Insights Into Your Med-Pay Insurance Coverage

While Legal Romantics would like to characterize the trial of a lawsuit as a “Search For Truth” that’s not a reality!
Cases are decided on the evidence. When reviewing cases before them, judges invariably use the phrase, “The evidence shows”, rather than, “The truth of the matter is”. That first phrase is a reality that filters from the courtroom down to the objective evaluation of each case tried.
If Fred Fuddle is the town drunk, or if his conduct at the accident scene was provably abnormal than the value of your case should increase. If your injuries are visible and/or demonstrable, it’s likely your settlement will be larger. The conduct of both Fuddle and you before the accident may be significant. If you had been at a bar drinking heavily or raising holy hell out on the highway before the accident, you’ll get less regard from the jury than if you were driving to your house of worship with your family.
So, the circumstances of your behavior before, during, or after the accident increases or decreases the value of your settlement.
THE SIX MOST IMPORTANT ELEMENTS IN THE “EVALUATION PROCESS”: To be fully informed, you must know and understand the six primary evaluation elements that figure into the process of evaluation. They are as follows:
(1) THE FACTS (2) THE EVIDENCE (3) THE LAW (4) YOUR INJURY (5) SPECIAL DAMAGES (6) THE INTANGIBILITIES.
(1) THE FACTS: The gathering of the provable factual information is the first step in the evaluation. If you try to evaluate a claim without as complete a file of facts as possible, it’s like going hunting for a lion with a slingshot.
(2) THE EVIDENCE: You must weigh all factual evidence known to you against the actual evidence you can produce to substantiate it. No matter what information you’re aware of, your position will always be stronger if you have the evidence to back you up.
For example: You can talk until the cows come home about the unsightly black-and-blue marks you had on your face, ribs, and hips, the scar on your forehead, or the 75 feet of skid marks Fred Fuddle’s auto left on the highway before he smashed into you, but Adjuster I. M. Smart will never adequately comprehend, (nor want to believe you) unless you provide him with photographs.
Providing Smart with the proof-positive of photographs will cause his Supervisor’s eyes to bulge as he inhales a deep breath of resignation and declares, “Hey, this one’s gonna cost us” .
QUESTION: “How can Dan be so sure about that”? ANSWER: “Because before Dan retired, after spending over 30 years on that firing line, he was an Insurance Adjuster, Supervisor, Manager and Trial Assistant. He’s been there, saw that, plus heard (and felt) that many thousands of times”!
Whenever possible you must help Adjuster I. M. Smart justify the settlement figure he wants to get approved by his immediate superior at Granite Mountian Insurance Corporation.
(3) THE LAW: As proved in over 83% of the accidents in the United States in 2003 the impact you were subjected to is clearly the fault of “Fumbling” Fred Fuddle, so the law is on your side.
Armed with the information found in my third book AUTO ACCIDENT PERSONAL INJURY (How To Evaluate And Settle Your Loss) plus THE BASE FORMULA (The Baldyga Auto Accident Settlement Evaluation Formula) you’ll be able to do that. THE BASE FORMULA will correctly evaluate your “Pain and Suffering”. Because of this, you can settle your own claim without handing a huge percentage to an attorney. A lawyer who has done nothing more than have his secretary send Fuddle a letter of representation and then think it’s perfectly acceptable (after many moths, sometimes years, of hiding/stumbling/fumbling and verbally pitching his well-practiced answer when you asked, “Hey what’s going on with my claim?” with an answer like, “I’m right on top of it, hang in there, old friend and I‘ll make it come out right”, and then proceed to take a huge portion of your settlement dollars, for doing little or nothing to earn it.
(4) INJURY TO YOU: The seriousness of your injury has to be considered. (Ole’ Doc Comfort, your attending physician’s Medical Report, should go into detail about that).Your age will have an effect on the time it takes you to recover. The time you lost at work will have a direct bearing on the length of your recovery.
(5) SPECIAL DAMAGES: All of your direct and tangible losses are prime factors to be implemented in the consideration of the value of your claim.(Clearly stated details regarding Damages are found in Chapter Four of my book).
(6) INTANGIBLE ELEMENTS: These include your reasonableness, your economic status, your standing in the community, the obvious sentiment conjured up when one considers the degree of the seriousness of your injury, plus the attitude of Fred Fuddle (and often your witness) regarding your case.
Sympathy will come into play if you’re a widow or a highly respected Little League Coach, in contrast to your being identified as a raucous bum with a history of getting into scrapes with the law.
Emotional factors often have considerable weight in the evaluation of your claim. Whatever the intangible elements may be, you must force yourself to investigate and then evaluate them just as objectively as possible. So, if what’s being contended is incorrect, you can deny them (plus you must prove the conclusions not to be true) when and where it becomes appropriate to do so

