POWER TO THE PEOPLE (in power)

Ever notice how normal working people who finally get the promotion from worker to management seem to take on a new personality.  Control over others is not only exciting but addictive!  Many good workers have done the "Jackal/Hyde" maneuver to exercise their control and at the same time trying to still be one of the good ole boys/girls!
Picture Frankenstein's monster when the surge of electricity went through his body. Pure unstoppable power! Pure disregard for the way he was before (dead) and now the ability to place fear while controlling others.
Then as they climb the Corporate ladder and refine those "power" skills, their distant past as a normal worker fades.  No longer do they take breaks or lunch or attend after work events with the working class.  They are now part of the "management" class and rubbing shoulders with others of like kind and quality.
This upward mobility not only in the private sector but in Government is identical! The power brokers and grabbers just want more and more power.  Often times when interviewed most who have reached almost the top will say they "love the chase!"
How many "bosses" have you worked for where you have seen this transformation take place? Many like the maggots that evolve into a fly, and few that evolve from a caterpillar into a butterfly!
If you are one of those with the power, tell me where I'm wrong!  Show me that power over others is often a good thing! Give me examples where that power is used for good!
While I'm in no way saying that we do not need "leaders" and "rules & regulations" we just need those people to retain much of the roots from where they came!
POWER TO THE PEOPLE


DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Labor Code Violations: Delay or Deny TPA agrees to pay large fine.

Sedgwick Agrees to Pay $1.129 Million for UR Violations

5.0

• by Greg Jones (Western Bureau Chief)
• State: California
• Topic: Top

Sedgwick Claims Management Services agreed to pay a fine of $1,129,600 to settle allegations of Labor Code violations stemming from a targeted inspection of utilization review practices the California Workers' Compensation Appeals Board ordered in 2013 after an injured worker who was denied hospitalization died from an infection contracted during surgery.
According to information provided by the Division of Workers' Compensation, the Audit and Enforcement Unit investigation resulted in 75 "mandatory administrative penalties" against the third-party administrator.
The investigation of 274 files that were adjusted at Sedgwick's office in Long Beach uncovered violations of Labor Code Section 4610, which establishes the rules for utilization review. According to a document provided by DWC spokesman Peter Melton, the violations include allowing someone other than a licensed physician to modify, delay or deny requests for authorization and failing to issue timely responses to requests for authorization.
Another document with more details on the audit results and the allegations was not immediately available Monday. Melton said the DWC needs to review the document to ensure it does not disclose personal information about applicants.
Sedgwick did not make anyone available for a telephone interview on Monday, but instead emailed an unsigned statement in response to inquiry by WorkCompCentral.
"There was a settlement reached, but the most important part of our statement is Sedgwick's commitment to ensuring injured workers receive the best possible care when they need it so they are able to return to full health and productivity," Sedgwick said.
Bert Arnold, president of the California Applicants' Attorneys Association and a partner at Boxer Gerson in Oakland, said on Monday the terms of the settlement appear to be a "nice start." He said he's happy to see the DWC investigating UR practices and would like to see the agency target more claims handlers and carriers.
Arnold also said he's not aware of any other times the DWC has assessed a penalty exceeding $1 million for claims handling violations. At the same time, he said he doesn't know how the amount of the fine in the case of Sedgwick compares to the amount of money the TPA saved through the alleged violations.
"It would be interesting to know how much was denied that generated a million dollar penalty," he said. "If it was more than the million dollars, that's a bad thing. I think they should be penalized more than what they denied."
Jesse Ceniceros, president of Voters Injured at Work, said a $1.129 million penalty is "probably a slap on the wrist" for Sedgwick and he doubts it will "change the way they do business."
"Unless an insurance company is forced to pay the price for their actions in a more expedient way, it's not sending out the message (the DWC) should be sending out when denying care and treatment, especially when it costs a life," he said.
Sedgwick did not admit to any wrongdoing or liability in the settlement agreement approved by Division of Workers' Compensation Administrative Director Destie Overpeck on Dec. 30.
The third-party administrator must submit a detailed statement of corrective measures taken in response to the findings of the Audit Unit within 60 days of Overpeck approving the agreement.
The settlement also requires Sedgwick to provide the DWC with copies of internal UR audits it conducted regarding its account with the Kroger Co. since Feb. 10, 2012. And it must provide the DWC results of all internal audits of claim files adjusted by Teresa McDivitt.
McDivitt was the adjuster on a claim filed by Charles Romano, who was injured in December 2003 while stocking shelves for Ralph's in Camarillo. After undergoing surgery on Aug. 29, 2005, he contracted methicillin-resistant staphylococcus aureus that shut down his lungs and kidneys and paralyzed him below the shoulders.
Romano sought treatment for the infection at Ventura County Medical Center and Medi-Cal footed the bill because Sedgwick refused to authorize hospitalization.
In October 2006, a workers' compensation judge issued an amended finding and award holding Romano sustained an injury to his left shoulder and that the infection was a compensable consequence of the injury. The judge ordered Sedgwick to pay all reasonable medical expenses, but the Workers' Compensation Appeals Board in a 2013 decision said the third-party administrator delayed paying for some services and refused to authorize others.
Several times, McDivitt denied treatment or refused to authorize a treatment request "without consulting with a medical professional and without referring the request for treatment to utilization review," the WCAB said.
The board said Sedgwick continued to delay and deny care until Romano died on May 2, 2008 from cardiorespiratory arrest, respiratory failure and pneumonia caused by the MRSA infection. Sedgwick didn't make any payments for medical care on the case until June 23, 2008, according to the WCAB.
The WCAB in 2013 rejected Sedgwick's petition for reconsideration on a February 2013 decision by a workers' compensation judge who proposed penalties of up to $110,000 after ruling that Sedgwick unreasonably delayed or denied medical treatment on 11 separate instances.
While Sedgwick argued, among other things, that it didn't know why Romano needed hospitalization, the WCAB said the argument was "utterly without merit."
The board said McDivitt "studiously avoided information that might lead to the provision of benefits, a tactic that may have saved her employer some money in the short run – at great cost to Mr. Romano – but which clearly violated the demands of (Labor Code) Section 4600."
The WCAB ordered the targeted investigation by the Audit and Enforcement Unit after saying it has "rarely encountered a case in which a defendant has exhibited such blithe disregard for its legal and ethical obligation to provide medical care to a critically injured worker."




