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Why Your Medical Records Matter in Personal Injury Cases

The subject has come up too many times in the past couple weeks where clients are disputing what is documented in their medical records that were written by their own treating physicians. I will admit, prior to becoming an attorney in South Carolina, I would trust what the doctor told me in the private setting of the examination room. As Lee Corso says, “Not so fast my friend.”

It does not matter if you are being assisted by Medshore EMS at the scene of a motor vehicle collision or talking to your long time AnMed Family Medicine physician, those medical providers are documenting everything you tell them. As a matter of fact, the Federal Government has mandated all records be made digitally so you can even read the physician’s handwriting. Well that wasn’t their main reason for doing it but it sure has helped in reading Dr. Wadee’s records.

You have the right to request your medical records and you should do that on a quarterly to annual basis depending upon your frequency in medical treatment. (No, the discharge or checkout paper you get does not count as a medical record that is important.) It will help you see what information is documented from your visit with medical providers and also help ensure that your medical concerns and complaints are actually being addressed. Let me provide a news flash when that may become relevant…IN A PERSONAL INJURYCASE! 

If you are involved in some kind of traumatic incident (workers’ compensation claim, car wreck, dog bite, slip & fall, product liability claim, nursing home negligence, or medical malpractice case) and claim the injuries you sustained from that incident are all because of that traumatic incident, you have to prove it to be reimbursed by the evil insurance companies. Your back may be hurting but if just the week before you were complaining of back pains, the question becomes how much more, if any, is your back hurting from the traumatic incident. Don’t come in telling me your life is changed forever for the worst because of this traumatic incident but have no medical documentation to prove that claim.

As an attorney, I can not tell the evil insurance company that your doctor told you it was all because of the traumatic incident. Shockingly, the evil empire would not believe me or you. However, the evil tryanny sometimes believes what is in the medical records. Not all the time but let’s not get caught up in the fact that the evil empire will have a 22 year old college, educated adjuster make medical diagnosis and decisions. We will save that subject for another article.

Today, your take away is this:

  • You are legally entitled to a copy of your medical records,regardless if you owe a balance to the medical provider. Now there may be a copying charge or retrieval fee but you are still entitled to those printed and detailed records, along with your itemized bills. Click here to print off this page, if the gate keeper at your medical facility doesn’t believe you.
  • Do you really know what your doctor has documented? What do you think your doctor will depend on as the truth a year from their visit with you if asked by a lawyer? That exact conversation or their medical records?
  • What is documented in your medical records will help your recovery from a traumatic incident or help the evil empire against your recovery. So, if you are experience back pain, emotional trauma, sleepless nights, relationship troubles, and so forth, I better read it in the medical records or it is not happening!

***When I Googled “evil insurance companies” there was a link with a discussion of whether insurance companies were evil or stupid.  Although it was about health care, the liability insurance carriers are designed the same way, maximize return to their shareholders while minimizing the payout of claims (YOUR CLAIM). I thought this was a very interesting response:

Doug Dingus, Everybody pays, everybody covered

622 Views

Insurance companies have a basic conflict with us in that their goal is to maximize for the shareholders, and that happens best when they deliver the least health care access for the most dollars.

So, the answer is by design, but said design is an artifact of our health care policy, meaning they are neither stupid or evil.

We can remedy this with regulation, or public primary care insurance, or competition, depending on how said competition is structured

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Do I Really Need a Lawyer?- The Insurance Adjuster Told Me How This Works

My wife, who is typically my worst juror or best devil’s advocate on cases, was appalled to hear about some of my more recent clients and how the insurance company was treating them. She said, “Well you never hear about those type cases in the news or on TV!”

I laughed and then felt overwhelmed with sadness because I realized that is very true and if most people knew or were privy to the things I experience on a daily basis they would:

  1. A) Call the South Carolina Department of Insuranceand ask how that is legal for an insurance company to do and then file a claim;
  2. B) Contact their state legislative representativeand/or congressional representativesseeking change, reform, or answers;
  3. C) Contact local media organizations (WYFF Channel 4WSPA Channel 7,  FOX CAROLINA)  asking them to do an “investigative analysis” to run on prime time; but then and more importantly;
  4. D) They would forget all about it and move on to another issue or concern because we are a fickle public almost immune to shocking news of being swindled out of our morality, justice, and legal rights.

Yet, I continue to see it every day and when I report it to the SC Department of Insurance I am crying wolf. When I blog about it or talk to friends, family, enemies, or strangers about it, they discount my opinion due to the obvious bias of my position as an advocate for the injured, harmed, and disenfranchised.

