Settlement with the Insurance Company of the Driver Who Hit Me

I reached a settlement with the insurance company of the driver who hit me for all but 5% of the full liability limit on the policy--which is $100,000.  The lawyer gets a third and there is an additional few hundred dollars taken out for fees related to filing against the driver and their insurance company for liability in court.

That may seem like a lot of money, and in fact some of my able bodied friends even commented, "Sounds like it's worth it!"  Trust me, it's not.  If someone proposed paying me far more than that to get hit by a car, lose my job, go through multiple surgeries, do all the paperwork I've had to do, not do the thing I love to do best for a year, go through at least a year of physical therapy, and have to build my strength back up from zero, I would spit in their face.  

This is not a reality show.  I was really injured, and I have had a hell of a lot of pain and suffering.

So then you might wonder why I settled for the limit of the insurance rather than take the driver and Utica to court considering the fact that my case is worth $300,000 at the minimum.  The main reason is that I don't have job security.  I had only started in my new job one week before getting hit, and as predicted going out on Disability immediately afterwards means there really is no way I will be able to return to it.  Let's just say the environment at work was not kind to the freshly disabled, even with a number of board certified surgeons swearing I was unable to perform my job (or even get to it) due to my injuries.  Bottom line: If I took them to court, I would be looking at winning the case probably two or three years later, and even after I won it would be a fat chance that I would ever see money from the driver who hit me.  If I had been in my job for several years, and knew I could return to it at the end of all this, no doubt I would have taken the case to court.  Likewise, if they offered me even $20,000 less I would have taken them to court.

Here's how it went.  The driver was served about two months earlier, and given a deadline to respond.  If she or her insurance carrier did not respond by the deadline then that would mean a decision in my favor automatically.

Like I wrote in an earlier post, Utica had blocked out all the surgical facilities in advance of my second knee surgery.  The strategy there was to not only avoid paying for the surgery, but to not pay the liability.  If I didn't fight the whole way, I could have ended up with only the left knee having been reconstructed, having my right knee and back disabled for life, and getting paid a small fraction of the liability money for pain and suffering that I had coming to me.  Since I did have the surgery, they then had to face the fact that they were in for a large amount, and it would cost them more to fight it than to simply pay up.

First they wanted to try offering me $70,000 but they knew I was a professional who was going to fight so they offered $90,000 which is just $10,000 short of the policy limit.  How do I say no to $90k? I did knowing that my case is worth at least $300k.  They were literally nickel and diming me.  But I also understand the pressure someone in insurance is in to get even a small reduction.  Giving them 10% would be like me paying them a service fee, and I wasn't willing to do that, so I instructed my lawyer, Robert S. Fader (link below), to tell them we needed the whole $100,000.

Utica's response was ridiculous.  Their representative said they were only authorized to offer $90,000 and that simply wasn't true.  If the policy limit is $100,000 then that's what they are authorized to offer you in a settlement.  They talked to their supervisor and came back in less than an hour with $95,000 and I agreed immediately.

Honestly, later on I regretted not going back one more time and telling them we need the entire $100k or we're going to court.  It's only 5% but on the other hand it's $5,000.  I finished off one of my student loans for about $4,300 and paid off about $700 in credit card balances--so there's an example of where I could have used another $5,000 right there.  And it wasn't like I didn't deserve it for my injuries.  Ultimately, if I pushed more, I may have ultimately accepted $95k without regret, but I do regret that I didn't give it that one last little shove.

OK, so like I said, I only saw about $63,000 of that money after paying the lawyer and court fees, and that still seems like quite a lot of money, but it isn't.  Consider what you would do if you won that much money--after taxes--in a lottery.  Sure, you might dream of world travel and a fancy car, but if you were smart like I am, you might catch up on buying some items that you really needed anyway, treating yourself just a little bit, paying off the car you already have, killing off some if not all debt that has been hanging over your head and never seems to go away.  And that's exactly what I did--with money left over of course.

Day 1, I immediately paid off my car loan.  Had I chosen instead to just make the regular payments through the end of the finance term, I would have paid $7,000 more for the car.  I also paid off a couple of student loans, as well as all credit cards.  By doing this--no exaggeration--I just reduced the amount of money I pay out in bills by over $700 per month. That's $8,400 a year that will stay in my pocket without the interest on it going to various financial institutions!  I don't know about you, but to me that's quite a chunk of money.

Basically, anything that has an interest rate on it needs to be paid off right away before you can even think about having any fun.  Just do it.  But also consider this before you settle your case against the driver and their insurance.  After you do whatever you need to do with the money, including paying the lawyer and killing off debts, is the amount that is left worth it to you given what you have had to go through with your injuries and all you have had to do to get it?  

In my case, I have to say the answer is no, but I balanced it against waiting another two or three years to settle this case for the amount of money it would receive in court, and then fighting to collect it.  The benefit is, I'm done and I have the resources to get me through to the next stage of my life, which may include a whole new career (or returning to the old one I liked so much) and relocation for all I know.

The Five Borough Bike Tour Kicks Off Bike Month and the Cycling Season in New York City: What to Do in Case of Accident

When I was hit, I nearly didn't follow my own advice, and I'm really glad that I did.  I suggest that you commit these basics to memory, or even carry a card with these instructions on it for every ride, tour or not.