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

WORKERS' COMPENSATION CLAIM VERSUS EMPLOYER NEGLIGENCE LIABILITY CLAIM

Came across a story (unconfirmed) where an adjuster (Workers' Compensation) during the investigation of a death claim discovered the accident was caused in part by the employers negligence.
Seems the employer (a supervisor) removed a safety device from a machine so that production time would not be impacted.  This removal did the intended purpose and keeping production high and there were no problems until a newly trained employee used the machine and was severely injured then died.
The adjuster before completing the report discussed the uncovered facts with their supervisor, the claims manager and then the underwriter!  Turns out that this insured was a very large account with multiple locations so a decision had to be made about going forward with the facts as presented.
If the death was caused by employer negligence the claim would not be processed as a Workers' Compensation Claim with a death benefit of under $150,000 but handled as a Wrongful Death which in most cases would be a much larger amount,  and with the possibility of Punitive Damages (not covered by insurance) being awarded!
The claim was then taken away from this adjuster and completed by an independent adjuster who determined that there was no employer negligence and the claim was paid using the Worker's Compensation Death Benefit!


DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions or comments"! There is absolutely no "legal" bases or claimed legal bases for any of the statements or opinions. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments or opinions!

United States Postal Service

Like most of you when I send something using the Post Office Flat Rate Envelope rarely do I purchase more insurance.  The Envelope comes with $50.00 of coverage which 9 out of 10 times is more than the value of the contents.
I sent some items to my grand children for Easter which included a $25.00 Gift Card to El Pollo Loco!  The envelope arrived but for some reason there was no Gift Card inside.
The Postal worker told me that Cash, Money Orders and Gift Cards were not covered by their insurance policy!  I asked if the envelope would have never been received would there still be no coverage for the Gift Card? The answer was yes, NO COVERAGE, "Lesson Learned!"

Read the FINE PRINT and if you are going to send a Gift Card be sure to Register it first.  That way if it gets lost or stolen you can go online, enter the account number and a PIN and get a new card!

