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Insurers Defend Profits; Deny They Overcharge, Under-deliver on Home, Auto Policies

National News • January 11, 2008
A national consumer organization has charged that property/casualty insurers are unfairly overcharging for home and auto insurance at the same time they are reducing payments to ...

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Subject: List Your Company

Posted On: January 11, 2008, 4:40 pm CST
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A 39-year-old Washington woman paralyzed from injuries caused in a car crash sued her insurer for denying coverage for surgery doctors agree could have prevented her paralysis.

Tara Sadler, a Yakima, Wash., resident and mother of two boys, filed the suit against State Farm Mutual Automobile Insurance Co., claiming the insurer denied her neurosurgeon's decision to repair a severe neck injury caused in an auto accident on Feb. 29, 2004.

The complaint alleges State Farm denied Sadler's personal injury protection (PIP) claim to maximize its profits. By the time the insurance company approved Sadler's claim, Sadler was paralyzed.

"This is the worst case of PIP insurance abuse I have ever seen," said Karen Koehler, an attorney with the law firm Stritmatter Kessler representing the Sadlers. "We have letters from Sadler's doctors that confirm State Farm's delay of the surgery is the reason for her paralysis."

According to law firm, the day of the accident, Tara Sadler and her husband Donald Sadler, were driving their 1999 Volkswagen Beetle on North First Street in Yakima. Another vehicle improperly crossed several lanes of traffic while fleeing from the police. Donald Sadler, the driver, slammed the car's breaks to avoid a collision. Tara Sadler, sitting in the passenger seat and wearing her seat belt, was thrown forward as the car came to a sudden stop.

After the accident, Sadler had neck and shoulder pain on the right side and arm numbness with tingling and loss of use. She saw her family physician, who ordered physical therapy for eight weeks, the law firm said. According to the complaint, in the days and weeks following the accident, Sadler's condition worsened.

Sadler decided to see a chiropractor in Yakima who stopped the physical therapy, reviewed X-rays, and made arrangements for an MRI on her neck. The MRI indicated a significant disc protrusion in her neck with spinal cord compression and her chiropractor directed her to see a surgeon.

According to the complaint, on June 11, 2004, Sadler saw an orthopedic surgeon in Seattle who agreed that the injury warranted immediate attention and referred her to a neurosurgeon, Dr. Srinivasan, who concurred that surgery would alleviate most of her neck, shoulder, and arm ailments.

Dr. Srinivasan contacted State Farm to inform them of the need for the surgery.

Sadler, who did not have health insurance, believed the remaining $18,000 of PIP coverage she purchased from State Farm would be sufficient to pay for the surgery, the complaint details.

"When I saw Dr. Srinivasan, she said the sooner I get to surgery the better the outcome would be," said Tara Sadler.

As Sadler returned home, Dr. Srinivasan called State Farm to advise them of the need for surgery and verify the availability of funds. State Farm replied that Sadler's PIP benefits would be suspended and were not available for the needed surgery, court documents say.

"State Farm had absolutely no basis to deny Tara's surgeon's conclusion," attorney Koehler said. "State Farm decided to gamble with Sadler's health to try to save a buck."

One week after hearing that she needed immediate surgery, State Farm sent a letter to Sadler that benefits were being withheld pending an involuntary medical evaluation scheduled for July 19 -- almost five weeks later. Meanwhile her medical condition continued to deteriorate, the suit states.

"By this point, the paralysis had now moved down her leg. People were noticing she was dragging her right leg when she walked," Koehler said. "She was frightened and did not know where to turn."

Tara hired Yakima attorney Scott Brumback, whose office began calling State Farm sometimes on a daily basis, the law firm said. As a result, State Farm agreed to move the involuntary medical exam up by four days to July 15, 2004. The examiner, Dr. Gorman, M.D., confirmed Dr. Srinivasan's prognosis and pronounced Sadler's condition a medical emergency, court documents show.

According to court documents, after Dr. Gorman examined Sadler he called State Farm to report Sadler needed immediate surgery but was told the State Farm claims manager was out of the office.

It took until July 20, 2004 -- 37 days since Sadler's surgeon urged immediate action -- for the State Farm insurance adjuster to file the appropriate paperwork and approve Sadler's surgery.

On July 29, 2004, Dr. Srinivasan performed the surgery, but it was unsuccessful in fixing the damage caused by the accident that was worsened by the delays in treatment, court documents show. Sadler is now bound to using a wheelchair.

