succinctly as such:

 to collect more in premium and investment income than is paid out in losses

Your injury, or insurance, claim is the loss being referred to above. What the at fault party’s insurance company pays you cuts directly into their bottom line and therefore the less they can get out of paying your claim, the more they can invest in those really complicated structured asset backed securities, or CDO’s. You remember the recession was caused by ____? Greed.

And that greed can work both ways, on your extreme valuation or consideration of the fair amount to be paid and the insurance company’s extremely low valuation of your claim-regardless of facts.  Thankfully, advocates and plaintiffs’ attorneys exist to assist you in this eternal struggle of good vs evil. If you had to pay a plaintiff’s attorney the hourly wage the insurance company pays the defense attorneys, or advocates, I doubt you would ever be able to fight a fair battle.

Again we learn from Sun Tzu’s, Art of War:

Thus, what is of supreme importance in war is to attack the enemy’s strategy.

Please consider disrupting the strategy of insurance companies to make profit off of your injuries by low balling, denying, delaying, and defending against what you know is wrong. Just because insurance coverage has almost been made mandatory doesnt mean those same insurance companies have to make millions in profits off of your backs. Rise up and fight, now is your time!

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Injured at Work in South Carolina? What you need to know. (Part 2)

This is the second of a series of blogs written to tell workers in South Carolina what they need to do if they suffer a work-related injury.

  1.  Tell the treating doctor that you got hurt at work!

In my previous blog, I stressed the importance of reporting your work injury immediately to your employer.  Today, I stress the importance of telling your doctor that you got hurt at work and how you got hurt at work.

In many denied workers’ compensation claims, there is, for lack of a better word, a swearing match going on between the injured worker and the employer.  The worker claims to have been injured on the job.  The employer denies that the worker got injured on the job or claims that the injured worker did not properly report his injury to the employer.  The workers’ compensation commissioner is charged with the responsibility of finding the truth and, therefore, must decide which one to believe.

In my experience, the commissioner often relies on the medical records to break the tie.  He discounts the injured worker’s testimony as well as the employer’s denial because they are both taking self-serving positions.  Then, he especially looks at the initial medical record of treatment of the injured worker to find the truth because he assumes that the initial treating doctor does not “have a dog in the fight.”  If the initial medical record documents that the employee was being treated due to an injury that the employee contends occurred at work, and especially if the record describes how the injury occurred, the commissioner will view that record as giving credibility to the injured worker’s claim.  On the other hand, if the injured worker does not mention anything about the work injury to the initial treating doctor, the commissioner will likely view that record as giving credibility to the employer’s defense that the employee did not get hurt at work.

Therefore, if you were injured at work, it is imperative that you document that you are at the doctor’s office seeking treatment for an injury that occurred at work on all of the forms that the doctor’s staff may ask you to complete prior to your examination and then you must describe the injury to the doctor when he examines you so that he will include it in your medical record.

As a general rule, the more details that you can give to the doctor, the more believable your claim will be to a commissioner.  For example:

  • know the exact dateof your injury before you go into the doctor’s office.  Do not guess at your date of injury because it will come back to haunt you if your claim is contested and the date of injury that you give the doctor is wrong.  I have seen situations where the injured worker haphazardly reports to the doctor that he got hurt at work on Wednesday about two weeks ago and then prior to the workers’ compensation hearing we learn from  reviewing his time cards that the worker did not even work on that Wednesday.  At that point after closer examination, we realized that the injury actually occurred on Wednesday, but it was three weeks ago rather than two weeks ago as reported to the doctor.  That is an error that can be explained and corrected, but it could have been avoided all together if the worker had been prepared when he initially went to the doctor.
  • be specific in your description of the injuryto the doctor.  Which is more believable?
    • “I hurt my back at work last Wednesday just doing my job;” or
    • “Last Wednesday afternoon at work, I injured my back lifting a 75 pound box  off of the floor.  I was going to put the box on my work table.  As I twisted while lifting up the box, I felt a sharp pain in my lower back and pain even went down my left leg.  I had to put the box back down on the floor and was never able to lift it up to the table.”

In conclusion, it is imperative that you give your doctor specific details about your work-related injury during your first medical appointment after the injury.  If you do so, the employer and insurance carrier will likely admit that you got hurt at work and will provide you with workers’ compensation coverage without unnecessary delay.

My next blog will be about the fact that you can suffer a work injury without being required to suffer trauma.

 

(Ernie Trammell is the author of this blog post and subsequent posts on Workers’ Compensation in South Carolina. Mr. Trammell has been a Workers’ Compensation attorney in South Carolina for 29 years, primarily in the Upstate encompassing the counties of AndersonAbbevilleGreenvilleGreenwoodLaurensOconeePickens, and Spartanburg.)

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South Carolina Free Medical and Dental Clinics

If you do not have any other resource to seek treatment for your injuries, ailments, disease, or disorder please use this resource to find medical and dental assistance.

We hope this helps you get the medical and/or dental treatment you need. No one should go without care in the United States. Additionally, those that are able should donate to ensure these facilities remain open.

http://www.freemedicalsearch.org/sta/south_carolina

For more specific local areas, please see below:

ANDERSON:  Anderson Free Clinic

GREENVILLEGreenville Free Medical ClinicNew Horizon Family Health ServicesNew Horizon Family Dental Care, and West End Medical Family Alliance

PICKENSClemson Free Clinic

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If You Are Injured After a Wreck, Dog Bite, Slip & Fall or _______:Seek Medical Attention

It sounds so simple but so many people I interact with from GreenvilleAndersonOconeeSenecaClemson, and the remainder of South Carolina, have a hard time understanding that lawyers are not doctors.

If you are hurt, hurting, in pain, or otherwise not in the same physical, mental, or emotional state you were in prior to some traumatic injury, or incident, then you should seek medical advice.  Doing this simple act can help you on several fronts:

  1. This helps diagnose and assess your problems;
  2. This helps you get better; and
  3. This helps objectify and validate the change(s) in your condition.

Having grown up in the rural area of Prosperity, South Carolina and now working for people from similar areas of the state, the comment:

“I dont like going to the doctor. They are just going to give me medication and run up a lot of bills.”

is a comment I hear all too often. However, try telling that evil insurance company that you are hurt, hurting, in pain, or otherwise not in the same mental, physical, or emotional condition you were in before ____________. (fill in the blank-wreckslip & falldog biteinjury at work, and/or negligent product).

Try figuring out a reasonable and fair amount to be compensated for your injury when you are the only voice or piece of evidence in your favor. Think that evil insurance company will believe you more or a disinterested third party that has no interest in the outcome?

I know, most times the evil insurance adjusters wouldn’t believe they were on fire if they saw their skin melting but you can only do your part as a reasonable person. Leave the insurance fighting to those that do it all the time and fight for your rights–trial lawyers, aka Trey Mills.