Posted On: March 20, 2006, 1:21 pm CST

Posted By: Jacqueline

To Nick Timko & Linda Fermoyle Rice:

Since you lawyers calim to be so much more educated than the rest of us, perhaps you should read up on your history of the origins of insurance companies. There were insurance companies before there were modern tort lawyers. Insurance was a concept that began a long time before the British legal system evolved and the American Legal system evolved. Insurance was pooled monies collected by a group who wanted to protect their interests regarding the possible total loss of goods due to unforeseen disasters while enroute to their destination by ship.

I am sorry to disappoint all the lawyers who got their panties in a bunch over my posts, but with LESS lawyers and LESS frivolous lawsuits, we insurance agents and brokers would still have jobs - and our E & O would probably cost us a hell of alot less, too!

As to the "evil" insurance companies screwing over insureds and doctors, how about all the doctors, dentists and hospitals that exaggerate their billing codes to inflate their insurance claim payments? Let's talk about that!

Here in Erie, PA, a young mother with an unemployed husband (he was in technical school)went to work in a local hospital here after moving here from Ohio. At this hospital, surgeons and doctors pressure the medical coders into falsifying the codes in order to effect more payments from insurance carriers (especially for workers comp and health insurance carriers). When she refused to "play the game" because of the risk of her possibly getting busted for insurance fraud, which is a felony in PA - punnishable by revocation of professional licenses, steep fines and a prison sentence, this girl found herself fired. Now Erie is somewhat of a small city, where all the local doctors, lawyers, CEO's and bank presidents hob-knob at the same exclusive dining club and yacht club. The hospital doing this is one of the region's last large employers. When this woman went to seek justice for the unfair loss of her job for refusing to commit what amounted to insurance fraud, unlike the rest of her department of medical coders, she was told by a young and conscientious lawyer that although she had a very strong and win-able case - both for wrongful termination AND insurance fraud, he was not willing to go up against the region's largest employer because he was afraid it would jeopardize his future and his career as a local lawyer.

Also, since this woman refused to "play the game", she also found herself unoficially black-balled from any other comparable employment, except for maybe a crappy minimum wage job at Wal-Mart's. This lawyer confirmed this for her and it was affirmed by other lawyers in the area, none of whom would take her case and help her get some justice. So much for lawyers being out for the disenfranchised. This poor working mother nearly ended up homeless as a result of the loss of her job and being unable to get another job to support herself and her family. She and her infant son and husband (who had to drop school when they moved) had to try to start all over with no money in another state where she finally could get another job, all because of the lack of acess to justice afforded to this woman (and lack of justice afforded to the insurance carriers who were overbilled) - and a good ole boy network of greedy doctors, lawyers and a powerful and rich hospital executive. Meanwhile, insurance costs for individuals, groups and workers comp policies as a whole are higher than they would have to be if not for those seeking to get unjustly enriched by "playing the game" of insurance fraud. It happens more often than you think.

Second case: A local dentist is, and has been, getting away with false insurance claims for work (not) done on Medicaid patients, for several YEARS. I have it on reliable authority that he has submitted copies of his treatment plans to one of the local residential facilities for mentally handicapped residents, all who are on Medicaid and SSI. Yet, when several of the people who work at this facility checked some of their residents who were still complaining of toothaches, they found that this dentist had not drilled and filed the teeth as he claimed he did, both in his claims filed to Medicaid and also stated in the individual residents' treatment plans which this home keeps a record of. This dentist drives an $85K Hum-V and lives in a $500K home w/ an acre of lakefront property w/ private beach access. Since these types of cases would be morally right and just in pursuing, you would think that at least one lawyer would be ready to jump all over that hospital and the dentist, for the economic harm and medical harm they have caused respectively to the people involved. However, because these types of cases don't bring in big bucks in billable hours, and the lawyers hob-knob with the perpetrators of the aforementioned injustices, the aggrieved in each case were denied access to the legal system - justice had been denied. Now who do we blame for that - Milton Berle?