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Consumer Directed Health Plans

Most of you have heard about “consumer directed health plans”. The Bush administration has been a strong supporter of this concept as a way to get a handle on soaring healthcare costs. The recent inaugeration of Mr. Bush signals that consumer directed health plans will increasingly make up a larger percentage of group medical plans over the next several years. In the past, consumer directed plan designs have taken on many forms: Medical Savings Accounts (MSAs), Flexible Spending Accounts (FSAs), Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs).
Many experts consider HRAs and HSAs to be the first generation of viable consumer directed health care products. HRAs are typically paired with a high-deductible health plan and are employer-funded Section 105 defined contribution plans. HSAs are the latest version of consumer directed health care plans. The core components of HSAs include a high deductible insurance product and a cash spending account. HSAs combine the pre-tax treatment of a FSA, the portability and roll-over characteristics of a 401(k), and the tax-free distributions of a Roth IRA.
One of the main goals of any consumer directed health plan should be to get the consumer more involved in both the cost and statistical outcomes of certain healthcare procedures. Informed healthcare consumers will make wise healthcare decisions and typically these decisions will result in both lower costs and improved quality.
Although the advantages of HRAs and HSAs can be substantial, employers will want to do their homework prior to setting them up. Effective implementation will require a clear understanding of the consumer directed healthcare plan that best fits your organization as well as the administrative requirements. Employee education will be essential. Companies will also need to look into how the creation of a HSA or HRA may affect their HIPAA medical privacy compliance requirements.
Just like most endeavors, the successful implementation of a HSA or HRA will greatly depend on how much research your organization does on the pro’s and con’s of each alternative. The type of consumer directed health plan that best fits your company will depend on a combination of your corporate structure as well as the overall objectives of your group health insurance plan.
Although consumer directed healthcare plans are becoming very familiar to human resource managers and other benefit professionals, remember that your employees and their dependents will need a substantial amount of education and communication

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Cure The Insurance Blues By Lowering The Cost of Your Premiums

Does the current amount that you pay on your insurance premiums keep you awake at night? If so you’re not alone. In today’s fast paced society many people are looking for ways to save money unfortunately this can lead to scrimping and watching where you spend every penny you make. Not only is this difficult it can also be a real pain in the neck and lets face it – what’s so fun about not spending money you worked hard to get in the first place.
Fortunately there is an easy way to save a few extra dollars every month by checking to see if you’re overpaying on any of your insurance premiums. This could be your auto insurance, life insurance, home insurance or renters insurance. The reality is you can save on almost every form of insurance you have. Ok, so what’s the secret?
Welcome to the wonderful world of the Internet and free online insurance quotes. The Internet is perfect for checking to see if you can save money on all of your current insurance policies. Most online insurance providers allow you to input your information (which they keep confidential) by having you fill out a simple and easy to use form on their website. They then use the information to generate free quotes that allow you to see how much you would pay for an insurance policy. You can use that information and compare it to the cost of your current insurance premium to see if you can save some money.
The benefits of shopping for your insurance online are numerous. For instance you can adjust your coverage amount to see how it affects the cost of the policy. A live salesman never pressures you or scares you into purchasing a policy you may not want or really need. Additionally you are never under any obligation to purchase any policy offered to you giving you the time and flexibility to decide when you’re ready to change your insurance provider and coverage. Perhaps the best reason to shop online for your insurance needs (besides saving money) is the freedom to shop in the comfort of your own home, even in your pajamas if you so desire.
Start saving money now by finding insurance online that provides the coverage you need at a price that won’t keep you awake at night

