I researched the New York State Department of Insurance General Counsel opinions and found a strikingly similar issue. The opinion was issued in response to a request by a consumer asking if he was able to negotiate a cheaper insurance policy by excluding lost wage protection from his coverage. The General Counsel opinion made it clear that what the consumer proposed could not legally be done in New York state. Every insurance policy must include coverage for Basic Economic Loss.

I filed for arbitration to force GEICO to pay the client the lost wages, despite the policy exclusion. As an exhibit, I attached the New York State Department of Insurance General Counsel opinion. GEICO was due to answer the arbitration request on November 20, 2009. Instead of an answer, I received a phone call from an adjuster agreeing to settle the claim for the full amount owed. Despite the opinion, GEICO defended their actions and still maintained that the policy as sold was permitted in New York.

This case should be a reminder to all to use an insurance broker or read the terms of your policy if you decide to buy online or over the phone. I have published a book, “A Lawyer’s Guide to Car Insurance”, to help you understand your insurance policy and to make sure that you are properly protected. You can order the book, free of charge, by following this link.

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This was not the first time that The Hartford terminated benefits. In fact, twice before, The Hartford terminated Mr. Whitten’s benefits. His doctors have declared him permanently disabled. Although The Hartford has apparently agreed that Mr. Whitten is disabled, they are treating him as if he is temporarily disabled. Although he was injured 7 years ago, The Hartford is covertly suggesting “fraud” and attempting to intimidate recipients into foregoing their benefits. When is Mr. Whitten going to be “permanently” disabled in The Hartford’s eyes? Is it fair for The Hartford to constantly reassess the claimant’s medical condition, despite the medical evidence that has already produced and ruled upon? I say no and would like to see more government oversight into the disability insurance area. The disabled person is the least likely to be able to afford an attorney as a major source of income has been taken away. Most companies bet on the fact that the denials will never be appealed because of a lack of money or the fear that they committed a “fraud.”

What The Hartford has done is to lump Mr. Whitten in with those who commit “fraud.” Rocky will forever be equated with the video of a supposedly disabled man carrying a flat of shingles up a ladder or of another man playing all types of sports. Think about the video – would you want that to be your daily life? Was Mr. Whitten working in the video? Was he lifting anything heavy? No he wasn’t so why should he be equated with “fraud?”

The Hartford makes mention of an “Independent Medical Examination” that determined he was able to perform some type of work. Such a medical examination is certainly not independent. In fact, it is anything but. The doctor is hired by the insurance company to evaluate claimants and their injuries. The doctor is paid by the insurance company and will testify on its behalf. Independent Medical Examinations are big business. Doctor’s are intelligent enough to understand that insurance companies really don’t want to pay out on a claim. If they approve every claim, do they really think that the insurance company is going to use their services? The Hartford’s doctor never even examined Mr. Whitten. He made his decision based on medical records – wouldn’t Mr. Whitten’s own doctors be in the best position to determine if he is disabled? The claims process must be regulated as the companies prey on those least likely to be able to shoulder the burden, especially after paying thousand of dollars in premiums.

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