If You Are Hit or Have an Accident During a Bike Tour:

Call 911 (or have a Ride Marshal call for an ambulance);

Make sure either you or the Police (not a ride marshal or other rider) take down the contact and insurance information of the person who hit you or who you collided with (always carry ID of course);

Get in the ambulance and go to the Emergency Room (keep all papers you receive from police, ambulance, and ER);

See if someone can take your bike for you, and make sure to exchange contact info so you can get it back;

When you get home, contact a lawyer even if you think you don't have a case in the event that it turns out you do (the lawyer will tell you if you have a case or not, and get paid a percentage of whatever is due you--which will be significantly more than it would be without a lawyer);

Contact your insurance company about any damage to or loss of your bike--if it's someone else's fault they will recover the deductible from their insurer.  (Don't let the other person's insurance company determine the damages.  If you don't have insurance, take it to a bicycle shop and have their claims adjuster inspect the bike there along with YOUR bike mechanic).

See an orthopedist one week after your visit to the Emergency Room.  (If it's on No Fault you can go straight to an orthopedist who takes No Fault insurance--so you don't have to use your own;  if it's on your insurance, and it requires a referral from your general practitioner, visit your doctor the very next day and get the referral--but absolutely go see the orthopedist).

Anything that hurts a week after, get an MRI.

Long Term Disability: Approved!

I purchased my own Long Term Disability (LTD) insurance through MetLife back in late September when I started my new job, and I purchased the higher limit which pays me 66.66% of my regular salary starting from six months after I go on Disability.  That first six months was covered by Short Term Disability.

Putting in a claim for LTD was not nearly as easy as it was for Short Term Disability (STD).  With STD, I simply had to have my doctor fill out a form every couple of months, fax it in, and it was approved.  For LTD they needed statements from me, my manager (who definitely was not on my side), and the principle medical provider --for the first part.

After that initial submission they sent me a package asking for more details--a self-description of my condition and ability to perform work and normal daily activities.  And I submitted this along with a pharmacy record, and another statement of attending physician.

Then they contacted every physician who ever treated me over the last several years, to make sure that I never went to any of them about the knee or back conditions I was being treated for prior to me purchasing the LTD insurance.

The good thing for me is that I rarely have been to doctors before being hit by a car on October 2 last year.  My entire pharmacy history was pain relievers, and only doctor visits were for check ups and flu shots.  In other words, I was a mighty specimen of health before getting hit.

Still, of course I was nervous.  I knew my job was kaput, and if I didn't get this LTD money I wouldn't be able to support my wife and myself.  I wouldn't be able to pay for my car or rent.  And I would fall deeply in debt.  I would lose everything because a driver couldn't bother to stop before the crosswalk when she had a red light one day.

So when I received the call the other day, telling me my claim was approved, it was a giant relief.

I've been buying this insurance for years, but now wholeheartedly endorse it adding that if you don't buy Short Term Disability and Long Term Disability insurance that's available to you, you're out of your mind.

Thank you MetLife.

Auto Insurer Preemptively Blocks Surgery

Want to read something outrageous?  The No Fault insurer contacted ALL the surgical facilities in my area in advance to tell them that they would deny any claim for surgery performed on me, saying the surgery is 'not medically necessary.'


Of course I had the surgery anyway.


So what happens next is the claims will be submitted to the no fault insurer, and when they deny the claim it will go into arbitration, and they will have to pay anyway.  All they've done is delay payment, and cost themselves more in fighting it.  This is one of the many unjust reasons your insurance premiums are so high, not entirely because of bad drivers, but because insurance companies and the firms they hire to perform bogus 'independent' exams are allowed to spend great amounts of money to deny and arbitrate claims that they know they are supposed to pay.  They know!  And yet this is standard practice, which is costing you money and injured people in many cases their physical abilities or even livelihoods.


Naturally you ask yourself, why would they bother doing this when they know that the surgery is medically necessary and they will have to pay for it?  The fact is, most of the time when an insurance company throws up obstacle after obstacle in front of an injured person, even though the injured person is right they will give up.  For example, imagine if I, like most people, didn't have my own Disability insurance, I couldn't work, and I wasn't receiving even the inadequate amount of money that the insurer is obligated to pay for lost income (about $2,000/month)--which they haven't paid a dime of yet.  Obviously I could not afford the time off work and therefore the surgery, and eventually I would maybe get a couple of thousand dollars out of them for pain and suffering, but no treatment.  Further, if I didn't have my own property insurance, or know how to use it as I described in an earlier post, I wouldn't even have a bike to ride.  In other words, I would have been disabled for life, and lost the ability to do something which is not only a normal activity for me, but dearly important to me as well.


That's what they do, to thousands, perhaps tens of thousands of people every year, who have been injured.


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OK, so now that we have that out of the way, a bit about this latest surgery and how it went.


The first surgery, on my left knee was done at Surgicare in Manhattan.  The right knee surgery--which was the same surgery--was done at Manhattan Eye Ear and Throat (MEET), also in Manhattan.  Both facilities are excellent, but I can do a little comparing for those of you who might be in the position of choosing one or the other.


Since this was my second time in less than six months having knee surgery, I went prepared.  I brought a book, my iPod with a movie rental download, my glasses, mobile phone fully charged, and various other little comfort items which I was or would have been allowed to use while at Surgicare for the first surgery.  This preparation was almost completely useless at MEET.


