Friday, April 29, 2011

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.

Tuesday, April 5, 2011

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.