Does Nationwide Insurance Company have a policy of discriminating against people who are overweight? Do they care about fairly and honestly settling auto accident cases? It seems a very strange turn-around for what has historically been a very credible insurance company. After reading this story, you decide.

Our story begins in Bakersfield with a minor, three-car accident. Car 1, driven by Richard, stopped for a red light. He was rear-ended by car 2 slowing for the same red light when it was hit by car 3. As this accident was at low speed, there wasn’t a lot of property damage.

Low impact can still injure

In a low impact, slow speed accident, you can still be hurt, even if you car has sustained minor damage. While it is usually true that the more physical damage to the car, the greater injury to occupants, as a police officer for 10 years, I have seen many cases of significant injury, especially rear-end accidents where occupants have some health or physical condition — such as weight issues or disc disease — which makes them more likely to be injured.

A large person involved in a minor accident has a greater risk of striking the steering wheel with their chest and suffering whiplash symptoms. I have seen many cases of older drivers, symptom free, with serious disc disease, suddenly wind up with major neurological problems after whiplash accidents. They were what we call egg shells, fragile, yet feeling perfectly fine before the accident, according to Bakersfield private investigator Riley Parker.

Mr. Parker was quick to point out that “there are many insurance companies who try to wiggle out of their legal responsibility, using bogus-biomechanical science, claiming that no one could possibly be hurt in some of these low speed accidents, and to that I say, garbage!”

Our experts say you can’t be hurt!

Richard and his 9-year-old daughter were more than a bit shaken up. “We were both wearing seat belts, and thrown into the seat back. It was strange. There was such little damage to my car, yet my shoulder, neck and back hurt and so we went to a hospital emergency room to be checked out,” he told me. The Emergency Room physician wrote in his chart, “Myofascial neck and back pain. Bed rest and Motrin, 60 mg intravenous Toradol now.” Toradol is an anti-inflammatory, equivalent to morphine. It is never used unless there is a serious reason. He was also prescribed Ultram — a potent opiate pain medication — for “break through pain.”

But Nationwide — representing the third car — whose motto is, “we are the on-your- side company,” has a different view of things. They sent a check for Richard’s property damage, clearly accepting liability, and then two of the most uncaring adjusters I have met echoed the same story. “We had our bio-mechanic expert look at the physics of this accident and conclude that statistically, no normal person could ever be hurt. Therefore we are denying their injury claims.”

When I pointed out that Richard is somewhat overweight, and that could be why he was so banged up, both adjusters laughed. In fact, one Nationwide adjuster, Ted, said, “Our experts tell us that if you are fat, it provides extra padding so you won’t be hurt as bad!” And then, when I asked them if I should conclude that Nationwide has a policy of actively discriminating against overweight people, they both said “You conclude what you want to! We aren’t paying a cent.”

The higher you go the more stubborn they get

I have normally found that when a case of this nature is brought to the attention of a the Public Relations Department, common sense prevails and a solution is found. That’s what usually happens with ethical companies, but I have to wonder about Nationwide. I spoke with spokesman Mike Palmer, and it was like talking to a zombie. The poor guy can’t seem to answer any questions or talk.

Our conversation went like this: “Speak with the claims supervisor.”

“But they already said they were denying the claim!”

Mike refused to answer one important question: Does Nationwide discriminate against overweight people when handling claims? I repeated this several times, “Mike, it sure looks to me like Nationwide is actively discriminating against overweight people. Are you?” Silence was his response. I will take that to mean “Yes, we are.”

What does this mean for you if you are overweight?

By far the most maddening conversation I had was with a “director” of Nationwide Insurance, Greg Mareno, who was quick to tell me that he sleeps well every night, and denies claims routinely when his “biomechanic expert” tells him that there is a “statistically low chance of anyone being hurt.” Mr. Mareno said this without ever looking at Richard’s medical records. Instead of doing what California law requires — and paying for the medical treatment — Nationwide’s “Director” laughed. When I raised the issue of discrimination against people who are overweight, he hung up.

By the way, we are only talking of $2,700 in ER bills and x-ray charges, not a lot. Is there a message here from Nationwide Insurance for the 65 percent of Americans who are overweight and the 25 percent who are significantly overweight? The impression I get is that Nationwide can be seen as engaging in discrimination and in using questionable science to justify denying legitimate claims. While I am not overweight, if I were, seeing how they are treating this completely innocent man and his daughter, this is the last insurance company on earth I would ever want to insure my car.