Jeff Weiss



DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

DISRUPTION

Please read an outstanding article written by Alex Polyakov:  Alex is co-founder and CEO of Livegenic, a company that delivers real-time visual technology to help organizations improve customer service and field operation support capabilities.
Here is the link for the article: http://www.livegenic.com/what-does-disruption-mean-for-independent-adjusters
Alex also asked me for my opinion and here is what I sent him!
Alex, 
Having worked for several major carriers and running an IA business for about a 40 year span, and now writing short stories about the dark side of claims, I must say, your article on disruption was outstanding. Very well composed, and researched and your insight is far superior to 90 percent of those up the corporate food chain. 
Here in lies the rub or the anomaly! On the surface and what most people see and believe about Insurance Companies is that they are a necessary evil. People reluctantly pay their premiums based on a fear spread by Insurance companies that you need things, very nice things, and you need to protect them from damage, theft, fire or some other such type thing. And regarding real estate or automobiles you own, if you do not insure them the lender will place forced insurance for you! 
All this said, as I have said many times, most, not all Insurance Companies sell you a Promise they never intended to keep! 
"Bottom Line", "at the end of the day" and "truth be told" (all over used cliches) PROFIT is the one and ONLY motivator! The Stock Holders care nothing for how the profit is made and how many lives (not their own) are forever changed or ruined by the stroke of the pen or keyboard in denying or reducing payment on claims. Overall cost per claim is the prevailing factor along with "how can we deny the claim." 
On the more positive side, I would say that any IA organization that wants to stay in business would have to or utilize an in-place team of Virtual Adjusters. Vetted and ready to handle various types of insurance claims. A Virtual Claims Team along with Virtual Managers and Supervisors! 
Also an active and updated list of upcoming companies that will soon be specializing in "Drone" operations. The Drones can in fact become the eyes for the initial field inspection. Then if damages warrant a personal inspection and face to face meeting with the insured or claimant, a list of Independent Field Adjusters in major locations along with professional photographers with some insurance background! Technology as you indicated is moving quickly in the insurance claims business, so recognizing those things and adapting how to use them is needed. Real time websites dedicated to keeping the inside adjuster and the insured and or claimant in the loop is also needed! 
Again, a very excellent written article and I'm looking forward to reading more of your insight! 

Jeff Weiss 




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

WAIT

Introduction:

If I had to guess at what percentage of our lives we “wait” I would go with 90%!  Granted that seems high, but if you take into consideration not only waiting to see a medical professional, or waiting for “results” but also waiting for the traffic signal to change, waiting for your transportation to arrive or your significant other, I think you see my conclusion!

If still not convinced there is also waiting in line(s) to buy something like groceries, sports tickets, and pay traffic tickets, boarding a flight or waiting for a train or bus!  Babies are born waiting to be sent home from the hospital, have their dippers changed, be feed and learn to walk and talk.  Religious people are waiting for their Savior to come, or the end of the world or both!  Families are waiting for their children to come home from an evening on the town, work or military service.  Just about anywhere you go you will see a line of people waiting and you always want to find out why and are tempted to join the line!

While I’m sure I have missed hundreds if not thousands of ways we spend most of our lives waiting I think the point is made!  Think about some catch phrases like: Wait Up, Wait for me, Wait a minute, Wait and watch, Wait it out, Wait until the time is right, and Wait for the light to change to green. In short we are a people “Global” of “waiters!”  Not just in the USA but in every Country in the World!  We are all “WAITING”

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

BABY'S DELIVERY COMES WITH NEARLY $1 MILLION PRICE TAG

 ABC7 News--> http://abc7ne.ws/1F5t2C2

Check out this story on ABC where after purchasing "Travel Health Insurance" Blue Cross denied this pregnancy claim citing things like "High Risk!"

This is yet another way in which Most but not all Insurance Companies sell you a promise they never intended to keep!

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Makes you "Think" REALLY!

