Expansion Into Grant County, WA

Graham Lundberg & Peschel has now expanded to Grant County. Our main office is located in Tacoma; however, our Senior Managing Partner, Ken Golden, has been spending more and more of his weekends at his condominium in Moses Lake. In early 2009, Ken met with several health care professionals in the area, all of whom expressed interest in the services our office provides.

As a personal injury law firm, we are dedicated to assisting those injured in motor vehicle, motorcycle, trucking, boating and even wrongful death accidents. Additionally, we strive to serve the health care community by protecting the rights of their patients. We achieve this goal by representing their personal injury patients, ensuring the health care provider is paid for their services by the insurance company, and hosting educational seminars.

We held our first seminar in Moses Lake in early June on the topic of Medical Liens. This seminar was held at the Holiday Inn Express & Suites and a delicious lunch was provided by Griffin's Bakery. A total of 17 health care professionals attended, including chiropractors, massage therapists and physical therapists. In addition to gaining a wealth of knowledge in the area of medical liens, each health care professional received 1.5 Continuing Education Credits. We very much enjoyed our time in Moses Lake and will be scheduling another seminar next month (TBA).

It is our continuing goal at Graham Lundberg & Peschel to provide health professionals with updated information that will be helpful to their patients and their practice. If you have any questions about GLP's expansion into Grant County or the services we can provide, please feel free to call our office. 1-800-273-5005

Insurance Fair Conduct Act

What is The Insurance Fair Conduct Act?
The Insurance Fair Conduct Act (or “IFCA”) was passed by the Legislature, signed by the Governor and approved by Washington State voters (by Referendum 67) in 2007. It became effective on December 6, 2007.

According to the Office of the Insurance Commissioner, IFCA “provides legal remedies for policyholders, including the ability to seek punitive damages in court if their claims are unreasonably denied by their insurance companies or their insurance company violates particular regulations governing unfair claims settlement practices”.

In lay-person terms, that means that your own insurance company must treat you fairly. If it does not, it can be liable for “treble damages”, or three times the amount of the worth of your actual physical injuries and economic injuries put together. Damages are available to claimants upon a finding that the insurer unreasonably denied coverage or payment. A claimant may also recover damages upon a finding that the insurer violated one of five rules found in Chapter 284-30 of the Washington Administrative Code (WAC). The five WAC rules regulate insurers’ actions in the following areas: (1) specific unfair claims practices; (2) misrepresentation of policy provisions; (3) failure to acknowledge pertinent communications; (4) standards for prompt investigation; and (5) standards for prompt, fair, and equitable settlements.

If the rules are violated, a court must award: (1) the actual damages sustained; (2) reasonable attorney’s fees; and (3) actual and statutory litigation costs, including expert witness fees. The court has the discretion to also increase the total award of damages to an amount that does not exceed three times the actual damages suffered by the claimant.

Who does IFCA benefit?
IFCA applies to any policyholder in Washington State who is making a first party claim (a claim with their own insurance company, such as a PIP claim, or an Underinsured Motorist/Uninsured Motorist claim). It does not apply to third party claims (claims made by a person against someone else’s insurance company).

In what situations is IFCA of use?
IFCA applies to many types of unfair claims practices, but for our purposes it mostly comes into play with PIP payments, and Underinsured Motorist/Uninsured Motorist claims.

In the PIP situation, if the patient’s bills are not being paid on time, or the patient’s benefits are cut off improperly, or if bills simply are not being paid with no valid excuse, the patient may have an IFCA claim. For instance, if PIP payments are not timely made and it adversely affects the patient’s credit score, our office has been successful in getting the PIP carrier’s right to subrogation waived, leading to a better monetary recovery for the patient. (The traditional PIP exam followed by the “PIP cut-off letter” is still a valid way to cut off benefits, however.) IFCA is of greatest leverage in the UM/UIM scenario, however. There, the patient’s own insurance company must make a fair offer to settle the claim. If the attorney for your patient does not think that the carrier is making a fair offer, the attorney should (1) give the insurance company all the information they need to properly evaluate the claim, then (2) mail written notice to the insurance company and to the Office of the Insurance Commissioner, stating why the offer is unfair, and in what manner the insurance company has breached its duty of fairness. The Statute then gives the insurance company 20 days to “cure” the unfair offer by making a fair offer. If the insurance company does not make a fair offer within 20 days, and does not request any additional information to help them evaluate the claim (thereby technically extending their time limit), the attorney has properly set up the case for an IFCA claim.

