Sacramento, CAJust about anyone who has been involved in a car accident can tell you that dealing with insurance companies is a gigantic pain. Although the car crash itself is an ordeal, dealing with the paperwork and insurance adjusters to file a claim is a whole other nightmare. Karen S (not her real name) says that since her automobile accident on July 2, 2008, she has had problems getting her emergency medical care covered by the insurance company.
"I was just driving through a parking lot head for the art store," Karen says. "All of a sudden, there was a big bang. A car backed out of its spot and I think the driver must have been in a hurry and not paying attention. He hit me pretty hard—it took out the side passenger door. I have several bulging discs in my neck and back and those three places with the discs hurt really bad. I was walking around like that walking wounded. I was a bit dazed and confused."
Because of her bulging discs, Karen was not sure if she needed medical attention or not. Eventually, paramedics were called to the scene, but they did not have enough knowledge of her condition to determine if she needed help, so a nurse was called. The nurse told Karen that she was taking too big of a chance with her health if she did not see a doctor immediately.
"I felt kind of stupid getting in the ambulance, but I did," Karen says. "The doctor said that she couldn't see anything critical and gave me a list of symptoms that would indicate that I needed to get back to the ER right away. She also told me that I needed to see my own doctor the next day to follow up. I saw my own doctor the next day and was given anti-inflammatory pills, pain pills and muscle relaxants.
"The insurance company called me a few days later to interview me. I told the woman what happened and she said that they were taking responsibility for the accident and someone would come out and estimate the damage to the car, which they did. Then, they turned the case over to anther adjuster because I asked them to pay for my emergency treatment and doctor's visit following the accident.
"I felt bad asking about it because I hadn't needed to go to the ER, but I had no way of knowing it at the time. After that, the insurance company started dragging their feet. They wanted all sorts of extra details—this little detail or that little detail. In the event of a car accident, the insurance is supposed to pay for emergency care."
Karen says that although the hospital was nice about the unpaid bill, saying they would bill Medicare and pay it back when the insurance payment came in, the ambulance service was not as nice.
"It's against the law to not provide a prompt and fair settlement," Karen says. "All I asked them [the insurance company] to do was pay the emergency bill and the follow-up bill. They already accepted responsibility for what happened. I've heard through other people that insurance companies try to bully injured people and extract indemnities from them. So, when I spoke to the insurance company I asked them outright, something to the extent of, 'Are you holding up payment because you are intending to send me some sort of settlement document that indemnifies you for unknown and future liability?' And the answer was a muddled, 'Yes.'
"I have had increased pain since the accident—the pain medication I take has doubled. I usually took 1 or 2 pain pills a day and one is not strong enough now. I have to take between 2 and 4 pills a day. I'm also getting terrible headaches. Tomorrow I'm going for an MRI to see if there is anything else wrong. My back pain is hard to judge. I have a series of three epidurals in my lower back, which have been working really well, but it did hurt in those spots after the accident. Mostly, though, the pain is in my neck and it's a different pain from before. It's shooting up and down, where before it used to go laterally out into my shoulders. I have sessions of pain now.
"Fortunately, this isn't a horrible accident, but how is someone who is critically injured supposed to deal with this? If someone is critically injured, they cannot deal with all these bills. They [insurance companies] don't want to pay if there's an accident—they withhold payment and that makes it difficult to get treatment. I asked for something simple and they made it quite complex. It's sickening. It's a shame."