And my saga continues,

[dlist777]

I got a call yesterday from the HR dept of MarineMax, they left me a message saying its urgent that I get in touch with them, the women even left me her cell number, when I called the news she had was just not what I needed to hear, seems that the health insurance company we use, and what I'm using now to recover from my neck surgery is taking it upon themselves to drop me from the policy, I'm supposed to start PT in a few days but was told I'm getting dropped effective the 30th, she did say I have no issues with employment, I still have my job but as of tomorrow no insurance, and with that no PT, she said she can put me on COBRA, but I don't have the money for it.

 

This craps getting old now, I'm the victim in all this but I'm the one that keeps getting screwed!!! Anyway, this women seems nice and will be getting in touch with the insurance co, she never heard of an insurance co, dropping anyone mid recovery, gonna call my attorney and see what can be done.

 

I think I jinxed myself the other day when I thought to myself that my recovery and my situation was going smoothly, two days after I thought that I get this. I just can't win.

I've worked in CFO/Controller positions at companies for 20 years.  I've never heard of an employee getting dropped.  It's group coverage..isn't it?  

[tjfslaughter]

Lawyers will always want to do what is in THEIR best interest d settling is almost always in their best interest. One third of a small settlement is better than nothing, which is what can happen if they go to court. not to mention that going to court actually takes real preparation and time. To them it is just another case, so why take un-necessary risks.

 

I am going to have to disagree with this.  My wife is an attorney and I have had to use attorneys multiple times in recent years.  If this is your opinion you should look into a new attorney, there are quite a few good ones out there.   

[GhostBear]

I've worked in CFO/Controller positions at companies for 20 years.  I've never heard of an employee getting dropped.  It's group coverage..isn't it?

 

yes it's group coverage, my HR person is of the same mind, she's never heard of anything like this!

[GhostBear]

A small settlement is NOT in the best interest of the attorney, in fact quite the opposite is true, the more money they can get for you the bigger that 1/3 is for them, anyway I have a good one and I'm sure he will do right by me.

[Haskell_Hunter]

A small settlement is NOT in the best interest of the attorney, in fact quite the opposite is true, the more money they can get for you the bigger that 1/3 is for them...

 

 

I disagree.  Most of the attorneys I've dealt with are more keen on the easy settlement, not the biggest one.

 

The case I am fighting pro se right now, if it gets class status, could bring in a few million dollars.  Not a single attorney will touch it because it's going to be a lot of work and an uphill battle.  Most attorney's told me to settle and pay them money.  Why?  Because it's easier for them to do that and move on to the next client.

 

"Most" is a generalization.  But it's business.  Quick, high-paying gigs that require little effort are deals you make.  Ones that don't have a high probability of a payout and require a ton of work are ones you avoid.  Basic business.

[outdoorslife]

Someone I know had a case going on for about 3 years. In general, and in short, said person was recommended to settle...lawyers best interest. If the lawyers and client were in it for more duration(maybe another 3 years? more? who knows?), they could have possibly been in for a huge payday $$$. Case could have went from 6 digits to possibly 8. Lawyer didn't want to invest in that much more time/work for possible outcomes. Risk reward factor I guess. Like many things in life, I don't think court cases/law suits in general, are that black and white....lots of grey in between and each one is different. Too many variable I assume? I really don't know, I'm no lawyer, never went through a law suit but found it interesting that what this person just went through, is very similar to what a few just mentioned. Either way, I just hope it all works out for you Paul.

[Cousin Brown]

Sorry to hear, good luck

[tjfslaughter]

Someone I know had a case going on for about 3 years. In general, and in short, said person was recommended to settle...lawyers best interest. If the lawyers and client were in it for more duration(maybe another 3 years? more? who knows?), they could have possibly been in for a huge payday $$$. Case could have went from 6 digits to possibly 8. Lawyer didn't want to invest in that much more time/work for possible outcomes. Risk reward factor I guess. Like many things in life, I don't think court cases/law suits in general, are that black and white....lots of grey in between and each one is different. Too many variable I assume? I really don't know, I'm no lawyer, never went through a law suit but found it interesting that what this person just went through, is very similar to what a few just mentioned. Either way, I just hope it all works out for you Paul.

