Imagine being involved in an auto collision caused by an uninsured driver. Naturally, you would look to your auto insurance carrier to cover your injuries via your uninsured motorist coverage and medical payment (med-pay) or personal injury protection (PIP) benefits for which you’ve been paying premiums. Assume amongst promises of good claims handling, you go unrepresented by an attorney and sign medical release authorizations so your insurance carrier can get medical information directly from your treating physicians.
Suppose your carrier asks your treating physicians whether the treatment they’ve rendered is related to the collision with the uninsured driver, and your physicians answer affirmatively and write a report addressed to your carrier to that effect. However, your carrier never tells you of the report.
Further imagine, several months later while your claim goes unresolved, your auto insurance carrier hires one of its doctors to do a “document review” of your medical records. Maybe all the necessary records are provided to the doctor, or maybe they are not. Surprisingly, your insurance carrier’s doctor says there is no relationship between the injury and the collision. Your insurance carrier then denies your uninsured motorist claim based on its doctor’s “document review” opinions.
You are still never told of your treating physician’s opinion that your injuries are directly related to the collision. Only after hiring an attorney do you learn of it. This very scenario is occurring here in Ohio and other states. Insureds are forced to bring bad faith claims against their insurance carrier to try to secure benefits rightfully due them. In fact, State Farm is currently being investigated for alleged sham medical exams and document reviews. There is also a lawsuit pending against State Farm in the state of New York under the Racketeer Influenced Corrupt Organization Act (RICO) for alleged scientifically dishonest reports in order to terminate benefits of its insureds.