Q:

Why Was My Insurance Claim Denied?

A:

When you submit an insurance claim, you expect it to be paid. After all, that’s what you pay for when you purchase insurance, right? However, insurance companies often deny claims for a variety of reasons. Understanding why you may have been denied is critical to pursuing the benefits you need:

Drugs or Alcohol in Your System

If you filed a claim and tested positive for drugs or alcohol, your claim may be denied on that basis alone. Workers injured on the job are typically always tested for drugs or alcohol after an on-the-job accident. Drivers may be tested if they were hurt in an accident and were transported to the hospital.

Witness Testimonies Don’t Line Up With Your Accident Report

If a witness saw your work accident or car accident and their testimony differs from police or medical reports, your claim may be denied. Typically, insurance companies will look for any reason to deny your claim in order to save the company money. When a witness report doesn’t match other reports in the case, insurance companies often use this to justify the denial.

You Were Injured In An Accident

It seems counter-intuitive, but health insurance companies will deny claims if the insured was in an accident of any kind. This is because insurance companies expect that the personal injury claim will cover the medical costs. However, many personal injury claims take several months or years to resolve, leaving the injured responsible for costs in the meantime. This can happen even when an injured person has adequate medical coverage and under any other circumstances, the costs would be covered.

Errors in the Claim

Were there any errors in your claim, such as a typo, transposed number, or misspelled name? One of the most common reasons insurance claims get denied is due to simple errors on the initial paperwork.

Q:

What Are the Risks of Infection and Disease from a Dog Bite?

A:

Although dogs have the reputation of man’s best friend, sometimes they don’t quite meet the criteria. In fact, many dogs will attack or bite out of nowhere, seriously injuring both adults and children. Complications can arise from dog bites including life-threatening diseases like rabies and infections. Here’s what you need to know:

Dog Bites and Rabies

Very few dogs in the U.S. carry rabies, but it’s still a concern. If a dog bites you, verify that the dog does or does not have rabies. This can be done by bringing the dog in for testing or obtaining its vet records. If a stray dog bit you and you don’t know if the dog has rabies or not, or if you were bitten by a dog confirmed to have rabies, you must receive treatment immediately. Treatment consists of several small injections in the abdomen. Don’t delay or refuse treatment — rabies is a fatal disease.

Dog Bites and Infections

The more likely complication of a dog bite is an infection. Since a dog’s canine teeth are very long, they cause deep puncture wounds. Puncture wounds are more at risk for tetanus, and infections in the blood can also develop. Dog bites may appear less severe than they actually are. This falsely leads people to believe they can treat the bite at home. This can be dangerous, since applying antibiotic ointment and cleansing the wound may not be enough to ward off bacteria.

Professional medical treatment for dog bites may include IV or oral antibiotics. Depending on the severity of the bite, the victim may require a hospital stay for monitoring. If you were bitten by a dog and develop a fever or begin to see redness, pus, or red streaks leading away from the wound, get medical help right away.

Q:

What Are Pedestrian Accidents?

A:

When most people think of pedestrian accidents, their minds jump straight to someone being hit by a car. But really, pedestrian accidents take many forms. For instance, pedestrian accidents may happen without a car being involved at all — they can be a result of many factors, such as poor sidewalk maintenance, unsafe parking lot conditions, and construction-related issues.

Crosswalk Safety

There are two types of crosswalks: marked and unmarked.  An unmarked crosswalk is one that extends basically from the sidewalk and curb lines across certain intersections, without painted lines.  A marked crosswalk is one where there are lines painted on the roadway surface at an intersection.  It is legal to cross the street in either type of crosswalk, so long as the pedestrian has the right of way.  Pedestrians in an unmarked crosswalk, although crossing legally, run a greater risk of injury or death.  Without painted lines to attract their attention, drivers are likely not aware when they drive through an unmarked crosswalk.

Pedestrian Accident Liability Issues

When a driver strikes a pedestrian, many liability issues arise.  If the driver had the right of way then generally the pedestrian will be found at fault.  But, if the driver is not paying close attention, they have responsibility.  For example, even where a pedestrian is crossing outside of a marked or unmarked crosswalk, drivers have an obligation to scan the roadway.  When a pedestrian can be seen in the roadway for some distance, drivers should perceive the danger and react.  Failing to perceive and react to a pedestrian can lead to a fatal pedestrian accident, like the one above.

