The Insurance Company Is Doing a Peer Review of My Doctor - What is That?

After a car accident in Pennsylvania, your medical bills are covered under your own policy up to the medical coverage limits. This is called first-party or "no fault". Part of what you paid premiums for all those years was for medical bills if you get in an accident (regardless of who was at fault). The insurance industry lobbied for, and got passed, a law that allows for "peer reviews" of medical bills. This means that your insurance company can contest whether your doctor's medical treatment is reasonable and necessary. Unfortunately, there is great potential for abuse by insurance companies. There is a conflict of interest in that your insurer wants to save money on claims but they've already collected your premium money. Worse, they get to pick a doctor to do the peer review. So, they aren't using a court-appointed doctor. You typically have no say, nor does your doctor, in which doctor is chosen. If the insurer is puts its own interest in saving money over your health interests, do they choose the same doctors over and over who they know will tend to give them reviews that say they don't have to continue paying for treatment? Under the peer review rules (see PA Motor Vehicle Financial Responsibility Law). you and your doctor have the ability to ask for a reconsideration of a negative peer review. However, you will have to pay the cost of the reconsideration if the peer review doctor confirms their previous opinion. From our experience, the reconsideration rarely results in a change in the peer review decision. The costs, then, have a "chilling effect" on most people's willingness to request reconsideration. Your treating doctor should remain proactive with the insurance company. Your doctor should, as a best practice, stay in contact with the medical adjuster to try to prevent your treatment from going into a peer review.

Deposition Objections in a Civil Case

Typically, in a civil case, depositions are taken. This is part of the "discovery" process. Each side has the right to take a deposition of the opposing party to discover, or find out, what information they know and what their testimony would be at trial. It is a question and answer session under oath which is transcribed into a written transcript by a 'stenographer' (court reporter). Often, depositions of witnesses are also done to learn what they know. Usually, most objections are reserved until trial. This means that both sides agree to hold off on most objections until the case went to court. But, some objections are made at depositions. These typically include objections to the "form" of the question (for example: repeat questions, compound questions) or objections that the question asks for "privileged" information (examples: the questioning lawyer can't ask for what the person discussed with their own lawyer - that is protected by attorney-client privilege). When making an objection, the objecting lawyer is not supposed to give a "speaking Objection". This means that they are supposed to simply announce they are objecting and what the basis of the objection is. For example, "Objection, calls for compound question". The lawyer is not supposed to go into a long explanation which may suggest or tip off an answer to the witness - that is improper. If you are scheduled to give a deposition and you are a "party" to a lawsuit, your lawyer should meet with you before the deposition to explain the process and what to expect as well as go over what questions you may be asked. If you are witness and are not a party to the case, you have the right to have a lawyer with you, although, in a civil case, that is usually not necessary. You may want to contact a lawyer for advice on that if you are served with a subpoena. David E. Schreiber, Esq. Wolpert Schreiber P.C. (610) 792-3304 www.PAinjurycase.com

Roadway Defects

Perhaps you were injured in a car or truck accident on a State Route like Route 422 or Route 73 or Route 100. If it was a multiple-vehicle accident, there is going to likely be an at-fault driver. However, it's possible the design of the roadway had a defective condition. Maybe there was a drainage problem that caused ice to form on the road or there was a sign or traffic light problem. For a State road, the State/PennDOT would be responsible for the roadway. If a local/municipal road, then that would be the local municipality's responsibility.

Under PA Law, usually government entities have to be notified within 180 days of the incident. This type of matter may likely require an expert.

David Schreiber
Wolpert Schreiber P.C.
(610) 792-3304

Second Mile and Sandusky's Legal Defense in Civil Case

The Second Mile's insurer carrier (Federal Ins. Co., out of Warren, N.J.) has stated that any illegal acts by the former PSU football coach were not committed "in his capacity" as an official of Second Mile. Second Mile is the nonprofit organization Sandusky started bck in 1977 to help troubled young people. This is according to an article in www.Philly.com.