There is something frightening about the way Nationwide approaches these cases. Regardless of the fact that you are actually injured, by using a paid-to-help-us-deny claims bio-mechanic “expert” their adjusters and management engage in the worst kind of discrimination; against people who are hurt, but who “just shouldn’t ever be hurt.”

So now Richard must go to Small Claims Court and sue the owner and driver of the car that caused the accident, resulting in a potential bad credit mark for them. Nationwide needs to change its motto. “We will get you sued!” seems much more fitting.

Over the years I have met and spoken with many responsible and decent claims adjusters working for Nationwide. I am sure there are many who still remain with the company. I’d just like to know where they are.

Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.

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Slowing down, about to stop for a red light, perhaps doing one or two miles an hour, Patricia’s 2007 Toyota Camary was rear-ended in December 2011, leaving “the rear bumper scratched and pushed in slightly,” her email to You and the Law stated.

“While the damage wasn’t all that visible — repair charges only $710 — my daughter and I did feel a ‘jolt’ and I noticed an odd tingling in my right arm along with very slight discomfort in my lower back. That is why we saw our chiropractor, just to be checked out. He immediately referred us to an attorney friend.”

Now, let’s fast forward to June of 2012. This incredibly minor auto accident has generated close to $60,000 in chiropractic, physical therapy, MRIs and expensive “pain management” M.D. treatment bills. It was simply an insurance scam, taking advantage of trusting patients.

“We had never been in anything like this before,” Patricia told us, “and now realize that the doctors and our lawyer were having us going through all of these procedures just to run up a huge bill. We feel so bad, because our lack of knowledge helped them!”

Of course, it’s bad enough realizing you have simply been a money-making tool for unethical health care professionals and the lawyer they work with. As you’ll see in a moment, what Patricia and her daughter didn’t know at the time was the damage this incident may yet cause them, years from now.

‘No concern for the patient’s best interest’

“This happens all over the country, and your reader fits the pattern of the perfect victim who is in an extremely minor auto accident with little or no property damage or injury,” states Frank Scafidi, spokesman for the Des Plaines, Ill.-based National Insurance Crime Bureau.

“We want the public to be aware of what an insurance scam looks like, how greedy people in the health care and legal professions find their victims, to realize this is a fight over money and not what is in the best interests of the patient/client. Also, it is so important to understand the risks faced personally by being associated with insurance fraud,” Scafidi states.

“It’s the auto accident with little or virtually no property damage and injury that invites fraudulent claims. You need to use common sense and good judgment, and listen to that little voice which tells you things are not right.”

Scafidi outlined some of the red flags:

1) You have a minor accident and are approached at the scene, or later contacted, and urged to see a certain doctor or lawyer. This is a huge red flag and the first step in what we refer to as “engineered fraud,” where you become a portal through which excessive and unnecessary treatment begins.

2) There is a well-established connection between property damage and bodily injury. If you are in a truly minor accident and basically feel fine and yet are being referred to specialists and scheduled for expensive tests and treatment, something is wrong.

3) If you are encouraged to continue treatment as a way to get a higher insurance settlement, this is trouble with a capital “T.” There is a distinction between a person who has been victimized and one who is part of the fraud. You could face prosecution if you are a knowing player.

4) We know real claimants get caught up in these things and do what they are told to do. If and when at some point things do not seem right, just out of self-protection, make an inquiry. Speak with your own insurance agent or claims adjuster.

Finally, if you think you may be the victim of insurance fraud,  please call our hot line — 800-635-6422 or TEL-NICB. Also, look at our website: www.nicb.org.

Patricia now has a C.L.U.E.

Patricia and her daughter are facing long-term consequences from being involved in what is clearly insurance fraud, even though it would certainly appear they are innocent of any wrongdoing.

Their names are in a national database known as the Comprehensive Loss Underwriting Exchange. This is the 500-pound gorilla of personal information — claims history — used by insurance companies to “reduce risk and liability by assisting the underwriter in predicting future claims,” as its website states.

CLUE takes a seven-year look backwards at accident claims, with information submitted to it from insurance companies all over the country. On the condition that we not reveal her name, one fraud investigator for a major auto insurance company told You and the Law that someone in Patricia’s situation “will be looked at like ‘The Boy Who Cried Wolf.’