I arrived early, at about 5:45am, was done with the paperwork in a flash, then taken to a locker room to change into my surgery clothes.  I was not allowed to take anything with me while I waited for surgery to begin, so the iPod and all  were not worth bringing for pre-op.  However, at Surgicare I had a lot of paperwork to do and quite a long wait compared to MEET where I only had to sign a few things (after reading them of course) and hardly waited at all.  Even if I was allowed to bring my things, I wouldn't have had time to use them.


Honestly, I'm not sure which of the two experiences I liked better.  Both were rather decent; MEET is a bit fancier of a hospital, but who really cares when you're not even awake most of the time.  MEET has tiny TVs with streaming news, but without being allowed to bring my glasses to the waiting area I couldn't see them and the volume wasn't high enough to hear anyway.  At Surgicare, I had a good amount of time before and after to mentally even out, lots of people came to talk to me, and though I had to fill out a lot of paper work it really wasn't bad at all.  For the surgeons, I'm sure MEET is better, but for the patient it's a toss up.


By this time, my surgeons knew me, so when they came over to talk before the surgery it was more like were shooting the breeze.  They said they never saw anyone with such huge, muscular legs as me.  I told them it was really due to cycling all my life.  I told them I had done a fresh cycling leg shave a couple of days before, so one less thing to do, and that I would be taking my new knees up Mount Fuji next year--which I genuinely plan to do.


OK, so all rather boring, and that's what I really want you to know.  There is nothing to be scared of or nervous about.  By the time you're getting prepped for surgery, you've been checked in every possible way to make sure you actually need the surgery and that you're healthy enough for it.  All you have to do is relax.  Your big job is going to be physical rehabilitation afterwards.


The anesthesiologist came, put a tube in my arm and the next thing I remember I was sitting up in the recovery room being asked if I wanted coffee or juice.


Then they asked me if I had any pain.  I said I had a little so they gave me a Percocet.  This was a mistake.  A little while later I threw up.  I had an empty stomach--hadn't eaten in over fourteen hours--so what was this yellowish stuff I asked.  It was bile--which according to Wikipedia is "(ater (85%), bile salts (10%), mucus and pigments (3%), fats (1%), inorganic salts (0.7%) and cholesterin (0.3%)) which is produced by the liver."  That "ater" part is basically cholesterol as I understand it.


My brother arrived around 1:30pm--a little later than the planned 1pm.  At Surgicare they told us 1pm, that's when they woke me up, and my brother was sitting right next to me.  At MEET they woke me up right after surgery at about 11:30am, and the expectation was that I had some poor soul waiting in the lobby since before dawn--so Surgicare wins on that point.  MEET is a lot busier facility.


We went out front, flagged down a taxi, rode it home, deposited me on the sofa, chatted awhile before sending my brother off to the one pharmacy in my area that takes No Fault for prescriptions without me having to wait for them to get paid first, he came back, I gave him a bottle of Michael Collins whiskey--from the last independent whiskey maker in Ireland by the way--as a thank you, and he went home.


For the rest of the day, I attempted to eat and threw up absolutely anything that went down my throat, except for some homemade bread my landlord had made for my wife and me, with a bit of Smucker's Natural Peanut Butter.  The next day I asked the doctor if it would be OK to take Pepto Bismol along with my medicine and he said OK--so long as it wasn't anything with other medicine in it.  The Pepto Bismol saved me from throwing up after taking Percocet from then on.


And that's my story for now.

Long Term Disability Application, Getting Ready for the Second Knee Surgery, and How I'm Doing in General

My next surgery, on the right knee, is scheduled for April 18, 2011.  I received a letter from the No Fault insurer requiring that I appear for an IME (Independent Medical Exam) to re-examine my condition on April 20.  Insert your own punch line here.

Financially I'm basically not bad off, but nervous of course because my Short Term Disability coverage will end on June 3 and I am currently submitting a claim for my Long Term Disability coverage through MetLife for any period thereafter that I continue to be disabled.

Submitting a claim for Short Term Disability and getting it extended is fairly easy.  So long as I am genuinely disabled my attending physician / surgeon will certify it and that's about all there is to it.

With my Long Term Disability there is a lot of work to do, but it hasn't been too bad so far.  MetLife sent me an initial package which consisted of a Personal Statement, a Physician's Statement, and a job profile from my manager at work.  Then they do a phone interview.  At this point it's been verified that I am injured and what my basic losses are in terms of income.

Then another package arrives, and this is where the real work begins.  There is another personal profile basically asking the insured to describe their own disability and limitations.  I am also required to show my work history for the past fifteen years and to apply for Social Security Disability.  If I am turned down for Social Security Disability, I am required to appeal.  Any money received from Social Security Disability, the insurance of the driver who hit me, or any other source providing for lost income will reduce the amount I receive from MetLife--so that my total compensation during my period of disability does not exceed my insured loss (which is 66.66% of my salary).  Additionally, I must provide a pharmacy record to basically prove that my disability is not the result of a pre-existing condition.  This process is meant to both confirm any income I may be receiving, and verify that my disability is the result of the particular incident which I claim caused it.