Does it really work?
The insurance companies are taking IFCA very seriously. An IFCA letter usually gets a higher-up involved, and usually gets an increased offer from the adjuster, if the pre-letter offer really was unfair.

In practice, the IFCA letter resolves about one-half of the cases where it is necessary to send it. In the other one-half the case may proceed to litigation, which can start once the 20 days has run.

When should IFCA not be used?
The insurance companies are closely tracking every claim filed. They are hoping that it is abused, and that they will be able to get IFCA repealed in the future. Therefore, the IFCA threat should not be used when the settlement offer is simply a little low, or not quite what the patient was hoping for. It should only be used when the carrier really is not treating the patient fairly.

6. Does the Office of the Insurance Commissioner take any action?
The Office of the Insurance Commissioner simply files the 20 day notice letter in case there is a dispute about whether it was properly sent to the insurance company. The OIC takes no other action.

RESOURCES

For more information on the Insurance Fair Conduct Act, please see:

• RCW 48.30.010 - Unfair Practices in General - Remedies and Penalties
• RCW 48.30.015 - Unreasonable Denial of a Claim for Coverage or Payment of Benefits

If you have any questions about the Insurance Fair Conduct Act, please make sure to contact one of the attorneys at Graham Lundberg & Peschel.

1-800-273-5005

Attorney Profile: Kenneth B. Golden

Meet Our Senior Managing Partner: Kenneth B. Golden

Kenneth B. Golden is the Senior Managing Partner for the South Sound Offices of Graham Lundberg & Peschel. He has successfully operated the offices in Tacoma and Port Orchard since 1999, when the offices were established as part of the merger with his prior firm, Golden & Associates, P.S., Inc. Ken has practiced law for over twenty years, the entire time of which has been devoted to vigorously pursuing the rights of injured victims in personal injury matters. Ken attended the University of Puget Sound School of Law, graduating with honors with his Juris Doctorate degree in 1986.

In addition to being a strong advocate for his clients, Ken Golden is also an avid motorcyclist, and has represented other bikers who have had the misfortune of being involved in accidents. He and his wife, Lynne, enjoy exploring the Pacific Northwest on their Harley's, weather permitting.

You have just been in a car accident - now what?

If you have ever been in a car accident you know that the minutes immediately following that accident you can be scared and confused. Many people do not take the proper steps to ensure their rights are fully protected, especially if the accident was not their fault. Here are some simple steps to remember after your involvement in a car accident:

1) Are there serious injuries? Check to see if you, your passengers, and the person in the other vehicle involved are injured. If anyone is seriously injured, immediately call 911! Do not move the vehicles or anyone from their vehicles. Wait for the Medical Professionals to arrive to do so.

2) Are you safe? If there are no serious injuries, move all vehicles out of the roadway. Leaving vehicles in traffic can cause more collisions, or injure you more seriously. Move to the shoulder or find a close parking lot to pull into.

3) Report the Accident to the Police. If there is significant damage, or one person is at fault, call your local police department. If the police arrive, an accident report will be completed and the at fault party may be issued a ticket. This will be helpful when the insurance company is contacted.

4) Exchange Information. Once you are safely off the roadway you will need to exchange information with the other vehicle involved. Make sure to record the following pertinent information: Facts of the accident (including date/time/location), names/address/phone numbers of passengers and witnesses, vehicle information (including make/model/year/color/license plate), other driver information (including name/address/phone number/driver's license number), Insurance company name and policy number.

5) Take Pictures!! It is very important to take photographic evidence of the damage to both vehicles. It is recommended to keep a disposable camera in your car at all times.

