Schmidt, Sethi & Akmajian Blog

Understanding Insurance Policies: A Note About the Importance of Having Health Insurance

Posted by Dev Sethi | Apr 16, 2014 | 0 Comments

Insurance is confusing to lawyers and non-lawyers alike, but it is important to have it, especially for your automobile, your home and your health. Many people would rather take the risk than pay the expensive premiums. But when the risk becomes a reality, and the uninsured suddenly finds himself in a bad situation, that situation just got worse due to the fact there is no insurance to help cushion the fall. All it takes is one incident to make purchasing insurance more than worth its cost.

Kinerk, Schmidt and Sethi unfortunately sees a lot of injured people come through its doors without any health insurance. This presents numerous problems for the injured person's case, including its value. Here are three major problems:

1. Getting Adequate Treatment

Medical treatment can be extremely expensive. Without insurance, the patient is responsible for the full price of the medical service and oftentimes cannot afford it. The result is the patient either does not receive the treatment they need, waits a substantial amount of time before getting it or receives treatment far inferior to what she actually needs. This is not a good thing for the person's health or case.

An injured person bringing a lawsuit against someone else has the duty to mitigate her damages. In other words, she must do whatever she reasonably can to get better. If she is not getting the treatment she needs or waiting a substantial amount of time to get it, the defendant can use these facts against her. This is an effective argument for the defendant--jurors do not like a plaintiff who appears as though she is milking her injury and dragging it out. This can substantially bring down the value of a case.

2. Liens and Loans

People who don't have insurance must often resort to getting treatment on a medical lien or loan. In other words, the medical provider agrees to treat the patient on the condition that the provider will receive full reimbursement when the case settles. If the case does not settle for the full amount of the medical lien, the patient is oftentimes on the hook for the remaining balance.

This presents two problems. The first and most obvious one is the injured person does not receive as much money in a settlement because the majority of it must go to to fully reimburse her medical providers (many health insurance policies, on the other hand, do not require reimbursement, and if they do, it is for a much smaller amount) .

The second one is this: when a patient with health insurance is being treated, she is being treated for significantly lower rates because health insurance companies negotiate with medical providers for substantial reductions in the prices for services. A patient treating on a lien is not so lucky--the medical provider is charging her the full amount for the service. This means patients treating on a lien will have to reimburse medical providers much larger amounts of money than someone with insurance.

3. Lack of Medical Treatment/Bills

When attorneys or insurance adjusters evaluate an injured plaintiff's case, they rely heavily on the injury itself, the medical treatment the person has received and the cost of the treatment. In other words, one of the most important elements of case evaluation and value is the stack of medical documents, often containing objective, unbiased and reliable information.

As noted, people without health insurance usually get less treatment because they are unable to afford it. This results in having a small or nonexistant stack of medical documents containing little information, and therefore, very little that an attorney or adjuster can go off of in making a fair and full determination of what the case is worth. This oftentimes results in a much lower case value than someone with the same injuries, but who has had more treatment because they are insured.

About the Author

Dev Sethi

Dev Sethi litigates and tries a wide-range of complex injury and death cases throughout Arizona. He has Martindale Hubbell's highest rating, AV, and he is listed in "Best Lawyers." Dev is also recognized as an Arizona Super Lawyer in the area of plaintiff's products liability litigation.Dev has been at the forefront of auto product defect litigation. He played a key role in uncovering the Goodyear Load Range E tire scandal and worked to hold Ford Motor Company responsible for the danger posed by their now notorious 15-passenger vans. Dev is currently representing families in product liability suits against the nation's largest corporations including General Motors, Ford, Pentair Pools and Invacare.


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