In the civil suit filed, Sandusky's role as an officer or executive of Second Mile might place the insurer in a "duty to defend" him. Meaning, the Second Mile's insurer could have to bear the costs of his civil defense. The insurance company may in such situations issue a "reservation of rights" and still pay for the costs - meaning that they reserve the right to challenge having to insure him or defend him. This duty to defend may also go along with a duty to insure him for damages. Of course, there is a separate issue of whether such an organization will itself be found liable for civil/personal injury damages to the victims. This would be on grounds that an employer or organization can be negligent in hiring/retaining/continuing to have an officer employee as their agent and allowing that person to use the authority of the organization as a means to get access to children.

But, if the Plaintiffs' lawyers can establish that such an organization's insurance policy has to insure the actions of the agent/employee/officer and they can show that there was a connection with him acting in his capacity as officer or agent of the organizing in allegedly committing acts, then they may be responsible for insurance coverage. Often, an insurance company will seek a "declaratory" judgment - a ruling from the court to declare whether there is insurance coverage. So,

Accident Insurance Claims - Don't Forget to Take Pictures

The overused saying, "a picture says a 1,000 words" couldn't be more true when you have an insurance claim.

Take pictures of any damage to your car or vehicle after an accident. It's likely that the insurance company will take pictures, but you want to have your own. Don't assume the insurance company will take all the necessary pictures or that you will easily get a copy of their pictures.

Getting photos of the crash scene is really important to preserve the evidence, especially if there is a dispute as to who is at fault. Skid marks, broken pieces of the vehicles, the layout of the intersection-- these are all important. Over time, that evidence will be gone, that's why prompt photos are key.

Common areas of car accidents in our area include Route 100, Route 73 and Route 29. There are certain intersections or blind spots that would best be shown in photographs.

If you fell or were injured because of an unsafe condition, get pictures of the defect as soon as possible.

Of course, if you are injured, you will want to get photos of your injuries. The insurance company will look to downplay your injuries. They'll have a hard time downplaying pictures.

If you have any questions, feel free to call us. (610) 792-3304

Wolpert Schreiber P.C.

Will the Insurance Company Pay for Wage Loss after an Accident?

In Pennsylvania, if you lost income or wages due to being in an accident, you can recover. First, say you were in a car accident in Collegeville or Pottstown or Limerick on Route 422 or Route 100 or elsewhere, and it was someone else's fault. you woull have two possible sources of recovering lost wages. You should first check with your own insurance company. If you have wage loss coverage on your own policy (sometimes called "no fault" or "first party" coverage), then you can apply for the wage loss as you lose it. You will need to get proof of your earnings (maybe a W-2 or paystubs from before the accident) and a doctor's note of disability. The advantage of having it on your own policy is that you can get reimbursed as the wage loss happens. It is true that the at-fault person's insurance company would owe you for wage loss-- but they generally won't pay it to you until the end of the case or without a release. If you are having ongoing symptoms, injuries or other losses, you want to be very careful abut signing anything which could affect your rights. If you have any questions, you want to contact an experienced personal injury lawyer.

Car Insurance in Pennsylvania Basics To Stay Protected

AUTO INSURANCE COVERAGE: SOME BASICS


Some items that you may want to check for when buying or renewing your car insurance:

• Full Tort (not Limited Tort)

• Underinsured Motorist/Uninsured Motorist Coverages (UIM/UM)
(Protects you and your family against the other drivers on the road. Acts as excess liability coverage for you if another driver at-fault has insufficient or no liability insurance)

• Medical Coverage
(“No fault”. Regardless of whose fault, your medical covers you up to the coverage limits)

• Wage Loss Coverage
(Also “No fault”. Inexpensive. Advantage: Pays wage loss as you lose it).

• Stacking
(When you have more than 1 vehicle on your policy. Inexpensive. Advantage:
Multiplies your UIM/UM coverage by number of vehicles on policy)

• Read your Policy / “Declarations Page”!