However, once an attorney gets wind or retains a client with one of “those cases” most times they are settled with the insurance company paying all the money available on the claim. However, that doesn’t mean the insurance company pays lots of money QUICKLY. Or in return doesn’t try to divert the injured party away from sound advice that is on their side versus working against them.  (See my article entitled: Would You Take Advice from the Devil on How to Get to Heaven?: Insurance Company Lies).  Insurance companies make money by keeping it out of the injured party’s hand as long as they can while still investing the premiums their insureds pay them to protect against harms they cause others. (See my article entitled: How Do Insurance Companies Make Money?)

In all of the cases the injured party was being ignored, getting the silent treatment, or being talked down to like they were money hungry panhandlers looking for a handout from Big Daddy. When in fact the people that the insurance company insured were:

1) drunk driving behind the wheel and could have harmed anyone reading this;

2) were high on drugs with stolen merchandise in their trunk trying to get out of state before the police caught up with them and could have harmed anyone reading this;

3) traveling 20 mph or more over the speed limit through a busy intersection trying to get to their plane for a vacation to some tropical paradise and could have harmed anyone reading this;

4) had just left the strip club drunk and ran through a stop sign striking a client working their second job to provide for a family and could have…….

I know, I know bad things happen and you just have to deal with it. Well, that is true but insurance (health and auto now) is mandated by state and federal laws so everyone has to have some form of it. Thus, when insurance companies come into pay and should be reimbursing the injured party for the wrongs, harms, loses, and injuries their insured has caused another innocent party that s*&& doesn’t always work the way it is suppose to. Insurance companies deny, delay, and defend money from injured parties. Wake the f*& up people. WTFU!

Why do you think I am in that trial in front of a jury? It’s not to take money from that poor person that just had an accident and I am trying to take their home. Or some business made a simple mistake and I am trying to close down someone’s American Dream. Really!? It’s to get that person’s insurance company to pay a reasonable amount to my client. 

If you have “one of those cases” give us a call and at least run it by someone first before you walk like a cow to slaughter down that line to sign a check for little bit over your out of pocket medical bills thinking that is all you are entitled to because that is what the insurance adjuster told you. When you do that you are forever and ever releasing the insurance company from any wrongs their insured caused you for the rest of your life. If nothing else remember this, “It’s not what the insurance adjuster says that matters, it’s what they pay.”

Give us a call at 1-800-483-0880 or 864-231-7171 and visit us online at Trammell & Mills Law Firm, LLC or I85lawyers.com

 

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Don’t Listen to Insurance Adjusters or Friends When It Comes to Legal Advice

You have just been involved in a traumatic incident of some kind and now your world is turned upside down. You never planned on being:

  • injured;
  • unable to work;
  • permanently disfigured;
  • without an avenue for medical treatment;
  • no knowledge on how to get out of the hole someone, something, or some event has put you into; or
  • what steps to take to get back before your world stopped.

The next thing you do is communicate with family, friends, and/or co-workers. They know someone, read something, saw it on the Internet, watched “Judge Judy”,  or have a “friend” themselves that has been through the exact same thing and this is what you …….STOP THE MADNESS!

It’s great to have loved ones and I am sure they want nothing but the best for you but I don’t claim to know everything about everything. I hire real estate agents to move property and tax advisers (Patterson Tax Service) to do my taxes even though I have had Real Estate and Tax classes in law school (which means I know enough to be dangerous to myself, or absolutely nothing).

My common saying is, “You don’t listen to the devil on how to get to Heaven, so why listen to an insurance adjuster on how to settle a claim against them?”  They are going to lie, or mislead you. You don’t go to your opponent in the middle of the game and ask them how to beat them do you? NO! Stop listening to what an adjuster says about your claim. Talk to an attorney. You at least have recourse against an attorney if they give you incorrect legal advice. (You could have recourse against an adjuster but it is hard to prove).

Likewise, stop listening to your friends give you “arm chair” legal direction on your case. Go talk to a lawyer. It is free to consult with a lawyer on most civil cases and no fee is received by the lawyer unless a settlement is negotiated or trial verdict rendered. Tell me who else you know works 100% on performance pay? Defense attorneys and insurance adjusters work hourly or salary and may get some kind of bonus based on performance but I would imagine 75% of their income will come to them regardless of how well they perform.

I work 100% on performance and get close to 70% of my business from word of mouth based on clients, friends, family members, colleagues, and other professionals that are familiar with our firm’s performance. Seek out the help you need from the right professionals rather than receiving the wrong information. You may not hear what you like but at least it will be an honest, experienced, and informed response looking out for YOUR BEST INTEREST.

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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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