The Unfortunate Reality of Insurance & What It Can Potentially Mean for Car Accident Victims

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You’re a responsible individual. You try your best to avoid accidents while making sure to pay your insurance premiums. Whether it’s auto, health, or life insurance, you expect your company to be there when you need them most.

You honor your responsibility in the contract and expect your insurer to honor theirs. But that isn’t always the case and a recent investigation into insurance giant Aetna proves it.

Your New Orleans car accident attorneys at Cardone Law Firm have extensive experience helping clients when their insurer has failed them. No amount of profit or stock shares should ever come before a client and we’ll make sure you obtain the recovery that is rightfully yours.

The Unfortunate Truth

In early February 2018, the unfortunate truth of just how despicable insurance companies came to light in an ongoing investigation into insurance giant Aetna.

Dr. Jay Ken Iinuma, former Medical Director for Aetna in Southern California from 2012 to 2015, admitted under oath that he never looked at patient’s medical records when deciding whether to deny or approve coverage. Dr. Iinuma claimed that he was only following company procedures and was basing his decisions solely on summaries and information provided by nurses.

Dr. Iinuma made this statement in a courtroom appearance for a lawsuit filed by Gillen Washington. An Aetna patient who was denied treatment for a rare immune disorder, Washington suffered an acute attack and nearly died as a result of not being able to obtain the treatment he needed – an expensive treatment known as intravenous immunoglobulin which would have made up for the immune cell deficiency his disorder causes.

Dr. Iinuma also stated that he knew next to nothing about Washington’s illness.

This outright refusal to provide the care Washington needed without any guidance from doctors or specialist nearly cost a life and appears to have only been one case in a horrendous trend that has affected unaccounted numbers of individuals who have needed coverage.

What Happens Next

This unbelievable revelation has led to two different California state agencies investigating Aetna to determine if any laws were broken as well as three other states launching their own probes into the insurance company. These three states include Colorado, Washington, and Connecticut.

The Connecticut investigation should prove to be especially interesting as this where the Aetna headquarters are located. Thus far the company’s response has been that the testimony was “taken out of context”.

This response hasn’t proven to be effective as California Insurance Commissioner Dave Jones, who launched one of the investigations, stated the whole story was of “significant concern” to him and potentially law-breaking. In the state of California, there is a provision that requires medical directors who are not qualified to review a patient’s case to seek consultation from another expert.

It appears that Dr. Iinuma failed to do so in the case of Mr. Gillen Washington.

The California Medical Association and American Medical Association share similar concerns to Commissioner Jones.

Investigators will look to see if anything illegal occurred as well as probe whether the actions taken by Dr. Iinuma in California are consistent with Aetna practices in other states. This could blow the doors open on illegitimate industry practices and hopefully help to correct bad faith actions taken by these major insurance companies.

What the Aetna Case Means for Car Accident Victims

The most important aspect of this case is recognizing how insurance companies – life, health, vehicle, home, etc. –  are willing to act in bad faith for the sake of ensuring higher profits for the year.

But you don’t have to accept their bad faith practices, denials, or minimal settlement offers. Insurance companies are required to act in good faith and provide you the support you need with honest intentions. If your insurer or the negligent party’s insurer intentionally fail to fulfill their contractual obligations by acting in bad faith, then you have the right to make a claim against the company for improper practices.

Our experienced New Orleans car accident attorneys can help you to determine if:

  • Your insurer misrepresented the policy or coverage.
  • The company ignored your communication attempts and did not act in a timely manner.
  • The insurance company failed to properly investigate the claim and still denied it.
  • The company attempted to settle for less than is reasonable.
  • There was no good faith attempt to settle your claim in a timely manner.

When your insurer or that of the other party fails to act in good faith, then you will need to appeal the denied claim. An auto accident lawyer can help you to gather all the proper evidence and documents you will need to state your claim for approval. They will also be able to represent you in negotiations with the insurance company during the settlement process.

Don’t allow an insurance company to unlawfully deny your claim. In the face of tragedy and hopelessness, trust in the Cardone Law Firm to support you in your time of need.  

If the day comes that an insurance company shows their true colors and denies you the coverage you need and deserve, contact the Cardone Law Firm. Our dependable Louisiana attorneys will give your case the attention your insurer has denied you and ensure you receive the compensation to take care of yourself and your family.

Contact us today at (956) 541-7600.