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.”
The CFA study estimates that retained earnings, or surplus, for the entire industry was $687 billion at the end of 2007, which it describes as “excessive by any legitimate measure.”
The group also calculates that the pure loss ratio, the actual amount of each premium dollar insurers pay to policyholders in benefits, was only 54.6 cents in 2007 and that over the past 20 years, this has declined from over 70 cents per premium dollar, “indicating a huge loss in the value of insurance to consumers
Lates Homeowners Insurance cost for Folsom, La. 167,000 coverage 50,000 for outbuildings $1925.00 yr w/1/2 & 2%(windstorm&hail) as a deductible. There is no way that I’ll flood. That’s way more than $900 a year. The windstorm and hail is running $900 by itself. Auto insurance $570.00 a half..in the rural country.
Tens of thousands of drivers across the nation have recently received notices from state attorney generals with some shocking news: used cars they purchased in good faith were actually salvage cars that had not had their titles changed, due to a “mistake” by State Farm Insurance. In some noticed letters, such as those sent in Pennsylvania, the consumer is advised that because of the glitch, the vehicle certificate of title must be “frozen” pending return to Pennsylvania Department of Transportation for issuance of a new salvage title. Consumers are then encouraged to accept a partial cash reimbursement for the loss of value, under a schedule based upon the purchase price paid for the car. Even if a consumer accepts and signs, the amount to be received is described as “an approximate”, though the consumer is giving up their right to pursue other remedies. The amount offered is part of an agreement between attorney generals and State Farm, requiring the insurance carrier to pay millions of dollars directly to the attorney generals for “legal fees and expenses”.
The Pennsylvania letter notifies consumers that by accepting, they are required to disclose the salvage history to any subsequent buyer of the vehicle, but does not indicate:
that salvage title cars are nearly worthless in the used car market;
that the amount being paid under the plan is but a small fraction of the actual losses related to the change in classification of title;
that mechanical or other charges incurred by the consumer as a result of the salvage history will not be reimbursed;
that the consumer is not required to accept the amount and may do much better by filing suit on their own against State Farm or their dealer;
Whether any of the “total loss” vehicles pose a danger to the driver or public from continued use.
The Automotive Consumer Advocacy and Lemon Law Firm of Kimmel & Silverman believes these proposals unfairly favor State Farm Insurance by limiting liability for its conduct to a small percentage of the true losses consumers have suffered by the “mistake”, in ways that the attorney generals may not have recognized or appreciated when negotiating the settlement. If you purchased a State Farm salvage car and have recently found out about its history, we’d like to hear from you.
like any business whether small or not, that company is striving to make a profit and grow. they then pass either the savings back to the consumer or put it back into their pockets for later expenses. i work for a company that tries to keep a 4% profit, but when mother nature is being a blessing, that profit can definately increase. if the claims filed are less frequent, again, increase of profit. the company also uses old funds (money available but not for solvency of claims), is invested into the market allowing the company to make some more money to pay for expenses. we are so focuses in today’s society we forget the businesses are supposed to bring profit. that enables companies to hire, expand, provide higher wages, etc – which in turn creates a better economy. now if you really want to look at things differently, let’s take a look at a different industry.
oil: whose making money here? the oil guru’s in the mideast and the big companies here stateside. we allow them to keep upping the ante of the oil and that transfers back to the gas. so we pay more at the pump and they get awfully richer. nothing stopped them. if you own a vehicle or take public transportation, you need a form of gasoline.
power: most of us can only take it from the local source. run by your local power company in-line with a contract with the local government. is there competition in this? no! why? there is no way to create a separate power into the city for each and every house – so a monopoly! oops – sounds like that is against the anti-trust law! afterall, is that we wound up doing with the telephone? now there is a way to give folks a choice there. funny, don’t they all use the same phone line?