This is an important point about insurance in general.  The sole purpose of insurance is to return the insured to the state or condition they were in prior to the loss.  My bicycle for instance, which I discussed in an earlier post, had a loss paid equal to the cost of replacing the bicycle with a current, similar model--less depreciation of my old bicycle (which I object to, but them's the breaks); insurance doesn't pay for you to be in significantly better circumstances or with a superior replacement for your losses. Of course, being compensated for losses isn't necessarily a matter of money either.  An insurance company may choose to repair or replace something that is damaged rather than write a check.  The bottom line is, the compensation provided by an insurer for a loss should never be expected to exceed the value of the loss.

Having a loss is never like hitting the jackpot.  Your goal in dealing with the insurance after an accident is to be compensated for your losses as well as for any personal injury--such as pain and suffering or a significant change in circumstances such as the loss of ability to live, work, and even love as you would have had the accident never happened.

IME (Independent Medical Examiner / Examination) : 'Independent' from the Truth That Is!

As noted in an earlier post, the IME visit is required by the insurance company that is paying for your medical care.  If you fail to appear at the IME appointment they will refuse to pay your claim, but that only seems slightly better than what happens after you do show up.


I just received a Denial of Claim letter from Utica Insurance in the mail including the IME's detailed report with the "D&D Associates" fax tag at the top of each page--a quak doctor, the lawyer who hired the doctor, and the auto insurance carrier doing it's best to keep its hands clean while committing insurance fraud. There are several inaccuracies in the report; to name a few:

• ACCIDENT HISTORY:  It states that I said the ER x-ray revealed displacement.  I actually said--in writing--there was no displacement or broken bone.  I was specific about this because my injury is not to the bone structure and only the latter MRI could have shown the ACL tear and other damage.  I also wondered at the time of the IME why I--a non-expert in medicine of any kind--was being asked for diagnosis.  I have a degree from Harvard in Social Sciences, not medicine.
• EMPLOYMENT HISTORY: It says I state that I do not perform household chores, shopping, heavy lifting, kneeling, or carrying bags.  I currently can't perform these normal, every day actions, but normally I perform all of these functions--particularly because my wife has Rheumatoid Arthritis.  As respects kneeling, not only are we a Japanese household, but we are Buddhist, so kneeling is something I normally do on a daily basis, but obviously can't (been practicing Buddhism in a chair lately, and outstretched on the sofa before that).  We need a copy of the document I filled out at the IME's office to verify the context of the question and how I answered it--particularly because I wrote all over it.
• ORTHOPEDIC EXAMINATION: Lumbar--I told the IME I have constant pain in this area which makes it impossible to sit in a chair for long periods of time--like at work for example.  I recently had an MRI of this area to determine if I need surgery or some other kind of treatment as a result of being twisted when the car hit me.  It hurts as much right now as it did the week after I was hit.
• SUBMITTED RECORDS (Page 3): He notes the narrative report of the foot and ankle specialist but none of the other orthopedists who examined my knees.  Basically, they've chosen to review all medical information irrelevant to what I am being treated for and ignored the rest. 

This IME performed examinations on an assembly line.  His whole business seemed to be examinations like mine where the aim was to deny claims. 

At one point in the exam he said, "So the right knee isn't so bad." And I replied, "Not so bad?!  The MRI revealed a torn ACL and the surgeon says I need to have the same reconstructive surgery I just had on the left knee!"  But no note of this.  In fact, it seems my right knee is injured worse than my left knee was, but because the left knee was hit directly by the car it was in greater pain.

OK, so here's the game.  Do you stop going to treatment because you received this Denial of Claim Letter?  The answer is no.

Before this next part, please note the following Disclaimer:

EVERY CASE IS DIFFERENT AND EVERY JURISDICTION IS DIFFERENT.  THIS EXPLANATION IS NOT MEANT TO BE LEGAL ADVICE AND READERS ARE ADVISED TO SPEAK TO A LAWYER ABOUT THEIR OWN SITUATION.

OK, got it?  Good.  So here is the basic explanation why you shouldn't immediately go back to work untreated and injured for life (between the dotted lines):

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When you go to see a doctor after an accident involving a motor vehicle, the doctor asks you to sign a form called an "Assignment of Benefits".  This form allows the health care provider to bill the no fault carrier directly and to get paid directly.  It also assigns to the health care provider all the "rights and responsibilities" relating to the bill.  So, basically, the doctor assumes all of your rights to fight the insurance company to get paid.  This is very important because it means that once a doctor submits a bill to the no fault carrier, it is the doctor's sole responsibility to fight a denial.  The assignment further insulates you because, unless the denial is based upon something that you did wrong, such as failing to appear for an IME, or failing to give the doctor the no fault carrier's information within 45 days, the doctor is legally barred from trying to collect the bills from you. (You might want to confirm that you did sign an assignment for your surgeon).  The theory behind this is that the doctor is the best one to make a determination as to whether or not a particular treatment is related to the accident and once he has made that determination he should be willing to stand behind it.  

Now, many doctors do not realize that they cannot come after the patient for any denied bills but many do realize that and most busy medical practices employ lawyers who only do fault arbitrations. 

There is one thing to remember, however, about no fault arbitration:  If a doctor arbitrates or litigates a no fault denial and loses,  you would be barred from claiming that the treatment which was the subject of those bills was part of your case because a judge or a jury alread said it wasn't.  As a practical matter, though, it's not much of a problem because most of the arbitrations settle, most of the ones that don't settle are won by the doctors and, your case will likely be over before the arbitration is done.