Family Will Not Collect $2.4M for Worker's Death

By Jeff D. Gorman 1 hour ago

Font size:  

Daytona Beach, FL (WorkersCompensation.com) - The family of a Florida construction worker who was killed by a 1-ton falling steel column cannot collect a $2.4 million judgment from his employer, a state appeals court ruled.
     Victor Lizarraga worked as a foreman for Metal Bilt, a subcontractor on a warehouse expansion project. His company worked on the 33-foot-tall steel columns that would support the building.
     The general contractor, R.L. Haines Construction, told the Metal Bilt employees to begin settling the steel columns after the epoxy had been drying for 44 hours, rather than the recommended 72 hours.
     Lizarraga was tightening a wire attached to one of the columns when the column fell on him and killed him.
     His wife, Eva Santamaria, and their two children sued R.L. Haines for wrongful death. The trial court agreed with them that the case fell within the intentional tort exception to workers' compensation immunity and awarded them $2.4 million.
     Florida's Fifth District Court of Appeals reversed 2-1 on Sept. 19, saying the standard Santamaria had to meet was that her husband's injury was "virtually certain."
     "Appellees were required to establish, among other elements, that as a result of the shortened epoxy cure time, the column was virtually certain to fall and injure the decedent," Associate Judge D.E. Silverman wrote for the majority. "This court must, therefore, review the facts and circumstances of this case to determine whether the evidence was sufficient to satisfy this 'extraordinarily high' standard."
     For the majority, the evidence did not meet that standard.
     "The record is devoid of evidence of prior similar accidents," Silverman said. "Moreover, the remaining three columns in the set - all of which were subject to the same shortened curing period - remained anchored to the base and standing upright."
     Even if the column was virtually certain to fall, no expert said it was virtually certain to kill someone, the ruling notes.
     Judge Jay Cohen wrote in dissent that R.L. Haines ignored the "red flag" of the movement of an anchor bolt on the set of columns and that the company falsely assured the employees of their safety.

Source: Courthouse News

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Another Carrier Promise!

A recent advertisement from a Major Insurance Carrier states they will not raise your rates after your first car accident!  They did not say they could simply cancel your policy or non-renew or a host of other things to penalize you!  Remember most but not all sell you a Promise they never intended too keep!
Someone I know very well had some water damage and called their insurance carrier and then within the hour called back to cancel the claim.  Seems the damage was very minor.  Within a week they received a letter from this carrier that said their policy could be cancelled if another claim was filed! With that they called the insurance company and reminded them that they had cancelled their claim within one hour after reporting it.  There was no assurance from the carrier that another claim reported still might trigger a cancellation or a non-renew status!  So now they feel threatened by their insurance company!

Jeff  

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Change.org

Recently joined www.change.org where liked minded people can petition companies, organizations or government entities!  Let me know about your Case Denied story and if think a petition is in order!


DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Esurance the "Good Hands People"

Now that Esurance is owned by Allstate, many of the cost savings (for the carrier) are starting to emerge.  I have composed the following to try to explain the newest approach to Video/Virtual Auto Damage Appraisals that could save this carrier a large amount of money!  Let me know your thoughts!

Interesting approach to having your vehicle appraised after being involved in a “minor accident”!  Most times however there is always hidden damages that can’t be seen until parts of the vehicle are removed.  For example if your front or rear bumper is damaged, there could be hidden damage to the vehicle behind the bumper.  This is very common, so getting the first appraisal is just the start and once you go to a shop there very likely could be more damage.

Also the reason that the insurance company wants to settle with you quickly and get you paid quickly is that they are gambling that you will just keep the money and not seek out repairs or other estimates.  Percentages are high that you will keep the money and not make the repairs which will save the Insurance Company a lot of money.  If they could save $1.00 on every claim, and average a million claims per year, that would be one million in savings!

Now that Esurance is owned by Allstate, many of their cost savings (to the carrier) will be employed.  In my opinion things like this tend to benefit the insurance company more than the insured (you)!

Then keep in mind that often times the first estimate will come in under your deductible, so if there is another person that you feel is responsible for the damages, the insurance company will not pursue recovery for you.

If you have any such stories, please share them with me at CaseDenied.Blogspot.Com

Jeff

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Changing name of my next book from "Case Denied" Adjusters to "Insurance" A Promise made, never intended to Keep!

Same Introduction, different title.

This is a work of fiction.  Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously.  Any resemblance to actual persons, living or dead, events, or locales is entirely coincidental.