government: why is it that we all blame Bush and Chaney? i think most of you forgotten that we need to look at the local government and then the current us house of rep and senators. most of them have been in office for a long time. in our current business, it has been made that you have to retire after the age of 62 (if memory serves me correctly). yet, if you look into the congress, how many are actually older? how many of them really know the current generation? how many of them can forsee the future? so, why do they want to know about steroid use within BASEBALL? baseball is not a national security risk. it is a company of its own and is trying to regulate itself. baseball is a sport – the congress needs to look at what it can do to help our fellow americans – baseball is entertainment!
finally, remember that one bad apple does not mean that the bushel is bad. i noticed on several earlier blogs, state farm is mentioned. remember the same goes for drivers as well, if one driver is reckless, does that mean we all are? NO! same thing when it comes to companies. same goes for the US Government – it starts locally and goes up.
I work for an insurance company and can’t tell you the number of times people aren’t interested in switching even if it saves them hundreds, because of blind loyalty. True story. All I can say is if people want to complain about prices, they need to shop a bit. Don’t blame the companies, we are Americans and when companies lose customers they have to adjust or suffer. People think it is easier to stay than take the 20 minutes to shop and save so I have no sympathy for those complaining about profits. This is America, not China.
VERY GOOD MESSAGE, WUDCHUCK! BUSINESSES ARE BUSINESSES, AND SHOULD BE PROFITABLE. OTHERWISE, WHY BOTHER? THE REAL PROBLEM IS POLITICIANS SUPPORTED BY BIG BUSINESSES AND PACS WHO THEN ARE REWARDED BY THOSE POLITICIANS. WE NEED TO SEVERELY LIMIT WHAT YOU CAN SPEND TO GET ELECTED—LOOK AT THE CURRENT PRIMARY CANDIDATES!
How can car insurers in this state,nj, take reductions of hundreds of dollars in their ads if they didn’t overcharge to begin with. Where is the savngs coming from/ Credit etc have been around awhile and I’m no better a driver today than I was 2 yrs. ago.
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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.”
The CFA study estimates that retained earnings, or surplus, for the entire industry was $687 billion at the end of 2007, which it describes as “excessive by any legitimate measure.”
The group also calculates that the pure loss ratio, the actual amount of each premium dollar insurers pay to policyholders in benefits, was only 54.6 cents in 2007 and that over the past 20 years, this has declined from over 70 cents per premium dollar, “indicating a huge loss in the value of insurance to consumers
Lates Homeowners Insurance cost for Folsom, La. 167,000 coverage 50,000 for outbuildings $1925.00 yr w/1/2 & 2%(windstorm&hail) as a deductible. There is no way that I’ll flood. That’s way more than $900 a year. The windstorm and hail is running $900 by itself. Auto insurance $570.00 a half..in the rural country.
Tens of thousands of drivers across the nation have recently received notices from state attorney generals with some shocking news: used cars they purchased in good faith were actually salvage cars that had not had their titles changed, due to a “mistake” by State Farm Insurance. In some noticed letters, such as those sent in Pennsylvania, the consumer is advised that because of the glitch, the vehicle certificate of title must be “frozen” pending return to Pennsylvania Department of Transportation for issuance of a new salvage title. Consumers are then encouraged to accept a partial cash reimbursement for the loss of value, under a schedule based upon the purchase price paid for the car. Even if a consumer accepts and signs, the amount to be received is described as “an approximate”, though the consumer is giving up their right to pursue other remedies. The amount offered is part of an agreement between attorney generals and State Farm, requiring the insurance carrier to pay millions of dollars directly to the attorney generals for “legal fees and expenses”.
The Pennsylvania letter notifies consumers that by accepting, they are required to disclose the salvage history to any subsequent buyer of the vehicle, but does not indicate:
that salvage title cars are nearly worthless in the used car market;
that the amount being paid under the plan is but a small fraction of the actual losses related to the change in classification of title;
that mechanical or other charges incurred by the consumer as a result of the salvage history will not be reimbursed;
that the consumer is not required to accept the amount and may do much better by filing suit on their own against State Farm or their dealer;
Whether any of the “total loss” vehicles pose a danger to the driver or public from continued use.