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I will add my bit as an Insurance Guy that this really isn't dissimilar from what I said about Subrogation.  It means that you have waived your right to pursue compensation for your losses and given that right to someone else--a lawyer, doctor, or insurance company for instance.  Your monetary losses are therefore no longer your own, they belong to someone else.  The obligation you have to that other party is to assist in any way possible in their recovery of those losses and--very important--not to admit liability by saying things like "Oh wow, I'm sorry, it was at least partly my fault."

NEWS Flash: Sudden Lack of Physical Activity Can Make You Fat!

When I first came out of surgery and was taking strong pain killers every day I did lose some weight because I lost my appetite and nearly felt like throwing up all the time, and then there was the new sport of getting around on crutches.  But soon after, with all the laying around an inability to even ride a bike on a trainer for the first couple of months I gained no less than 5 kilograms (1 kg = 2.2 lbs) at a rate of about one kilogram per week.

What could I do about it?  I couldn't very well hop on the bike and burn it off, so I had to cut back on my calorie intake.  I even considered outright starving myself until I was down to my preferred weight.

It turns out this is not as tough as it seems.  The amount I would normally eat is based on my normal level of physical activity.  Since I was barely physically active at all, I simply didn't feel the need to eat as much.  In other words, I could eat the same foods, just less of them.  Where I would normally have two sandwiches, I've been having one.

But this is also an opportunity not to be missed.  I've been trying to lose some weight I gained after moving back to the States from Japan for the last several years but just couldn't do it.  Now I can not only cut down on the food I normally eat, but really improve my food choices here in the States (in Japan I never had to worry about it--it's all good).

It's still kind of upsetting to see my presently bloated body in the mirror, but I also see that I'm trimming down and will soon be at least back to normal.

Seven Weeks After ACL Replacement Knee Surgery: Waiting For Spring

It has now been exactly seven weeks after the first surgery and I have switched from using crutches to a trekking pole instead of a cane.  The goal is to walk as normally as possible.  At this point I just need that wee bit of support from the pole, and will likely continue to need it for the next several months.  In the past week I'm getting to the point where I can hobble along without great pain, though still a lot of discomfort.

Just today, for the first time, I was able to pedal full rotations on the stationary bike.  I was told to do only ten minutes, slowly, but out of sheer joy I kept a seven mile per hour pace for fifteen minutes.  That doesn't sound the least bit impressive, but to me it was glorious.

It's not like living through Winter and waiting for Spring, where it might be cold and dark longer than expected and then one day it's warm and sunny and the trees are suddenly turning green.  Recovery is slow and steady.  You can't wish it into going more quickly, nor should you try.

You have to learn to be patient--not determined, motivated, and inspired, just patient.  Do only what your physical therapist tells you to do, nothing more, no additional exercises you thought up yourself.  If the physical therapist tells you to raise your foot three inches, twenty times, don't raise it three feet fifty times just because you can.  At the same time, don't take it too easy because you wont simply heal up.  Without the physical therapy, you could heal up in a way that disables you somewhat for the rest of your life--tear a ligament that was just repaired or remain too tight for comfort.

I am also looking forward to my next surgery.  I'm preparing for it.  Things I didn't have before but wish I did I'm getting delivered--like a laptop desk for instance.  I may even buy a recliner.

Learning How To Walk And Pedal A Bike Again; Be A Good Patient By Being Patient

I had the first knee surgery on December 6.  Now it's January 10.

I can stand and hobble, and I thought I could walk short distances without crutches, but apparently not according to my physical therapist.

She insists that I use the crutches because it's no good for me to be walking with a limp.

So now I practice walking, with crutches, perfectly.  Even at home, I am required to use the crutches.

Patience is very important when you're recovering.  When the therapist says kick only so high, even if you can do far more and better, you need to only do what they tell you to.  If you're able to do something which exceeds what the therapist has you doing, don't do it--it's a mistake.  Be a good patient by being patient.

On the positive side, I was allowed to get on the stationary bike for the very first time today.  As a cyclist, this is what I was really looking forward to.  I'm not able to make a full rotation of the crank yet, just back and forth, but having my feet on pedals again for the first time since I was hit on October 2 sure feels good.

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Disability: Top Of The List of Biggest Worries; How I Get Paid While Out Of Work

I've been talking to a lot of people who have been hit by cars and haven't met one--besides myself--who didn't fail to get the treatment they required and deserved.  One girl who works in the shop where I bought the money order so I could get a copy of the accident report from the police station told me she received only $2,000 and no treatment, and that hasn't been able to do the aerobics she loved to do so much before being hit in the years since.  She says she gained weight and now has no way to shed those pounds--and she is only about twenty years old.

Injured people usually miss out on treatment and benefits because they don't realize the need to take charge of the situation, to get an MRI on anything that's constantly painful and discuss it with a surgeon, or check with their Human Resources department to see if they're eligible for Disability benefits which are most likely part of their compensation package.  They're worried about losing their jobs or that they'll have to fight to get paid and in the meantime lose everything--their job, their home, everything.

I can tell you that in my case, until I asked to get an MRI I wasn't told I needed one; and once I had the MRI I was told I needed surgery--then another MRI and another surgery, and I will have yet another MRI later on and likely another surgery.  The moral is, you wont get anything that you don't ask for.

