MAY 2, 2008

ANOTHER TRIAL PENDING - WITH TWO IME 'S BEFORE THEN

I had started this post some time ago -three months, to be exact. I will keep it here because it does have some particular information.

For definition: IME is an Independent Medical Examination. The Insurance Carrier (AIG in my case) hires a Physician in a particular field that will examine me at one appointment only. This appointment generally takes one to one and one-half hours and will mean that this Physician will not be able to treat me at any other time. Because he/she is hired by AIG it also generally means that the findings will almost always be favorable to the Carrier. (I know you are surprised to hear this, but it is true.) Typically they have a large amount of business generated by the Insurance Company which pays them handsomely, so it is understandable that their report is one-sided.

This Physician's report will be used at trial as evidence on behalf of the Carrier. My attorney has the opportunity to depose the Physician prior to the trial, after receiving the report, which give us the benefit of asking some pertinent questions the can be favorable to my case.


However, I am now going to a Psychiatrist for an IME. Why a Psychiatrist, you ask?
That is another interesting thing. I was seeing a Psychologist. He was nice, capable for part of the time - Dr. Hoogerman - but he was retiring this year. He was getting a boat and sailing/boating away into the sunset.

Robin, the Adjustor, decided that even though AIG had been paying his bills consistently for several years, (and the Psychologist before him for even more years) that I would not be allowed to continue with counseling, unless a Judge approved it.

I found another Psychologist, and started therapy with her. Because Robbin and AIG refused, I had to pay for the counseling. Robin also decided that she would put into place a company at the expense of AIG (I do not know what the cost of this company is, but it is most definitely in addition to Robin's salary and the cost of their Attorney, Jake Smith.

The company, ProMed, is a "cost containment" company, at the expense of AIG has sent letters to every single physician that I see, asking for a complete list of all medications, treatments and plans on my behalf, in detail, which will then be sent to a doctor of their choice (not necessarily a doctor of the same specialty, incidentally - my Primary Care Family Practice Physician was reviewed by a Pulmonary Specialist)
and again - there is almost a given disagreement with the treating Physician. More money paid out by AIG to now have an IME!!!

It is almost one year since Dr. Hoogerman left, I have not had approval for another Psychologist. I paid the final amount due to the new Psychologist just recently and will not have access to a new counselor until I can meet with one I am comfortable with - and I will have to pay for that counselor until the trial determines if I am to have access to counseling.

Understand, in the almost 19 years since the auto accident, I have had several IMEs. I have not had a Judge take away my medical providers. I am not faking. I am not trying to rake AIG.

Why - why would I want to have 5 spine surgeries, I ask again? Is this my choice in life.

One of those ProMed questionaires went to my specialist for the splint that I wear.

I don't think I described the players in this group.

Claimant:
First there is me - I did mention that. I am the Claimant! I am the one who had the accident. I am the injured party. I am the really bad person who needs to take money away from the big Insurance Company who does not want to part with any money at all. No matter what!

I do not have to have an attorney. I choose to or I can choose not to. My choice to have an attorney came from having a civil case against the trucking company that owned the truck that hit and totaled my automobile. I had 5 attorneys going through that process and even went through a three day miss-trial before settling that case. That left worker's compensation, which was very confusing process to me.

I actually fired four attorneys in worker's compensation as well. I wasn't ready to settle, I didn't want to go to social security disability - I didn't know what was wrong with me, even though I did believe something WAS wrong.

Attorney:
There is now my Attorney, a bright young woman who has experience and knowledge.

Insurance Carrier:
In my case (AIG) - The Insurance Company who held the insurance policy that covered any possible injuries or illness that related to the company that I worked for at the time of injury/illness -10/3/1989.

Adjustor:
The Insurance Carrier (AIG) has their representative, who is an Adjustor. Her name is Robin Walker and she has an interesting approach to her job. It is to keep from paying out any money from AIG whenever possible. ALWAYS! If it is going to be necessary to pay out money, delay the payment. Perhaps it is the dictated job description, but it is absolutely against my best interests.

I cannot understand that. Because it is for medical care, it would be far better to resolve the medical problem promptly before it becomes a bigger and more costly issue. That is a financially sound approach. The better treatment will mean less treatment over time and thus less of expense over all to AIG.

Carrier Attorney:
The Attorney hired by the Insurance Carrier to handle the legal work that would be involved in the larger cases like mine. Generally he would work closely with the Adjustor and communicate with the opposing Attorney (my Attorney) over disputed issues. An example: When an IME is ordered, it is done through the court system, but my attorney is notified that it will be set up. Because I now live out-of-state, the Adjustor had initially set the appointment with a Physician in Florida (the state where the accident occured - not where I live (NC). This made it difficult for me, especially since it was in the middle of the state - 2 hours away from the location of the trial and on the day of the trial and at the time of the trial.

My attorney informed me, we replied that it was impossible to keep the appointment. The Carrier Attorney had to have the Adjustor cancel the appointment. Surprisingly she was able to find one in NC after all at a later date. Of course the trial was delayed. The trial has been delayed now three times due to her actions.

The trial has affected money due me and medical care I am to receive. There is no recourse in law to force action.

In fact, the Insurance Companies have lobbied and had laws passed to stop payment if actions have not been taken within a reasonable amount of time. It is interesting when they are the ones that have delayed the very actions that should have been taken.

Insurance Companies are very powerful! They advertise how powerful and strong that they are. AIG is noted in the 2008 list of FORBES as the 20th largest Company in the world.