Investigating Pedestrian Accidents

After a pedestrian accident, determining fault can be difficult.  The driver’s attention, the pedestrian’s action and the roadway configuration all come into play.  If the driver is not paying attention and should have seen the pedestrian from 100 feet away, they have some fault.  If the pedestrian darts off a curb, they have the fault.  On occasion, because of sight obstructions (such as a significant curve or rise in the roadway) the government is to blame.  Analyzing pedestrian accidents involves careful reconstruction and expertise.

Q:

What Happens After a Fatal Freeway Accident?

A:

After a fatal freeway accident, the responsible police agency will conduct an investigation which will include taking witness statements, photographs and measurements.  That information will be used to reconstruct the accident and determine fault.  When such an event, there are likely to be both criminal responsibility and civil justice for the victim and their family.  The only way to obtain compensation for the family is by pursuing a claim and a lawsuit, if necessary.

Q:

What Do I Need to Know About Medical Malpractice?

A:

Medical malpractice is one of the leading causes of death in the United States. Every day, medical professionals make mistakes that cause serious injury or even cost lives. Learn about the most common forms of medical malpractice and what your legal options are if you or a loved one were injured through medical malpractice:

Prescription Medication Errors

Prescription medication errors happen often, despite the many fail-safes in place to ensure that mistakes don’t happen. Whether the doctor miswrote the prescription or the pharmacy filled the prescription in error, medication errors can be devastating. A patient may take too much of the wrong kind of medication or may experience serious side effects that require hospitalization.

Failure to Diagnose or Misdiagnosis

A common type of medical malpractice is the failure to diagnose a patient, or the misdiagnosis of a patient. Life-threatening medical conditions that are undiagnosed or misdiagnosed can result in critical injury or even death.

Surgical Errors

When people hear the term “medical malpractice,” they envision cases where a surgical instrument was left inside a body cavity. This does happen and can cause great trauma to the victim, but other surgical errors can be just as detrimental. A surgeon who operates on the wrong side of the body or performs the wrong type of surgery can cause significant damages.

Childbirth Errors

Childbirth is an exciting time, but it’s also a time where medical professionals must pay close attention to the health of both mother and baby. Failure to act quickly in some situations may result in harm to either the mother or child. Common birth injuries include lack of oxygen due and physical injuries to the baby, such as shoulder dystocia.

Q:

What Is Dental Medical Malpractice?

A:

Medical malpractice refers to a medical professional’s negligent care that affects a patient in a harmful way. There are many forms that medical malpractice may take, and each field of medicine is prone to malpractice lawsuits. For instance, dental medical malpractice may occur if a dental professional provides inadequate care or causes a patient harm.

1.  What if You or a Loved One is Injured by Dental or Medical Malpractice?

Because these cases are complicated and often require the support of an expert in the field, be sure to contact an experienced malpractice attorney.  What most people don’t know is that certain rules must be followed when presenting a malpractice claim.  This is unlike any other type of claim.  For example, in a car accident claim, you usually have two years from the date of the accident to file suit.  In a malpractice case, with only certain exceptions, the lawsuit must be filed within one year of the alleged malpractice.  Otherwise, you will lose your rights.

2.  Some of The Rules For Dental and Medical Malpractice Claims

Under California law, when you have been a victim of dental or medical malpractice your claim is subject to certain limitations and rules.  First, you are required to give the health care provider a 90-day notice of your intent to sue them before filing the suit.  This is intended to allow the doctor or dentist time to resolve the claim before a lawsuit is filed with the court.  Another important rule limits the amount of compensation you can recover.  In this State, the most an injured party or their family can recover for their pain, suffering and emotional upset is $250,000.00.  This limitation has been in effect since 1976, and it applies to nearly all malpractice cases.

3.  The First Steps in the Process

After hiring a malpractice attorney, the first step is to gather the pertinent records.  Once that has been accomplished and the attorney reviews the documents, the formal claim is presented.  Almost always the provider’s insurance carrier will respond with a denial of the claim.  The next step is the filing of the lawsuit, followed by litigation and finally resolution.  The vast majority of malpractice cases settle short of trial.