At the company where I am employed, they automatically include Short Term Disability insurance in every employee's benefits package--covered from day one.  It pays up to 26 weeks, job protected, paid benefits.  For the first 13 weeks they pay 100% of regular salary and thereafter 66.66%.  If I had been with the company more than five years, it would pay 100% the entire 26 weeks (six months).

Additionally, employees have the option to purchase Long Term Disability at 50% of salary for cheap or 66.66% for about $19 a month.

I always buy the max--which I've never needed until now--because I'm a very active guy who enjoys cycling, hiking, and general outdoor head cracking activities.  But even if I wasn't so adventurous, I'd say it's a good idea to purchase this additional insurance.  I was hit in a crosswalk for instance, not during some glorious downhill, high speed adventure.  I was moving maybe 3 mpg.  This could have happened to anybody.  Even if I slipped and fell in the shower, and required Disability benefits, I would be paid.

If you don't have Disability coverage, you have to pursue payment from the driver's insurance carrier, and as I wrote in an earlier post their whole goal is not to pay or to pay as little as possible.

So far I haven't had any lost income because of the coverage I have, but after 13 weeks the amount of money I receive from my employer will be reduced by a third, which in my case is a rather large sum of money.  I would be stupid not to pursue payment from the driver's insurance for that lost income.

So in Week 5 I was required by the driver's insurance to see their doctor to determine just how disabled I am.  I went yesterday.

It was obvious that this is the bulk of this particular orthopedic surgeon's business.  People were packed in the waiting room to see the surgeon for five minutes.

I filled out a form which asked all too simple questions.  I advised everyone around me, "If these forms do not ask you for information you feel should be included, then write that information on the form.  And don't be the least bit shy about whining about how you feel, about every little ache and pain."

The insurer's doctor's entire goal is to make it seem like you're not really injured at all, that you will heal up just fine.  There will likely be another person in the room who will record everything you say--so complain, complain, complain!

In my case, I complained about both knees and my right ankle, as well as my back, my hip, my shoulder--anything that ever ached after being hit.  The doctor asked me to stand up, move side to side, raise my arms, reach for my toes, et cetera. 

Near the end he said, "So the right knee isn't so bad."  I wasn't going to let him get away with that!  I immediately said, "The MRI revealed a torn ACL and other damage that requires surgery.  I'd say any damage that requires surgery is very bad.  Just because I can dance around for five minutes after sitting on my butt for a month doesn't mean I can resume normal activities."  And sure enough, I saw the other person in the room writing down everything I just said.

Besides all that of course, I have my own surgeon, and MRIs, and physical therapists who can all attest to the fact that I require more surgery.  So the insurance company can try, but they can't win.

One final bit of good news: I was just approved for an extension of the Short Term Disability benfits I receive from work, to the end of February.  The doctor certified that I need to be out until July, but the benefits folks will only approve short intervals at a time.  In any case, I can relax and recover until at least March at 100% of my normal salary.

How To Prepare Yourself For Having Knee Surgery

You will no doubt receive instructions prior to surgery which include that you can't eat or drink after midnight the day before, but I have a few things to add.

Stock up on Wet Wipes or similar (something antimicrobial) because you won't be able to shower or bath for several days, perhaps even a week, after surgery.  Guys will think this is easy because we go camping for weeks at a time without showering, but trust me this is completely different.  Combat soldiers take wet wipes into the field for when they're stuck in a hole for weeks at a time.  (By the way, they're also a really handy thing to bring on your bike rides--especially on tours where you need to use public restrooms and port-o-potties.  Just bring a travel size pack and stick it in your jersey pocket or pack).

Get a haircut immediately before.  Women I imagine need to add to this list of pre-surgical grooming. You'll be glad you did it.

Load up the fridge and pantry before surgery.  Only my idiomatic experience, but I found that the medicine I was taking (Endocet which contains oxyconton of Rush Limbaugh fame, made from opium) after surgery made everything taste pretty dull, so I wanted strong tasting foods--extra strong coffee, spicy food, pickles, cheese.  Make sure you have Tabasco and mustard.  Next surgery, I'm getting Indian food for sure.

If you don't have a particular chair--like a sofa or recliner--which you can literally be on, with your leg raised, all day, every day, for a week or two, and you can afford it, then this is the time to buy it.  Whenever you're not doing physical therapy, you're going to be in that seat, watching TV, drugged up, falling asleep, eating, et cetera.  You might even sleep there as it may be more confortable than your bed, or you might not even be able to get to your bed in the beginning.

Bring something to entertain yourself while you wait for surgery, such as a book, an iPod with a movie download in it, or a laptop and a DVD.  It could be several boring hours before you're actually heading into surgery.  Don't count on having good wifi or cellular data service; try to have the media in hand.

Wear or bring a big pair of pants--such as sweatpants or warmup pants.  Most likely the dressing and brace will be too big for you to get anything else on.  Even if you brought shorts, you would have to get them on over the dressing and brace first.  I had a dressing, a brace, and refrigerated thingamajigg that keeps my knee cold.  My Carhartts wouldn't fit over it all, so I was glad I brought some semi-stretchy pajama pants as well because otherwise I would have been going home bottomless or in some kind of skirt.