What major industry other than Insurance charges you a premium for a promise and then tries hard to break that promise?  What if you knew the person making a life and or death decision regarding you and your future only had a High School Education, only had about two weeks training before being given a case load in excess of 100 files and told to resolve them as new claims to the tune of about five per day were coming to their desk?  What if these adjusters were sitting at desks in rows that resembled an assembly line and were more concerned with breaks and lunch and quitting time than the proper handling of your claim and spent more time in meetings and socializing after work at the local pub, then trying to get caught up on their work and become more proficient at their job?  What if these adjusters could recommend denial of your claim, or tell medical professionals that they could not do the medical procedure that Doctors had recommended and if these adjusters could actually use their preconceived ideas about you, and prejudices’ in deciding when and how much to pay for your claim?  Do you really think that the insurance companies with slogans like “the Good Fingers people” or “like a Next Door Neighbor” or “the Stone” or “we got your Back” has any actual merit or semblance of reality when it comes to handling your insurance claim?  Cute icons, like Cartoon Characters, or the Blue Panther, are in place to make you the consumer feel more confident about the insurance company that is looking to take as much of your money as they can, and give back as little as possible.  How would you feel if you knew the Insurance Company that you were paying your hard earned money to was using that money to not only promote Political Candidates that you would never consider endorsing, or on elaborate meetings and parties that make the recent IRS parties seem like a Church function?  What if that “security blanket” that you thought the insurance company was providing you was in reality nothing more than an elaborate scam trying to separate you from your money with a simple promise that they never intended to keep?  And then you must ask the question, how does the insurance company make us feel that we need insurance? The simple answer is “FEAR”!  Get consumers to purchase as many things as they can, live the life they have always wanted, then implant the fear that without insurance they could lose it all.  Without fear, which is manipulated by and in concert with, over reacted news coverage, most rational people would see through the fog of lies and misinformation that is presented on a daily bases.  Suggestion would be to limit your ownership to things you can protect without insurance, and if you buy insurance do your homework and find out as much as you can about that company.  It will not be easy, as they work hard to hide behind a wall of fabricated facts, and so called real life testimonials from Hollywood actors!  In this book your will follow my path from college to sales jobs to adjusting with several major insurance companies. You decide your fate and future and don’t let big insurance companies fear you into submission!  Just as with the percentage of fraudulent claims that are reported, so goes the percentage of “bad” or “fringe” adjusters.  For the most part most insurance claims are above board as are most adjusters.  I have worked with hundreds of adjusters and would trust my life with most of them!  Not all of them, but most of them!  This book is actually dedicated to all those hard working, honest and well educated adjusters that are out there.  Unfortunately many of them are now either retired or out of work!  

As I said at the introduction, this book is fiction, and I will add that any resemblance to actual people, companies, places, events or things is purely a coincidence and most likely the product of the authors’ imagination.

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

UN-AFFORDABLE HEALTH CARE aka Obama Care!

By January 1, 2014 I'm sure there will be tens of thousands of individuals that will have a "story" to add to this Blog!  When you find out that you really do not have Health Insurance even though you signed up for it, please let us know how that unfolded in your life and what current and lasting effects it will have.

I'm hopeful that many of those that are members of my Virtual Insurance Adjusters Group on Linked In will read this Blog and become a regular reader and contributor.  While sharing your stories may not change the circumstances in your particular case, your words and stories might just inspire others.

Please Read and Contribute!

Jeff Weiss



DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Case Denied: B A D F A I T H

No this is not about "Religion!"  It is however about "Relationships."
Remember that PROMISE the Insurance Company sells you in exchange for your money and calls it a Premium?  Well "Bad Faith" is also a legal term used in Insurance Claims when your Insurance Company wrongfully and with possible "Malice" and a few other legal terms denies your claim.