"It is nothing new for insurance companies to unjustly put profits over people by denying PIP claims," Koehler said. "But never have I seen this level of callous incompetence. We believe had State Farm done the right thing and stood by its promise to Tara, she would be walking today."
Subject Posted By Posted On
RE: RE: patriotism vs capitalism Scott
Jan 15, 2008, 2:57 pm
RE: patriotism vs capitalism FREDDIE FREEMARKET
Jan 15, 2008, 2:51 pm
RE: patriotism vs capitalism Dawn
Jan 15, 2008, 2:47 pm
patriotism vs capitalism wudchuck
Jan 15, 2008, 2:34 pm
RE: DWT is right Dawn
Jan 15, 2008, 1:39 pm
RE: Shop once in a while Nebraskan
Jan 15, 2008, 12:32 pm
DWT is right bubba
Jan 15, 2008, 12:16 pm
RE: RE: RE: RE: Shop once in a while ortho w begone
Jan 15, 2008, 10:36 am
RE: RE: RE: Shop once in a while wudchuck
Jan 15, 2008, 9:31 am
Can we all go back to making Rosie ill? Chad Balaamaba
Jan 15, 2008, 8:52 am
RE: RE: Shop once in a while ortho w. begone
Jan 15, 2008, 8:50 am
RE: Shop once in a while wudchuck
Jan 15, 2008, 7:52 am
Shop once in a while Brian
Jan 14, 2008, 10:41 pm
RE: RE: Overcharging lastbat
Jan 14, 2008, 4:02 pm
RE: Overcharging wudchuck
Jan 14, 2008, 2:25 pm
Overcharging Jayjay
Jan 14, 2008, 1:58 pm
RE: List Your Company-can we have facts? Chad Balaamaba
Jan 14, 2008, 12:57 pm
RE: This Makes Me Ill sammy
Jan 14, 2008, 12:09 pm
RE: Profit or Not?! FREDDIE FORPROFIT
Jan 14, 2008, 11:07 am
Profit or Not?! wudchuck
Jan 14, 2008, 9:08 am
CFA & Robert Hunter Rick
Jan 12, 2008, 1:03 pm
RE: RE: RE: RE: RE: Overcharging
Jan 12, 2008, 11:29 am
RE: RE: Overcharging
Jan 12, 2008, 11:27 am
RE: Overcharging Carol
Jan 12, 2008, 11:08 am
RE: RE: RE: RE: Overcharging Nobody Important
Jan 11, 2008, 7:16 pm
RE: RE: RE: Overcharging
Jan 11, 2008, 6:46 pm
RE: RE: Overcharging They're not in it
Jan 11, 2008, 6:41 pm
RE: Overcharging $3000. This is about a $50K
Jan 11, 2008, 6:39 pm
introducing his bill WHAT HAPPEN TO THIS?
Jan 11, 2008, 6:35 pm
RE: List Your Company
Jan 11, 2008, 4:43 pm
List Your Company
Jan 11, 2008, 4:40 pm
CFA Bang
Jan 11, 2008, 4:38 pm
RE: RE: Either/or thinking and Hunter as comissioner You Go, Rosie
Jan 11, 2008, 4:09 pm
comissioner
Jan 11, 2008, 3:41 pm
RE: Either/or thinking and Hunter as comissioner Nobody Important
Jan 11, 2008, 3:32 pm
Overcharging Glo
Jan 11, 2008, 3:24 pm
RE: This Makes Me Ill DWT
Jan 11, 2008, 2:55 pm
RE: Either/or thinking and Hunter as comissioner Scott
Jan 11, 2008, 2:22 pm
RE: Excessive profits I am the Law!
Jan 11, 2008, 2:20 pm
RE: Anything that makes Rosie ill WORKS FOR ME MOONBATS GO HOME
Jan 11, 2008, 2:17 pm
Either/or thinking and Hunter as comissioner media mogul
Jan 11, 2008, 2:16 pm
Priceless Ins Owl
Jan 11, 2008, 2:15 pm
Anything that makes Rosie ill chad balaamaba
Jan 11, 2008, 1:48 pm
RE: Robert Hunter: Get a Real Job MOONBATS GO HOME
Jan 11, 2008, 1:45 pm
RE: CFA Study Hunter was a commish
Jan 11, 2008, 1:35 pm
The Carville and Begala Show Scottsdale Slim
Jan 11, 2008, 1:28 pm
RE: Perspective Masonman
Jan 11, 2008, 1:27 pm
RE: Perspective Scott
Jan 11, 2008, 1:24 pm
Perspective media mogul
Jan 11, 2008, 1:16 pm
Go Rosie! Rosie is right
Jan 11, 2008, 1:07 pm
RE: Overcharging ORVILLE OVERCHARGE
Jan 11, 2008, 1:00 pm
RE: CFA study Patriot
Jan 11, 2008, 12:56 pm
CFA "Study" Richard Geiger
Jan 11, 2008, 12:53 pm
Overcharging Chuck
Jan 11, 2008, 12:48 pm
This Makes Me Ill Rosie
Jan 11, 2008, 12:44 pm
Overcharging Scott
Jan 11, 2008, 12:39 pm
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