All it takes is one highly questionable claim for a later accident — even a real accident — to be seen in a very different light.”

Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.

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We’ve all seen the excellent University of Farmers Insurance commercials featuring a lovable, yet gruff Professor Nathaniel Burke, played by character actor J.K. Simmons. The professor adds humor and a touch of sarcasm to questions he asks “agents-in-training.”

Today, it is our pleasure to welcome readers to a lecture conducted by “Professor” H. Dennis Beaver from the University of Beaverland, and we begin with a series of questions followed by an email from Patricia, a reader who felt something was strange about her auto accident case.

1) How bad a rear-end accident was it?

2) If you looked at her car, what would you expect to see?

3) Roughly, what would repair costs run if the car could be repaired, or was it a “total”?

‘My lawyer called me in a panic’

“My daughter and myself have just finished treatment for an accident we had in December 2011. Our lawyer just called me in a panic, explaining that the driver who caused the accident only has bodily injury liability coverage of $25,000 per person or $50,000 per occurrence, but my medical bills are $35,000, and my daughter’s total is $24,000.

“Even though this exceeds the maximum of what insurance would pay, he said that we would receive $1,000 each and wants us to come into his office and pick up the check. He also wants us to now tell the doctors to bill our health insurance, but has assured us that we will not be responsible for any unpaid medical bills because he claims to have a very good relationship with the doctors he sent us to.

“All of us are insured by the same company. When I contacted my claims adjuster and told him our lawyer’s comments about coverage limits and getting only $1,000,  his tone of voice communicated that something was very wrong.

“I never authorized settlement of the case and have not signed a release nor have I seen a settlement check. I’m not sure what to think or to do next.”

‘They told me I needed all of these treatments’

“Following the accident, my right arm had a strange ache and a tingling sensation. My lower back was a bit tender, but overall I did not have much discomfort. To be checked out, I went to a chiropractor, but he told me that I did have neck and lower back injuries, needed treatment and should hire his attorney friend, which I did immediately. After two months with the chiropractor, my lawyer sent me to a pain management physician.

“From March to June 2012, I used up all of my overtime and sick pay because the doctors told me I had to have these chiropractic adjustments, ultrasound, several expensive MRI and X-ray studies, painful nerve conduction tests, epidural injections and on and on.

“My bill came to over $33,000, and $25,000 for my adult daughter who had almost identical treatments. Neither of us had ever hired a lawyer before, and we just did what we were told to do,” our reader explained.

“In looking back, something just didn’t seem right. We wondered if all of these doctor visits, X-rays and tests were really necessary. But we had never been through anything like this before, and honestly didn’t know what to expect, but now feel that we were just a way for them to run up a huge bill.”

Experts in insurance fraud would agree with Patricia.

The clue that something is wrong

“At some point, the client is being pushed in a direction that she does not like. This is a clue to stop and take a breath. Ask yourself, ‘Is this something that really needs treatment? Or am I being used as a moneymaker for others?’” says Frank Scafidi, director of public affairs for the National Insurance Crime Bureau based in Des Plaines, Ill.

“There is a correlation between property damage and bodily injury. Photographs of damaged vehicles are admissible in most courts where the reality or extent of injuries are questioned. If you are in an accident where there is no, or virtually no property damage, and a health care professional says, ‘Hold on, let me send you to this law firm because they specialize in accidents and will take care of you,’ right there and then, things are bad,” warns Scafidi.

So, what was the property damage to our reader’s 2007 Toyota Camry?

“The rear bumper had a scratch and was pushed in slightly. They gave me $710 to fix it,” Patricia told us.

A trusting patient and client had been sucked into an insurance scam, unaware of the warning signs or how, in the future, she could easily be seen as “the boy who cried wolf.” We’ll explain why next time.

Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.

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When you cause an accident

My daughter was in an auto accident that, according to the police report, was partially her fault. There were serious injuries to occupants of the other vehicle, and I get the feeling that our own insurance company adjusters are doing nothing to protect us. Please, do not get me wrong, if she is partly responsible, we feel that our insurance should compensate those people who were hurt, but we do not want to be sued or exposed to having to pay out of our own pocket. Do you have any suggestions on what we should do to protect ourselves?

