Friday, February 23, 2007

Being an insurance customer for dummies, special edition

More about lawsuits:

I was surprised to get a call from the adjuster for the other party's insurance company on one of my lawsuit cases the other day. "The thing is, they've bounced this paperwork about three times," he told me. "The last time, it was for not filling in the county box on the form. What the -- do you know, I've been doing this for 16 years, and this is the first time they've ever wanted anything to do with the 'county' box?"

"Oh boy," I said. I had no idea, having never filled out any of that kind of paperwork.

"It's ridiculous! And I'm sorry I took so long to get back to you-- I've been at a week long meeting every day. Guess what? It's gonna get a whoooole lot harder."

"Flood claims?" I asked.

"Yep. See, the current legislation was put together by Republicans. The Democrats are in power now and they don't like any of it; wanna rewrite all of it. There's even talk of cutting funding."

"After Katrina?" I guessed.

"Yeah, even after that, can you believe it? Anyway, what they're doing now, like for next year, they're combining Wind and Water. Before, they were on two separate policies, see? And with Katrina, there was all this squabbling, they're still sorting out some of the claims if you can believe that, they go, 'no, this looks like wind damage.' 'No, that's water damage.' Well, you can't tell! There's no way to tell! And nobody wants to pay up! So they're combining it now."

Me: "That actually sounds pretty good, then."

"Oh, yeah, it's gonna be great! Seriously easier."

I squished shut my eyes. Sometimes conversations boggle my brain. "Super cool," I said.

"Yeah! Anyway, he should get a check, well, the delay should be momentary."

"One more thing--" I said, remembering. "You're aware there's a lawsuit, right?"

"Oh yeah, he's suing the county or some crap like that. Yeah."

"I just wanted you to be aware so that you were protected, you know."

"Yep. Well, let him know a check is on the way."

I asked permission, but they let me. He grumbled about having NEW claims because there was more inventory to account for than previously discovered: it was a flood at a business. But he's a nice guy.

So, live and learn, sometimes insurance money DOES come through for people in lawsuits, and some of the people in insurance can continue to work to get you money even when others have their hands tied. But expect, if you are in a lawsuit with an insurance claim attached, that one hand will not talk to the other.

Workers' Compensation:

This varies state by state. However, it pretty much goes like this: if you are hurt on the job, your employer should be able to give you a form to fill out to file a Workers' Comp claim. Your employer has Workers' Comp insurance, and it is his/her policy that you will be claiming against. (Only CRAZY rich employers can provide their own self-insurance for this in California, and I think they're crazy as well as rich, since this is a thing about which I would want to pass that buck... but then I am a big believer in social welfare and support systems in government, so you might have expected me to say such a thing.) If s/he can't provide you that form and doesn't know much about his/her insurance, it's still going to be okay... the Internet will have information for you.

On the California version of that form, there is an automated helpline listed. When an injured worker called us because it is through us that her boss has her Workers' Comp insurance, I faxed her that form, but really, she and her employer have to fill it out and submit it. I listened to the (incredibly good) automated helpline. I went to the website it mentioned. I sent her the relevant fact sheets to her claim, and the forms that she might need.

This is the most important part, I think. Your DWC or whatever it is called in other states has local offices, and in those offices, they might, if they are like California, hold monthly workshops for injured workers. That means that you get one-on-one and group help in sorting out Workers' Comp issues, and that you have access to people who can answer your questions and put the right forms into your hands.

If you are hurt on the job, don't be afraid to do a little research and even to enlist the help of your insurance agency in tracking down your next steps. You will be interfacing with the state... they will have their own claim evaluators come and see you, and they might require that you see one of their recommended doctors unless you submit special forms declaring your intention to go with your own physician. But, although it may look intimidating at first, the process is designed to be accessible and it is not impossible to decipher.

Better yet, don't get hurt. But, you know, life.

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