 

 

Lawyers make recommendations but the client ultimately makes the decision to settle.

[dlist777]

yes it's group coverage, my HR person is of the same mind, she's never heard of anything like this!

Honestly, your company should be dealing with this.  When a company gets health insurance for its employees, the policy is usually annual and non-cancellable during the policy term (at least in my experience).  As long as the Company is paying the bills, the insurance stays in place for everyone until the next renewal date  So, it's a bit curious / odd that your company is not fighting this because it seems like a breach of contract.  

 

It seems odd.  It's almost as if the insurance company told your company they won't renew the whole policy (for all employees) unless your company kicks you off. 

 

I know, kind of a conspiracy theory line of thought....I'm not an expert in this....

 

You're in an awkward position because you need your job.  I guess getting a lawyer is your best option.  

Edited November 29, 2017 by dlist777

[John B]

Advice on PT. Go once, see the exercises. It's nothing you can't do yourself in your own home. All the exercises are on YouTube for recovery from your condition. Unless PT is 100% covered, it's a waste of money. I learned this when I had my neck issue.

[tjfslaughter]

Honestly, your company should be dealing with this.  When a company gets health insurance for its employees, the policy is usually annual and non-cancellable during the policy term (at least in my experience).  As long as the Company is paying the bills, the insurance stays in place for everyone until the next renewal date  So, it's a bit curious / odd that your company is not fighting this because it seems like a breach of contract.  

 

It seems odd.  It's almost as if the insurance company told your company they won't renew the whole policy (for all employees) unless your company kicks you off. 

 

I know, kind of a conspiracy theory line of thought....I'm not an expert in this....

 

You're in an awkward position because you need your job.  I guess getting a lawyer is your best option.  

He has a lawyer and this should have been originally billed via his auto insurance and should have used is primary care provider as a secondary insurance.  

Edited November 29, 2017 by tjfslaughter

[GhostBear]

My company's HR dept is looking into it, even she said this has never happened before., my auto insurance NJM, is playing the pre existing card and has so far denied my claim, even though I'm the one that got hit, the other guy is at fault so I don't know why all the games.

Edited November 29, 2017 by GhostBear

[hammer4reel]

My company's HR dept is looking into it, even she said this has never happened before., my auto insurance NJM, is playing the pre existing card and has so far denied my claim, even though I'm the one that got hit, the other guy is at fault so I don't know why all the games.

Very fine line, as your aware your neck damage was pretty well documented by you as well as the need for surgery a few years before this accident .

While this accident probably agravated it more, all the pre existing doctor visits are throwing up a red flag..

And the insurance companies will def try to use that as their out to deny coverage.

 

.

[GhostBear]

Yeah, even the lawyer said it will be tough, but the doctor that did the surgery said it was aggravated and that the contrasting MRI's prove it, I may have been on the road to it but, he pushed me over the finish line!! Lol

[outdoorslife]

The case I know about also included pre-existing injury. The thing is, the person was working full time, no questions asked, until the incident occurred and then couldn't work after. During the case, much of it was a battle between pre-existing versus current condition because of the accident. The multiple lawyers, doctors etc. tried playing mind games essentially(at least it seems that way) and its easy to start overthinking things. I always reminded this person to stick to the basics, let the others do their job and use "xyz" line of thinking...you continue to think "abc". They were able to work full time and then some with the pre-existing condition and now they cant...simple. The cases and dealing with everyone is not, but that mindset seemed to help this person get through it. It was stressful as all hell (even for family and friends not directly involved as the stress overflowed into everyone else's lives and were affected one way or another) but you have to try to stay grounded as best as you can. Keep up the fight.