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Are You Sure That Heirloom Oriental Rug From Your Aunt Hilda Is Really Insured?

Gone are the days of the cinder block and wood plank bookcases. You've come along way from that old reliable jut rug and CDs (or in some cases, actual vinyl albums) stored in milk crates. That's the way it is with first apartments, and sometimes second and third apartments too. It's what you were able to afford when you first set out own your own. And it was fun, sort of. But today's a new day, and you've paid your dues and then some. You're the king or queen of your own castle, a castle as well-appointed as any luxury model home, with beautiful area rugs, antique furnishings, and other treasurers that you'd hate ever to see lost.
Because your home, and to a certain extent the items in that furnish it, will most likely be the best investment you're likely to make, it's important to protect this investment and those items that enhance it. The simplest way to do this is to make sure that you are carrying adequate insurance coverage on your home and its furnishings.
How Much Coverage is Enough?
Determining the amount of coverage needed is crucial. Say, that beautiful oriental rug once belonging to Great Aunt Hilda has finally come to rest in your hands, only to be irrevocably damaged when someone at the party you're hosting spills Merlot on it. Other than frantically going at it on all fours, with club soda and Baby Wipes to the delight of your guests, what would you need to do in order to be "made whole" again, and most importantly, stop Great Aunt Hilda from spinning in her grave?
First, if you own your home and have a mortgage on it held by a bank, then you will be required to maintain adequate coverage on the "dwelling," the actual building which makes up the structure of your home for the life of the loan. The lender recognizes the value of this investment, and will make sure that their investment is protected by requiring it be adequately covered by insurance. But how does this insurance coverage extend to Great Aunt Hilda's prized Persian rugs and all the other furnishings that adorn the inside of your castle/home?
Estimating Value
An insurance agent writing a policy on your home will probably leave an estimation of the value of your home's contents to your discretion. Your insurance agent may even ask you directly: "How much do you think your household contents are worth?" Following this query with yet another you may or may not feel qualified to answer: "Is that replacement or actual estimated value?" Your agent may encourage you to opt for coverage that allows for those lost items to be either made whole again either by: repair, replacement or receipt of cash payment--as most common household furnishings (other than fine art and other collectables), depreciate considerably in value with time.
But what about those two rare oriental rugs left to you by dear Aunt Hilda? Will you be expected to determine the value for these items? Well, not exactly. It's one thing for you to estimate the value of last year's CD player for $129, when it's costs may be closer to $89, and quite another for you to estimate the value of a pair of rugs at $5000 each. Because you are limited to $1000 coverage per theft on these types of items when claimed under your Homeowner's policy, an estimation of $5000 for each rug under your standard policy would only you provide with $1000 worth of coverage, for items you say are worth closer to $10,000. That's why you may want to consider covering such items, those you value at over $1,000, with a Schedule to your Homeowner's policy.
So, what is a Schedule?It's a list of items which may not receive adequate coverage under your standard Homeowner's coverage.
Who should consider a Schedule? If you own fine art, rare collectables, guns, jewelry, silverware, and fine area rugs, you might very well benefit by having a Schedule added to your policy.
Do Schedules cover loss other than standard peril?Items listed on the Schedule are subject to broader coverage—beyond fire and peril--than those provided for under the standard Homeowner's policy. Schedule items include coverage for accidental and unforeseeable occurrences: like rugs permanently stained by Merlot.
Are Schedule items included under the deductible?A Schedule also benefits you because these items are not subject to a deductible.
What proof needs to be provided to add a Schedule to your Homeowner's policy?To include a Schedule to your homeowner's policy, will be asked to substantiate the value of each item to be included on the Schedule. This can be provided in the form of certificates of authenticity, sales receipt or by appraisals.
Whether or not your household items merit the inclusion of a Schedule should be determined by you, the homeowner, assisted by your insurance agent. This way, with a little additional coverage, your Aunt Hilda's treasured rugs may exist to be passed on to the next generation.