Duty of to protect and defend

We buy auto, business or homeowners insurance to protect others from an accident that we might cause, and to also shield ourselves from what could be enormous financial burdens-hospital bills, lost wages and so on. Legally, we speak of an insurance company’s Duty to Defend and Indemnify-the legal duty to protect us. Of course, this implies that claims will be competently and professionally investigated, so that we are not unreasonably exposed to the risk of having to pay out of our own pockets for an accident where we may have been at least partially responsible. It’s one of the reasons we purchase insurance in the first place – so that our personal assets will be protected.

There is no mystery to world of auto claims. Most are handled in a routine manner, with fault initially determined by the claims adjuster after, we hope, a fair and thorough investigation. In simple cases, this may only require looking at a police report and speaking to their insured and perhaps the other side. In more complicated cases, or where injuries are substantial, hiring a private investigator and accident reconstruction expert might be appropriate.

If your adjuster objectively feels you were not at fault, or there are legal defenses to a claim, they must defend you, or attempt to settle the claim within the policy limits so that your personal assets are protected.

But what happens when this process breaks down? What happens when your auto insurance company fails to competently investigate a claim, and creates a very real possibility that you could be hit with a judgment far above the limits of your insurance policy? That what’s facing Annie, a teacher at a large community college in the Southern San Joaquin Valley. While the names and location have been changed, this is a true story.

Me and my skateboard

When her classes begin in the afternoon, Annie occasionally likes to spend a couple of hours shopping for plants at a nursery not far from where she lives. On September 1, 2004, she loaded the plants and related garden items into her car, and was just pulling out of the parking lot, carefully about to turn (right) westbound onto a divided main highway, when suddenly a 34 year skateboard rider smashed into the hood of her car.

The skateboard rider was, by his own admission, going “fast, really going fast, about 20 miles an hour,” against traffic, eastbound in the westbound fog lane, that very narrow strip of highway at the extreme right hand side of the roadway.

At 20 miles per hour, the skateboard rider was covering 30 feet every second, quite literally unseen and unexpected, to a driver looking left, in anticipation of turning right onto a one-way road. While Annie “did, of course, glance to the right, to be sure there were no pedestrians,” she was mainly concerned with west-bound traffic. The nursery is located in a commercial section of town, with no sidewalks and nothing but vacant lots nearby.

On a roll

The skateboard rider wound up with a badly broken leg and over $50,000 in medical bills, paid for by the nice taxpayers of California. According to a witness, “He was doing something with his hands.” That something was, unbelievably “attempting to roll a cigarette!” He saw Annie’s car, but instead of stopping or steering away, “yelled,” but took no evasive action at all.

When asked who was the main cause of this collision, a witness who was traveling westbound and saw it all, blamed the skateboard rider, for going the wrong way, at high speed. “Anyone turning right onto a divided highway would naturally look to the left, to be sure it was safe to enter. With no sidewalks and only a dirt shoulder, no one would ever expect to see someone on a skateboard, traveling in the wrong direction,” commented the witness.

Annie did look in both directions, but had no way of seeing the skateboard rider, due to his high rate of speed plus the fact that the edge of the highway was partially obstructed by a metal fence.

Who is at fault?

Under California law, believe it or not, a skateboard rider is classified as a pedestrian, and this gives greater legal protection when in an accident. However, skateboard riders must still observe the rules of the road, something that did not seem to have happened here.

Let’s say that you are a claims adjuster for Annie’s insurance company. What would you do to thoroughly investigate this accident? The answer is pretty much common sense; You’d send out an investigator, have good photos taken, interview witnesses, do a reconstruction of the accident, and try to accurately show what happened to establish a defense, or at least to show that the skateboard rider was himself greatly to blame.

We don’t investigate. We’re GMAC.

But that’s not what Annie’s insurance company did! Oh, no, not GMAC!

“Well, we did talk with her, and with the man on the skateboard, and we read the police report,” I was told by claims adjuster, Elizabeth Collar. “That’s all?” I asked, in disbelief! “You call that a good job of protecting your insured?”
Not only did has GMAC utterly failed to defend, but they did something even worse. Within weeks of the accident, with no credible investigation, they offered Annie’s $100,000 insurance policy. And, guess what? The skateboarder’s lawyer wants $50,000 out of Annie’s pocket, on top of that!

This case is still unfolding, but if you feel just a little bit scared-wondering if such a thing could happen to you-yes, it can. And for this reason, if you are in an accident and are partially at fault, never, never trust your own insurance company to protect you.

Next week, our recommendations — what you need to do if you cause an accident. Our advice could save you more than worry.

Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.