The Automotive Consumer Advocacy and Lemon Law Firm of Kimmel & Silverman believes these proposals unfairly favor State Farm Insurance by limiting liability for its conduct to a small percentage of the true losses consumers have suffered by the “mistake”, in ways that the attorney generals may not have recognized or appreciated when negotiating the settlement. If you purchased a State Farm salvage car and have recently found out about its history, we’d like to hear from you.
garbage and lots of greed
CFA & Robert Hunter’s time has passed. Most now know their funds come from Trial Lawyers & the Ralph Nader loonies.
like any business whether small or not, that company is striving to make a profit and grow. they then pass either the savings back to the consumer or put it back into their pockets for later expenses. i work for a company that tries to keep a 4% profit, but when mother nature is being a blessing, that profit can definately increase. if the claims filed are less frequent, again, increase of profit. the company also uses old funds (money available but not for solvency of claims), is invested into the market allowing the company to make some more money to pay for expenses. we are so focuses in today’s society we forget the businesses are supposed to bring profit. that enables companies to hire, expand, provide higher wages, etc – which in turn creates a better economy. now if you really want to look at things differently, let’s take a look at a different industry.
oil: whose making money here? the oil guru’s in the mideast and the big companies here stateside. we allow them to keep upping the ante of the oil and that transfers back to the gas. so we pay more at the pump and they get awfully richer. nothing stopped them. if you own a vehicle or take public transportation, you need a form of gasoline.
power: most of us can only take it from the local source. run by your local power company in-line with a contract with the local government. is there competition in this? no! why? there is no way to create a separate power into the city for each and every house – so a monopoly! oops – sounds like that is against the anti-trust law! afterall, is that we wound up doing with the telephone? now there is a way to give folks a choice there. funny, don’t they all use the same phone line?
government: why is it that we all blame Bush and Chaney? i think most of you forgotten that we need to look at the local government and then the current us house of rep and senators. most of them have been in office for a long time. in our current business, it has been made that you have to retire after the age of 62 (if memory serves me correctly). yet, if you look into the congress, how many are actually older? how many of them really know the current generation? how many of them can forsee the future? so, why do they want to know about steroid use within BASEBALL? baseball is not a national security risk. it is a company of its own and is trying to regulate itself. baseball is a sport – the congress needs to look at what it can do to help our fellow americans – baseball is entertainment!
finally, remember that one bad apple does not mean that the bushel is bad. i noticed on several earlier blogs, state farm is mentioned. remember the same goes for drivers as well, if one driver is reckless, does that mean we all are? NO! same thing when it comes to companies. same goes for the US Government – it starts locally and goes up.
I work for an insurance company and can’t tell you the number of times people aren’t interested in switching even if it saves them hundreds, because of blind loyalty. True story. All I can say is if people want to complain about prices, they need to shop a bit. Don’t blame the companies, we are Americans and when companies lose customers they have to adjust or suffer. People think it is easier to stay than take the 20 minutes to shop and save so I have no sympathy for those complaining about profits. This is America, not China.
VERY GOOD MESSAGE, WUDCHUCK! BUSINESSES ARE BUSINESSES, AND SHOULD BE PROFITABLE. OTHERWISE, WHY BOTHER? THE REAL PROBLEM IS POLITICIANS SUPPORTED BY BIG BUSINESSES AND PACS WHO THEN ARE REWARDED BY THOSE POLITICIANS. WE NEED TO SEVERELY LIMIT WHAT YOU CAN SPEND TO GET ELECTED—LOOK AT THE CURRENT PRIMARY CANDIDATES!
How can car insurers in this state,nj, take reductions of hundreds of dollars in their ads if they didn’t overcharge to begin with. Where is the savngs coming from/ Credit etc have been around awhile and I’m no better a driver today than I was 2 yrs. ago.