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Inside-Information Regarding Your Motor Vehicle Accident Insurance Claim

Here’s some “Inside-Info” you must know so you won’t be taken advantage of on your motor vehicle accident insurance claim and also: SO YOU CAN COLLECT EVERY DOLLAR THAT’S OWED TO YOU !
The following 8 are just “The Tip Of The Iceberg”:
#1. There are situations where you can collect for your “Lost Wages” even if you were paid by your employer and/or collected “Sick Leave” while unable to work.
#2. You can collect money and be reimbursed for any and all “Over The Counter” (non-prescription) medication you purchased during your recovery.
#3. Under normal circumstances unless a claim ends up in court (several years after impact has taken place and you are fully recovered) you do not have to agree to be examined by the insurance company’s doctor.
#4. There are many times that come to pass where you are entitled to collect the “Gross Amount” of your lost wages, not the so-called “Net After Taxes”.
#5. If you’re a housewife, you can often recover for “Lost Wages” (based on the “Value” of a maid or a domestic servant, who would execute the same work) which you could not perform due to the injury.
#6. You are entitled to extra compensation if you can prove you were forced to cancel a vacation and/or a special event.
#7. Under certain circumstances you may be able to make a claim (and collect for) a personal injury even if your state is “No-Fault” and you already have PIP (Personal Injury Protection) coverage.
#8. Your friends, and even relatives, have the right to execute statements which you can send to adjusters (and/or anybody you feel should get one) going into detail as to what happened to your body and what they’ve observed you’ve had to deal with (via your “Pain and Suffering”) during your period of recovery.
These statements can often provide you with an even greater dollar value - - when it comes to the calculation and then the ultimate settlement of your personal injury claim!

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Long-Term Care Insurance: Eldercare Solution

