We’ve posted articles here before about the importance of having the right to decide whether a case is settled or not. In those circumstances, the point was that you may not want the insurance company to settle, as that reflects badly on your practice and you may not feel you had done anything inappropriate. This post is about the opposite extreme, when you feel a patient is due compensation. There again, you having control over the case is important.
Consider this: In a recent case reported by the Houston Chronicle, a fatal office building fire killed three people. The cause on the death certificate was given as smoke inhalation. One of the insurance carriers, Great American, is reported to have denied the claim, saying that smoke is “pollution” and there’s an exclusion for pollution in the policy, so there is no coverage. Though the building owner openly disagreed with his insurance company, that’s the story they’re giving, and they’re sticking to it — at least for now.
Some states allow suits against the insurance company. Others, such as Oregon, only allow one to file a complaint with the state’s governing agency. In some states, that would be considered Bad Faith, and if it got to court, Illinois, for example, would hold the insurance company responsible for triple-damages. Unfortunately, it could easily take 10 years for the case to get to the courts, and such disreputable companies may try to settle on the courthouse steps, if they’re even still around.
Where does that leave you, the physician, if you feel that a patient’s claim is justified and want them to gain fair compensation for their injury? You’ve paid your premiums, so you shouldn’t have to pay the actual damages as well, yet you want to do the right thing.
Here again, your best solution is to go with top insurance companies — companies with good ratings and the assets to pay. A quality carrier is unlikely to try such a stunt. Be sure you have at least some control, some say-so in the settlement process.
Please feel free to contact Presidio. As independent insurance agents, we’re on your side. our job is to help you get the right coverage for your needs, at the best rates, from the best possible providers. We look forward to putting our expertise to work for you!