6) Seek Medical Attention. If you feel injured in any way, seek medical attention immediately. Often, injuries from low impact collisions are not realized until several days after an accident. If you or any of your passengers begin to feel neck, back, head or any other pain, consult with a medical professional as soon as possible. Do not assume the pain will go away with time.

6) Report the accident to your insurance company. Even if only minor damage occurs and you believe that you have come to an agreement with the other driver, it is best to let your insurance company know that an accident has occurred. The other driver may change their mind, or worse, report false information. It is best to protect yourself!

Getting into a car accident can be unsettling. If you are in a car accident, remember these tips and the insurnace process should run more smoothly. If you have any questions about an accident in which you were involved in Washington State, please call our office for a free consultation - 1-800-273-5005

Week One of Our New Building

We have now completed week one of construction on our new Port Orchard office. While the new building is being constructed we will still be working out of our small office which is currently located in the middle of the construction site. Day one of construction was very exciting and new, we were all looking out of our windows and eagerly watching tractors and trucks move dirt around. Here we are at day seven and now we are looking out of the window to see the dump trucks narrowly miss our cars. In fact today one of the trucks took out our mail box! We are obviously still excited at the prospect of a new office, however the building process no longer holds any excitment for us. I will keep you updated on the process as we go along.

"Independent Medical Examinations"

Do I have to attend a PIP "IME"
In your contract with your insurance company, there is a Cooperation Clause, which requires you to attend an "Independent" Medical Examination. If you do not attend, the PIP Carrier can cut off PIP benefits without requiring a doctor's opinion.

What Happens at an "IME"?
You will be required to go to a facility designated by the PIP carrier. Once there, you will be required to fill out paperwork as if you were a new patient of the facility. You will then meet with the selected examiner, who will proceed with taking a medical history and asking questions about your injuries and treatment, based upon information derived from the medical records provided by the insurance company. the doctor will then conduct a physical examination, the sufficiency and accuracy of which is often suspect. At the conclusion of the examination, you will be dismissed, and the examiner proceeds with preparing the report, most often without sharing the findings or conclusions with you. Nonetheless you must wait until the PIP carrier contacts them by which time several weeks may have gone by. PIP benefits may be denied retroactively.

How should I Prepare for a PIP "IME?"
Here are some simple tips that will help you get through your PIP IME.

1. Be prepared. You should have a general understanding of your medical treatment and injuries since the accident.

2. Be believable. You do not have to convince the doctor that you were really hurt. However, coming across as truthful and honest, without exaggerating symptoms, will lend credence to your case.

3. Focus on what is being asked. This is not a social visit, and you are not having a friendly chat. This is a medical professional, being paid by the insurance company, and looking for a reason to terminate your PIP benefits.

4. Watch out for traps. They examining doctor may say "This hurts right?" when in fact they know it does not hurt. they want to see if you are exaggerating your pain complaints.

If you are being sent for PIP IME, contact an attorney at Graham Lundberg & Peschel. There are strategies and procedures that may be put into place to assure continued PIP benefits.

Personal Injury Protection (PIP)

Personal Injury Protection is part of your auto insurance policy. It is designed to take care of you immediately after an accident. You should always take advantage of your PIP!Here are a few PIP TIPS to assist you: • PIP pays medical bills for 3 years or $10,000 (or more, depending on your policy)• PIP pays a portion of your lost income from missing work after an accident• PIP pays reimbursement for household chores that you normally do yourself• PIP does not have a deductible or co-pay requirements• PIP is no-fault, so it does not matter who caused the accident, you’re covered!!!• PIP must be included in your policy unless you rejected it, in writing• BY LAW, your insurance company cannot raise your rates for using PIP• BY LAW, your insurance company cannot cancel your policy for using PIPOPEN YOUR PIP CLAIM IMMEDIATLEY AFTER AN ACCIDENT!!! You shouldn’t have to pay expensive medical bills out of your own pocket until you settle your case! Take advantage of your PIP coverage - - - that’s why you have it!!! Contact the offices of Graham Lundberg & Peschel if you have any questions regarding PIP or any other issues related to Personal Injury @ 1-800-273-5005.