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This column often receives questions from readers asking about the pros and cons of handling an auto accident insurance claim by themselves, without hiring an attorney. Advice sought typically falls into these categories:

“Can I do this myself?” “Should I?” “When do I know if I am over my head and need to hire a lawyer?” “Can I get the other guy’s insurance company to help me pay bills before our case is ready to settle?” “Is it possible to simply pay a lawyer for a consultation, learn the steps that I should take and how much to ask for?”

The short answer to all of these questions is Maybe. Today, I want to shine a light onto the murky world of insurance claims practices, to help you understand just what anyone is up against in these David and Goliath struggles. Next week, You and the Law borrows a slogan from Home Depot: “You can do it — We can Help … I hope…”

Low impact or serious?

Naturally, just as all Brides are Beautiful, every auto accident case is serious for the people involved. There are, however, degrees of seriousness.

For example, if you are stopped at a red light and slightly rear-ended by an inattentive driver, resulting in a hard to see dent, this is clearly a low-impact accident. But, if the back of your car looks like an accordion, that’s serious.

“While actual property damage amounts vary, the threshold of what’s low impact has gone up dramatically. To some companies, anything less than $5,000 is low impact, especially if we’re talking about high-tech lighting devices, trunk mounted GPS, Entertainment units, or exotic paint jobs. If my company feels it is a low-impact case, we will completely deny payment for treatment — for any treatment, even if we know injury is possible,” a former claims manager for a major auto carrier admitted to me.

Why is he a former claims manager?

“It’s because I could not do this any longer. I was hurting people. If you became the perfect little Nazi and followed orders, they were happy, regardless of how blatantly unfair. When I got into this field 30 years ago, it was truly professional. But not anymore,” he said, shaking his head.

“Today, adjusters who thrive tend to be cold, heartless, and morally bankrupt. The turn-over is amazing, as anyone with a conscience cannot last long,” he added.

In an investigative piece that CNN did in 2007, household names-Allstate, State Farm and others-were found to play the “Deny, Delay, Defend Game.” Here’s how it was explained to me:

“Even when we know our guy is substantially at fault, deny liability or tell them we feel no one could be injured in this kind of an accident. If you must accept responsibility for your insured, and there is a valid injury claim, then you delay settlement hoping to wear the poor slobs on the other side down long enough so they will take much less that what you know is reasonable.”

“Finally if suit is filed, spend limitless amounts of money on your own defense attorneys to send a message to the plaintiff’s lawyer: You will regret the day your client didn’t accept our first offer, because taking us on is going to cost ya, pal,” stated my retired claims adjuster friend.

What about bad faith?

Because of lobbying by the Insurance Industry, there is no such thing in California as Third Party Bad Faith, as this column has discussed in the past. Practically speaking, this has left auto insurance companies free to act in bad faith, making it not profitable for most lawyers to get involved in a typical, not terribly serious case. Here’s why:

“Once a settlement offer is announced, field adjusters have virtually no authority to increase it by more than a few dollars. We use sophisticated computer programs, not in an effort to fairly evaluate a claim, but to unfairly evaluate it. Offers today tend to be an insult, and even if you hire your own lawyer, that offer is generally cast in concrete,” a supervising adjuster for a major insurance company told me not long ago. You can bet I am not at liberty to reveal his name.

Have adequate insurance

If you can’t expect a fair settlement on a good case, you can still protect yourself with the right kinds of coverage, so that, regardless of what the adjuster offers, you and your occupants are going to be OK.

“Medical Payments Coverage is very inexpensive, in terms of what you get for the premium paid. $30,000 coverage per occupant costs less than $100 a year with some companies, and if you want $100,000 per person, that’s less than $200. It is a real bargain, and the insurance company is legally obligated to pay for treatment, regardless of fault.”

“Yet, you’d be surprised at just how many people decline Med Pay — many of them have no private health insurance either. It is false economy, saving a few dollars, and gambling that nothing will ever happen,” a State Farm agent told me. She is absolutely right.

Next, always have large limits of Uninsured Motorist coverage, say $50 — $100 thousand per accident. Finally, have Collision or Comprehensive coverage unless your car is truly not worth repairing. You would be surprised at the calls I get from people who are so amazingly cheap, they could have afforded, but did not purchase UM or Collision coverage. Hit by an uninsured driver, all I can do is to pass them the Kleenex.” she said.

Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.

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Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.

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