Most insurance policies both Homeowners and Commercial have extended coverage for "legal liability" and in the event that you are sued, they (insurance company) should defend you.  There is a legal saying in this regard concerning you insurance policy that states "There is a Greater duty to Defend than to Indemnify!"  In essence even if there is a question as to coverage the Insurance Company will and should  provide you with a defense.  If the Insurance Company after starting your defense feels there is no coverage for your claim they can file a Declaratory Relief action with the courts.  This involves presenting your case to a Judge and asking the Judge to make a ruling on the merits of the claim and if in fact there is or is not coverage.  If the Judge rules no coverage, the Insurance Company will continue the defense but issue a Reservation of Rights letter informing the policy holder that if liability is found against them, the insurance company may not be paying for the claim.  This of course sets up all kinds of legal situations and it is highly recommended that before you proceed down this path you hire an attorney.
The Bad Faith part of the lawsuit against the carrier comes in when the claim and or the coverage or both is Denied by the Carrier.  If the policy holder (you) does not agree with the findings and you feel the insurance company acted in "Bad Faith" towards you, you can file a Bad Faith Lawsuit.  If you win this lawsuit, along with damages you are also awarded "Punitive Damages."  Punitive Damages normally set by the Judge or Jury are equal to a percentage of the worth of the company you are suing.  This award can be in the millions of dollars or as little as one dollar, so Bad Faith lawsuits are taken very seriously by the Insurance Company.

Here is the Definition of "Bad Faith" as found in Wikipedia: 
 "An insurance company has many duties to its policyholders. The kinds of applicable duties vary depending upon whether the claim is considered to be "first party" or "third party." A common first party context is when an insurance company writes insurance on property that becomes damaged, such as a house or an automobile. In that case, the company is required to investigate the damage, determine whether the damage is covered, and pay the proper value for the damaged property. Bad faith in first party contexts often involves the insurance carrier's improper investigation and valuation of the damaged property (or its refusal to even acknowledge the claim at all). Bad faith can also arise in the context of first party coverage for personal injury such as health insurance or life insurance, but those cases tend to be rare. Most of them are preempted by ERISA.[5]

Third party situations (essentially, liability insurance) break down into at least two distinct duties, both of which must be fulfilled in good faith. First, the insurance carrier usually has a duty to defend a claim (or lawsuit) even if some or most of the lawsuit is not covered by the insurance policy. Unless the policy is expressly structured so that defense costs "eat away" at the policy limits (a so-called "self-consuming" or "burning limits" policy), the default rule is that the insurer must cover all defense costs regardless of the actual limit of coverage. In one of the most famous decisions of his career (involving Jerry Buss's bad faith lawsuit against Transamerica), Justice Stanley Mosk wrote: "[W]e can, and do, justify the insurer's duty to defend the entire 'mixed' action prophylactically, as an obligation imposed by law in support of the policy. To defend meaningfully, the insurer must defend immediately. [Citation.] To defend immediately, it must defend entirely. It cannot parse the claims, dividing those that are at least potentially covered from those that are not."[6]"

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Introduction: New Book CASE DENIED ADJUSTERS

Case Denied

ADJUSTERS

By JW Mica

This is a work of fiction.  Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously.  Any resemblance to actual persons, living or dead, events, or locales is entirely coincidental. 