Pig Out the day before: Let me clarify, as I did with a friend who is an anethesiologist: When they say you can't eat or drink anything after midnight the day before, they mean the night before.  They do not mean you have to go an entire day without eating or drinking anything.  So for most people this should be as easy as skipping breakfast.  You will not piss and crap like a dead person on the operating table.  I went to an all-you-can-eat Sunday brunch buffet the day before just after speaking to my doctor friend, and I think I redefined all-you-can-eat.  I also ate normal meals the day before, and snacked on crackers and peanut butter just before midnight.

I was allowed to make phone calls on my cell phone, but out of respect to the other patients I would recommend you don't.

Don't worry about anything.  Trust your surgeon and the nurses.  They know what they're doing--and you don't.  Relax.  Whatever your problems in life are, there's nothing you can do about them right then.  On the other hand, if whining about your problems gives you some kind of relief, go right ahead--just don't transfer your worries to the other patients.

Have someone pick you up afterwards.  I actually think they wouldn't release me if I didn't have my brother come to take me home.  But do your friends and family a favor by not having them come with you before the surgery and waiting for you the whole time.  You're going to be unconscious pretty much the entire time, and when you're not they wont be allowed in the room with you anyway.  Having them waiting is just some sentimental silliness.  It's surgery, not your funeral.

After surgery, that same person who picked you up will need to go get your medicine from the drug store--which you're going to need desperately within the next few hours.  In my case, it had to be a drug store which accepted No Fault insurance, and it was some distance away.  You might want to have a nice thank you gift at the ready for this person.  In my case, I gave my brother a bottle of Hitachino Nest White Ale, which is the best beer in the world in my opinion.

If you don't have someone who is going to be home with you 24/7 after the surgery, think about various services you might need--like having your laundry picked up washed and returned to you, having your groceries delivered, or ideally have all your meals prepared and delivered to you.  Figure you're not going to be able to do anything yourself for at least the first week, and appreciate it when you can.

Overall, it's like preparing for a sporting event--like a bike tour.  You prepare everything you're going to need ahead of time, on the morning of the big event you just arrive and relax until the start, and then you pace yourself through it.  You don't head in unprepared, or psych yourself up for an hour before the event begins only to crash and burn later.  Being a patient is an endurance event.

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It Pays To Be An Insurance Expert: Bicycle Replacement and 'Subrogation'

Six years ago I started a career in Insurance working on large accounts--oil refineries, national governments and their departments of defense.  Though I am an expert on Property and Liability Insurance, I really didn't know anything or had any experience with what we call Personal Lines: car, home, health, life, worker's comp., et cetera.

Until I went to the orthopedist over a week later, after hobbling around work on crutches, the driver's insurance didn't know who I was, but immediately contacted me after that.

As I wrote earlier, I didn't think I was seriously injured.  I just wanted them to pay for my medical care, replace my bicycle, and maybe give me a few thousand dollars for 'pain and suffering.'

Given what I do for a living, I confidently called up the claims adjuster and did a recorded interview.  I was brilliant at this, but I wouldn't recommend anyone do it--in fact, I wouldn't do it again.  The claims adjuster asked me very specific questions meant to throw me off.  She asked how many lanes the crosswalk spanned, how many I crossed before I was hit, what color the car that hit me was, what I was wearing--even asking leading questions like "Were you wearing long pants?" so she could claim I lost control of the bike on my own and simply fell in front of the car.  I didn't give her an inch to stand on.  Still, it was a stupid thing to do.

You have to understand, an insurance company is not your friend--even if you're the insured, even if they seem not too bright, or if they come across as genuinely concerned about your welfare.  Their entire goal is to never have to pay a claim, and if they're going to pay anything at all it's going to be to their paying customer who has been sending them premium for years.  Don't agree with anything, don't sign anything, don't accept any quick offers of compensation.  In other words, I did a very stupid thing by speaking with that claims adjuster, which could have turned out very badly for me.  And this was just the Liability adjuster.  They had one claims representative for each: Liability, Property, Medical, and Auto Physical Damage.  The ones that really pissed me off though were the Property and Auto PD adjusters, and here's why.

The Property claims specialist was insisting that the Auto PD adjuster visit my home and look at the bike to see what the level of damage was.  Again, I do insurance for a living, so I said 'absolutely not.'  My argument was that an over one ton vehicle struck an 18 pound bicycle, which has no protective body around it (except the rider of course).  It's a given that the bike is unsafe to ride and should be replaced.  They weren't going to x-ray it for fractures or check to make sure the frame was still straight--literally just a visual inspection by someone who is not any kind of bicycle expert.  I did invite the adjuster to ride the bike down a mountainside at 50 miles per hour if he felt confident that his visual inspection deemed the bike safe to ride, that it wouldn't simply fall apart beneath him when he hit a bump at high speed, while I followed right behind him in an SUV, but he didn't take me up on it.

So I called State Farm, which is my insurance carrier for Renter's Insurance to ask if the loss of the bicycle was covered, and sure enough it was.  I told State Farm the make, model, year; when I bought it; what the equivilant current model would be that could serve as a replacement and its Manufacturer Suggested Retail Price.  I did not inflate the numbers.  I even provided the specifications of the bicycle that was destroyed and the one I deemed its replacement.

Most importantly, I didn't tell either the driver's insurance company (which asked) or State Farm (which didn't ask) how much I paid for the bike.  How much I paid doesn't matter.  I got a good deal, but let's say for example that it was a gift--would that mean that my loss was $0 ?  Of course not.  I was not going to pay to get hit by a car and have my property destroyed.