When I suddenly had to become a fulltime caregiver to my elderly parents, both with health problems and starting to develop dementia (namely Alzheimer’s), I had never even heard of Long-Term Care Insurance. After we burned through their life savings, and then started chipping away at mine, I was advised to apply for financial assistance for them through the government’s Medicaid system--a program for those at the poverty level. It was quite a long process with mounds of paperwork and numerous investigations, but finally my parents were approved.
I was so happy that monetary help would finally be on the way, until I discovered that the financial assistance would only pay to put my parents in a nursing home, not even in Assisted Living, and with very little help to keep them in their own home.
Since their levels of care were so different (my mother needed most things done for her), there weren’t any facilities that would allow them to be together. They’d be across the street from each other in different wings of the home. After fifty-five years of marriage, my parents were adamant about wanting to be together in their own home, in their own bed, where they could continue to cuddle and kiss--as they so frequently did. And, since my father was so “difficult” with a terrible temper and quite a long record of manipulative disruptive behaviors, the homes didn’t want to deal with him anyway.
It was challenging, but I committed to keeping my parents in their own home and attending Adult Day Health Care five days a week. Then, with the help of two marvelous caregivers, after four more years of loving each other--they passed, just a few months apart. Even though caring for every aspect of my parents’ last years was the hardest thing I have ever done--I am proud to say I gave them the best end-of-life I possibly could.
Had I only known to insist that we buy Long-Term Care Insurance for them prior to their illnesses--their years of in-home care could have been paid for, and I could have saved myself so much heartache, not to mention a small fortune. I encourage you to learn from my mistake and look into LTC insurance long before you need it—for your loved ones as well as yourself. Like fire insurance, hopefully, you’ll never have to use it.
Also, call your local Area Agency on Aging, or Department of Aging, and ask if there are any financial programs, waivers or grants available in your area that you can apply for.
STARTLING STATISTICS
· An estimated 4.5 to 5 million Americans have Alzheimer’s disease. In a Gallup poll, 1 in 10 Americans said that they had a family member with Alzheimer’s, and 1 in 3 knew someone with the disease.
· Increasing age is the greatest risk factor for Alzheimer’s. One in 10 individuals over 65 and nearly half over 85 are affected. Rare, inherited forms of Alzheimer’s can even strike individuals in their 30’s and 40’s.
· A person with Alzheimer’s disease will live an average of eight years and as many as 20 years or more from the first onset of symptoms.
· More than 7 out of 10 people with Alzheimer’s disease live at home, where family and friends provide 80 percent of their care. The estimated value of this informal care is $257 billion annually.
· One half of the U.S. population has a chronic condition. More than one quarter (26.6%) of the adult population provide care for a chronically ill, disabled or aged family member or friend, which translates to more than 50 million people.
· 37% of caregivers are living in the same household as the person they care for. 54% are between 35 and 64 years of age. 59% of the adult population either is or expects to be a family caregiver, and 2 million more caregivers will be needed in the next twenty years.
· An estimated 43% of Americans age 65 or older will spend time in a nursing home. By 2012, 75% of Americans over age 65 will require long-term care. Long-term care costs are rising at 6% annually.
· The annual cost of Alzheimer’s care in the U.S. is at least $100 billion, and will soar to at least $375 billion by mid-century, overwhelming our health care system and bankrupting Medicare and Medicaid.
· Alzheimer’s disease costs American business $61 billion a year, which is equivalent to the net profits of the top 10 Fortune 500 companies. $24.6 billion covers Alzheimer health care, and $36.5 billion covers costs related to caregivers of individuals with Alzheimer’s, including lost productivity, absenteeism and worker replacement.
THREE WAYS TO PAY FOR LONG-TERM CARE
1. Pay for in-home caregivers and assisted living/nursing homes out of pocket. This is expensive and can often deplete a family’s life savings.
2. Meet a very specific poverty level and qualify for government assistance through the Medicaid program. Unfortunately, options are limited, only paying for nursing homes that accept Medicaid.
3. Buy a Comprehensive Long-Term Care Insurance policy. This protects your family’s assets from the rising costs of caring for someone who needs full time care. An employer might pay the tax-deductible premiums. Consider buying it at a younger age, when more affordable and accessible. It must be bought before a major illness strikes. Medicare and regular health insurance does not pay for long-term care. The average cost for a person who needs long-term care is $40-$70,000 annually, depending on where you live, plus the cost to the family caregiver who may have to leave their job.
QUESTIONS TO ASK YOUR INSURANCE AGENT
--Is the coverage comprehensive, meaning it includes all levels of care: in the home, assisted living, board & care, and nursing/dementia facilities?
--What is the daily benefit?
--Is there 5% annually compounded inflation protection?
--What is the elimination period?
--Is it a lifetime benefit period or a limited time benefit policy?
--Is there a spousal discount?
--Can you hire caregivers privately as well as from an agency?
--Is the home care benefit based on a daily, weekly or monthly maximum, and if the benefit is not used, can it be used in the future?
--Does it cover home care coordination of services?
--How many ADL’s (Activities of Daily Living) does it take to trigger a claim?
--Is there a time limit for filing a claim?
--Does it cover the cost of Adult Day Care & Adult Day Health Care, hospice and respite programs?
--Is it a tax-qualified plan?
--Is the company highly rated and have they ever raised premiums?
--Can you see the company’s published annual audit to check their track record for paying claims?

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