JW Mica

All Rights Reserved
 

What major industry other than Insurance charges you a premium for a promise and then tries hard to break that promise?  What if you knew the person making a life and or death decision regarding you and your future only had a High School Education?  What if that same person, known by most as “adjusters” only had about two weeks training before being given a case load in excess of 100 files and told to resolve them as new claims to the tune of about five per day were coming to their desk?  What if these adjusters were sitting at desks in rows that resembled an assembly line and were more concerned with breaks and lunch and quitting time than the proper handling of your claim?  What if these adjusters spent more time in meetings and socializing after work at the local pub, then trying to get caught up on their work and become more proficient at their job?  What if these adjusters could recommend denial of your claim, or tell medical professionals that they could not do the medical procedure that Doctors had recommended?  What if these adjusters could actually use their preconceived ideas about you, and prejudices’ in deciding when and how much to pay for your claim?  Do you really think that the insurance companies with slogans like “the Good Fingers people” or “like a Next Door Neighbor” or “the Stone” or “we got your Back” has any actual merit or semblance of reality when it comes to handling your insurance claim?  Cute icons, like Cartoon Characters, or the Blue Panther, are in place to make you the consumer feel more confident about the insurance company that is looking to take as much of your money as they can, and give back as little as possible.  How would you feel if you knew the Insurance Company that you were paying your hard earned money to was using that money to not only promote Political Candidates that you would never consider endorsing, or on elaborate meetings and parties that make the recent IRS events seem like a beach party?  What if that “security blanket” that you thought the insurance company was providing you was in reality nothing more than an elaborate scam trying to separate you from your money with a simple promise that they never intended to keep?  And then you must ask the question, how the insurance company makes me feel that I need insurance, and the simple answer is “FEAR”!  Get consumers to purchase as many things as they can, live the life they have always wanted, then implant the fear that without insurance they could lose it all.  Without fear, and manipulated by and with over reacted news coverage, most rational people would see through the fog of lies and misinformation that is presented on a daily bases.  Suggestion would be to limit your ownership to things you can protect without insurance and if you buy insurance do your homework and find out as much as you can about that company.  It will not be easy as they work hard to hide behind a wall of fabricated facts and so called real life testimonials from Hollywood actors!  In this book your will follow my path from college to sales jobs to adjusting with several major insurance companies. You decide your fate and future and don’t let some big insurance company fear you into submission!  Just as with the percentage of fraudulent claims that are reported, so goes the percentage of “bad” or “fringe” adjusters.  For the most part most insurance claims are above board as are most adjusters.  I have worked with hundreds of adjusters and would trust my life with most of them!  Not all of them, but most of them!  This book is actually dedicated to all those hard working, honest and well educated adjusters that are out there.  Unfortunately many of them are now either retired or out of work!  As I said at the introduction, this book is fiction, and I will add that any resemblance to actual people, companies, places, events or things is purely a coincidence and most likely the product of the authors’ imagination.




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Case Denied Kindle E Book completed and Published!

Well is seems that writing and getting the E book published was easy as compared to "Marketing" it!  Kindle is very supportive and has some excellent tools available to help you write, edit and publish your E book.  There are also a lot of information (most for sale) on how to get you E book noticed!  What I'm doing now is sending copies (that I purchase) to people that I not only think will like what I wrote, but might just recommend it to their friends!  The book sells for 99 cents and is a very short read.

Currently while marketing this book, I have started on my next book "Case Denied" "Fraud or Bad Faith."

It started out with JW Mica being somewhat of a Super (insurance adjuster) Hero, but I think it will take on a more true to life (while still being fiction) tone!

I have included a Link to Amazon Kindle should you want to purchase a copy!

Thank you!

Jeff

http://www.amazon.com/s/ref=nb_sb_noss?url=node%3D154606011&field-keywords=Case+Denied



DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

"Case Denied" the E book Introduction

Here is the "rough draft" copy of the "Introduction" or "Trailer" that will be used to promote the E book.

Whistle-blower pays the ultimate price, his life, to try and make things right. 

Insurance greed, and Medical Cover-ups, contributes to the lack of faith in not only Corporate America, but in the entire medical profession.  How much is your life worth if you suffer a catastrophic injury?  Can "Cost Benefit Analysis" be used to see if you live or die?  Is the value of life changing into what's best for the bottom line?  Does your living or dying have an impact on the company you are working for?  Have we been transformed into walking, talking, breathing ATM machines for our employers?  Do others have more control over your future than you do?  Has greed taken the place of common sense, living and family?

It is one aspect of life in our society, to expect any sized company or organization to make a profit!  How far can or should the company go to maximize those profits.  Companies that actually take out million dollar life insurance policies on young employees, where the company is the only beneficiary!  Companies that actually have meetings to be sure they are maximizing on those policies, as those employees life or death is part of the Profit and Loss Statements.  The company. also can keep the life policy in force even when the employee leaves or is fired, and the company never has to tell the employee or their family about it!

 

High ranking Doctors testifying before Congress that they lied on Medical evaluations, denying coverage to people in life threatening situations by finding “loop holes” in the coverage, to benefit the Insurance Company!

 

The bottom line, is the bottom line, are you worth more dead than alive?  Would the insurance company pull the plug on you if it added dollars to their quarter results?  Do you think the “Shareholders” care how the company made its profit as long as it did?