State Farm adjusted for depreciation and altogether calculated the loss of my two year old bicycle at just short of $2,000--which is a bit more than I paid for the bike and upgrades I mentioned to them, but only just a bit.  Less the $500 deductible, I received a check for about $1,500.

The way insurance works is my $2,000 loss was then State Farm's $1,500 loss, and they wanted their money back.  Also, I was given the amount of my loss less $500, so I wanted my money back too.  This is where Subrogation comes in.

What Subrogation means is my insurance company has just bought me a new bike and therefore the right to collect from the driver's insurance for that loss is now theirs instead of mine--I can't collect twice for the same loss--not like in the movies where someone's $100,000 house blows up and they get a million because they overinsured (that's just a myth).  The duty of the Insured is to provide any requested evidence for them to recover their loss.

So I went out to the crosswalk where I was hit one week later, at the same time of day, to take pictures and video.  Sure enough, not only did I clearly show the scene, but I easily found several drivers who stopped in or after the crosswalk in the exact same spot I was hit.  Some of the pictures are actually hillarious, but for privacy reasons I will not share them here.

I sent the pictures as well as a satellite image of the location and a detailed description of what happened to State Farm, and in a very short time I received a check for my $500 deductible as well.  Had I not done the work, we wouldn't have seen that money for months, if ever.

If you're thinking why didn't I get my insurer to pay me for the liability portion as well and have them subrogate against the driver's insurance for that, the fact is they simply can't do that.  In Property insurance, it's easy to adjust a claim because there are definite dollar amounts attached to property and repairs, but liability awards to injured parties are indefinite; they could be simply the amount of lost wages, or double the amount of the medical costs for pain and suffering; or they could be enough for you to retire comfortably, buy a house and a car, pay off your student loans, and take a trip to Europe. 

If you want more than the monetary equivilant of a light apology, and particularly if you are really injured, you need a lawyer.  Don't worry about paying for it, as most (perhaps all) lawyers will take your case on a contingency fee basis.  In New York the lawyer gets one third of any money awarded you by law, no more / no less.  And if you think that's a lot, consider the fact that without a lawyer you may only receive a few thousand dollars--if anything--whereas with a lawyer you will likely get at least whatever the Liability limit is on the driver's insurance.  In New York state, the statutory liability limit is $25,000 but many drivers purchase excess limits of $100,000 or $300,000 because it protects them against your lawyer going after their personal assets to make up the difference between their coverage and what a judge has awarded you in court--which, again, could be any amount whatsoever.

This Is Gonna Hurt: My One And Only Collision and the 'Blame It On The Sun' Defense

On October 2, 2010 I headed out on one of my regular rides, which usually last two hours and 30 miles.  I started out from where I live in Astoria, NY and was planning to ride to a favorite bike shop in Great Neck, NY then ride home as I've done literally hundreds of times.

Just a mile or two after starting out, at 4:15pm, in the crosswalk over the service road leading from the Grand Central Parkway up to Astoria Boulevard at 78th Street, after waiting for the light, I crossed two lanes out of three before a car hit me from the left side.

My first reaction was to get up and get out of the street, but when I stood up I felt a strong pain and looked down to see that my left knee was badly bruised, and also saw that my bicycle wheels had twisted and snapped.  So I went from reprimanding the driver to immediately sitting down on the street in front of the car which had just backed off me--behind the line that she should have stopped at apparently in an effort to make it look like it wasn't her fault.  I was determined that this driver wasn't going anywhere until the police arrived.

I called 911.  A witness came over and talked me through the shock--can't thank him enough.  The police came along with an FDNY ambulance.  I told the officer that I had the light and was hit in the crosswalk.  I verified this three or four times.  When the light turned to the walk signal I said, "Just like this.  I was crossing, with the light in my favor as it is now, and the car hit me right here in the crosswalk where I'm sitting."

I was so shaken up that I actually had to call my wife and ask her to verify our home address where we have lived for the past four years, completely forgetting that I ALWAYS carry my Driver's License and health insurance cards on every ride for this specific reason.  All I had to do was hand him my ID, but I was in a kind of stupid shock.

Once I was in the ambulance, I was asked if I have a lock for my bike and nearly didn't go to the hospital for fear of losing the bike.  I told the police officer that I even if I had a lock, my road bike (a Trek Discovery bike) would be gone in five minutes if we left it there.  The police officer--from the 114th Precinct in Queens--volunteered to bring my bike to my home where my wife was waiting, to just leave it behind the house.  In reality, he actually went to the front door and told my wife, who was worried sick, "He's OK."

The police took down the driver's insurance information and statement and assured me that I didn't have to worry about it--and indeed I didn't. 

The driver's story was that she could not see the traffic light because of the glare from the Sun.  I joked, "But she could feel the accelerator."  Obviously nobody bought the 'Blame It On The Sun' defense.

I was taken to the Emergency Room at Elmhurst Hospital, where they x-rayed my knee, said it appeared 'normal' and released me with a pair of crutches.  In my mind, I thought I would recover in a few months and was only concerned about having my bicycle replaced.

I had no idea that this event was about to cause me to possibly lose my job for lack of ability to perform, have multiple surgeries--rebuilding both knees and my ankle--and go through all sorts of red tape to make sure I was compensated at all.