What would you do if you knew these things to be true?  Hide your head in the sand, just ignore it?  You don’t know these people that have been put on Death Row based on an Accounting decision.  And then what happens one day when you wake up on the table, the surgery table, and realize your “Cost Benefit Number” is up!  How well do you know your close friends?  Is there a difference between telling the truth and not telling the entire story?  Does your own life measure up to those in the real world around you?  When you are down to your last true friend, the only one you can trust, and that friend betrays you, what next?  Will you embrace capitalism because you think it is the best in the world, or is it? Will capitalism survive with all the corruption from the top down?

While this story is Fiction, do your homework! Know how you will react when the letter comes stamped "CASE DENIED."

Wake up now before it is too late!

You have been warned!

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

<a href="http://www.hypersmash.com">HyperSmash.com</a>




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

New Insurance Exclusions for "Terrorism"

Here is a copy of an interesting article written by David Dybdahl, CPCU, ARM MBA Senior Consultant, American Risk Management Resources Network, LLC

The reason I post this is because of the recent "fire" that took place at the Big Bear California Cabin where it is believed that the ex-cop Dorner was held out.  At one point the news and or LAPD stated that Dorner was considered a domestic terrorist, thus my feeling that the carrier might consider denial of the fire claim?  What are your thoughts?
Terrorism and Mold are new exclusions in many HO policies, and it will be interesting to see if the carrier tries to use it.

Jeff

"New Insurance Exclusions for Terrorism and Mold
Create Unprecedented Levels of Uninsured
Risks for Property Managers, Property Owners and Lenders.
Or
Sorry We Forgot to Tell You…
By:  David Dybdahl, CPCU, ARM, MBA
Senior Consultant, American Risk Management Resources Network, LLC
Faced with rapidly increasing and unpredictable claims costs, the insurance industry has
over the past year methodically excluded insurance coverage for mold and domestic
terrorism losses on virtually all of the property and general liability insurance policies
sold in the US. The impact on the risk management community from either of these new
exclusions individually would be significant. Together they leave a broad cross section of
insurance buyers including property managers, property owners and lenders with
unprecedented levels of newly uninsured risks.
In light of the magnitude of these loss exposures, it is surprising how complacent
insurance buyers, insurance agents and lenders have been in dealing with them. One
reason for the complacency could be that it is very difficult for insurance consumers to
put these new sources of uninsured loss exposures into perspective.  Maybe insurance
consumers would have reacted differently to the unilateral changes in their insurance
coverage if the following cover letter had been sent out explaining the new mold and
terrorism exclusions."




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

"DID I DO THAT?"

I’m sure most of you remember the phrase “Did I do that?” by the TV character Steve Eurkel!  If not it centers around “responsibility” and of course “liability.”  In essence whenever there is an accident, someone or something caused it!  Trick is trying to figure it out especially when you were not there and are just gathering information from the various people involved.

There is now a way you can put your cell phone on your vehicle dash and record a 30 minute loop of the activities in front of you.  This has been designed as an App to help in the apprehension of potentially drunk drivers that you might see in front of you while driving.  With this, law enforcement will have a much better chance of securing a DUI conviction if that is the case.  On the other hand, I think that all vehicles should have this running at all times, not just for potential DUI’s, but in the event you are involved in a vehicle accident.  Just think how much better your case will be, that is if you are not at fault, if you have it recorded.  Also another plus would be to see the condition of the vehicle in front of you that you just rear ended before the collision.  How many times do people who have been rear ended say there was no prior damage to their vehicle.

As to fault, one carrier I worked for used the DBCD method for determining liability.

D for duty

B for breach of that duty

C for casual connection  

D for damages

What duty or obligation did the drivers have just prior to the accident?

Did any driver breach that duty?

What was the casual connection between the duty and the breach of that duty that contributed to the accident?

What were the damages?

Simple scenario would be a vehicle backing out of a parking space, versus a vehicle passing behind it.  Both have duties, and in this case what would they be and who has the greater duty.  Of course the person backing up has the greater duty to be sure the road way is clear.  Yes the driver going behind has a duty to watch for cars backing up and also needs to maintain a safe speed.  However the greater duty and in the case of the collision would rest with the vehicle backing up. 

There was a duty, a breach of duty and a casual connection with damages that resulted!

Of course this is a very simply liability determination, and coming up will present you with some more complex situations.

“Did I do that?” by

Frank Rogers

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.