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Just The Aunt
Supporter
Username: Auntof13
Post Number: 3631
Registered: 1-2004
| | Posted on Monday, January 16, 2006 - 6:36 am: |     |
This made me mad enough I've decided to never shop in Walmart again!!! I just had to share it. What are your feelings?
ARE YOU SURE YOU'RE INSURED?
by Randy Cassingham www.StellaAwards.com
Do you have health insurance? Are you sure they're really insuring you from a huge loss? Maybe, maybe not.
After a collision between her minivan and a tractor-trailer five years
ago, Debbie Shank now spends her days in a wheelchair in a nursing home,
able to move only one arm and two fingers. Brain damage and memory loss
has drained most meaningful content from her conversations with her
husband of 30 years.
"She'll ask about the boys, she'll ask about the cat," says Jim Shank.
"Whenever I'm there, she thinks it must be a mealtime. We don't really
hold a conversation."
Her 17-year-old son is in the Army, which she knows, but he's
scheduled for deployment to Iraq next year, which she doesn't know. She
also doesn't know that there is a war in Iraq.
To help compensate for the terrible injuries she received in the
accident, Shank and her husband sued G.E.M. Trucking and James David
Shivers, the driver who hit her, in U.S. District Court in 2000.
According to that lawsuit, Shank suffered damage to her brain stem and
other injuries, and was in a coma after Shivers' tractor-trailer struck
her near Cape Girardeau, Mo.
The lawsuit was settled for $900,000; after attorneys' fees and other
costs, Shank's share was less than half -- just $417,477. The court set
up an irrevocable trust for the money so it could only be used to pay for
her long term care, and the money was sent directly there. Her husband
received just over $119,000, presumably for his loss of consortium.
Before the accident, Shank had worked the night shift stocking shelves
at a Missouri Wal-Mart so she could spend her days with her sons so she
could be a "better mother". "It's all she ever wanted to be," her husband
says. Luckily, she had gotten health insurance through her employer. It
paid for her huge medical bills after the accident.
But because she later got a settlement from her lawsuit, Wal-Mart's
health plan administrators demanded she repay the money her health
insurance paid toward her care. To press the case, the retail giant's
health plan is suing the Shanks in U.S. District Court in St. Louis. The
lawsuit, filed by the Administrative Committee of the Wal-Mart Stores
Inc. Associates' Health and Welfare Plan, claims that her total medical
expenses exceed $469,216, and it demands that amount in return. Plus
court costs to get it. Plus interest.
But wait; while Shank's settlement was $900,000, she only actually got
$417,477. Shouldn't that be the limit? No, the company says: it wants all
$469,216, as spelled out in its policy. So if the company wins, the
amount in Shank's trust will not be enough; the family could conceivably
have to come up with nearly $52,000 more than what they won in court.
Jim Shank had anticipated and feared just such an outcome. He received
a letter two weeks after the accident that, he recalls, said the
insurance would not cover his wife's care unless he signed over their
right to lawsuit proceeds. Not surprisingly, he signed it so his wife
could get the care she desperately needed to survive.
Lawyers familiar with this type of suit says it's not really uncommon.
In fact, according to the insurer's lawsuit, the terms are explicit in
Wal-Mart's health plan, which is to be reimbursed first from lawsuit
proceeds up to 100 percent of the medical costs.
According to the lawsuit, the health plan also places the burden of
attorney's fees and court costs on the employee. So the health plan also
wants the Shanks to pay for the costs the health plan is incurring to sue
them.
Maurice Graham, one of the lawyers for Debbie Shank, says only part of
the money she received was used to pay medical bills. Since the
settlement money was placed in a trust created by the federal court, he
says, it never came into the couple's hands and is supposed to be used
only for her ongoing support.
Marty Hires, a spokesman for Wal-Mart, says filing the lawsuit was
just a way for the company to preserve its legal options and that the
health plan has not decided whether to pursue the case.
Regardless, the lawsuit left Shank's lawyer, Graham, incredulous. "I
can't believe that they've done this," he said. "The cost to care for her
in the future is going to be literally millions. She is confined to a
nursing home, has a normal life expectancy, and requires full-time care."
If the insurance company does pursue the case and succeeds, Debbie
Shank's already dire circumstances likely would turn even more bleak. Jim
Shank says she'd probably lose her caretaker and the wheelchair-
accessible van they bought for her. Wal-Mart spokesman Marty Hires said
the company isn't sure whether it will actually pursue the lawsuit now
that it's been filed; it was filed before the statute of limitations
expired to "preserve our options," he said. "This is kind of a standard
procedure." He refused further comment, citing federal health privacy
laws.
How comforting that must be for Jim Shank to know Wal-Mart is only
"preserving its options." He also fears the prediction made years earlier
by a lawyer who specializes in elder care might come true: that if the
money runs out, Shank might have to divorce his wife so that she can
become eligible for Medicaid.
Lawyers familiar with insurance law say such measures are not unusual
for health plans that, like Wal-Mart's, are self-financed -- that is,
funded by employers and/or employee unions -- to recoup medical expenses.
"Wal-Mart has certainly been one of the more aggressive and assertive in
doing this," says Sheldon Weinhaus, a St. Louis lawyer. In his opinion,
courts are starting to "recognize the unfairness of this, and they're
looking for reasons to stop Wal-Mart and others from doing this."
On the other side of the coin is attorney Jim Singer, who has faced
Weinhaus in court over such issues. He says such lawsuits helps employers
from having to cut benefits or ask workers to contribute more. "You need
to put the money back in the trust so it will be available for other
people," he said. But that generally only works for self-financed
insurers; in most cases state law prohibits regular insurance companies
from attacking such settlements.
But don't make your mind up yet: this is far from a cut and dried
issue. The question becomes, was Mrs. Shank's lawsuit settlement in
compensation for her past medical bills, or for her future care? It's an
important question, since if it was for her medical bills, she shouldn't
be able to collect twice -- first from the insurance company, and again
from the lawsuit -- for that loss. And if that's the case, Wal-Mart's
health insurance subsidiary is well within its rights to recover after it
paid out for its client, even when a third party was apparently at fault
for her injuries.
Yet it was the court that set up her trust fund -- in an irrevocable
trust at that -- for her long-term care. That is a strong indication that
the settlement money was for future, not past, expenses. And if so, the
insurance company simply needs to swallow its losses, just like regular
insurance companies would have to do.
The issue of long-term care for critically injured people -- insured
or not -- is a big one that needs to be worked on. Meanwhile, insurance
companies suing their clients who paid their premiums in good faith to
protect themselves and their families from catastrophic losses is not a
reasonable solution to the problem, nor is making someone sign away their
rights when they're in the most stressful situations possible.
So if you think you're covered, you might want to think again. And
think about pulling out your policy and actually reading the fine print
to see if you've agreed to let them sue YOU after a catastrophic loss.
SOURCE:
1) "Insurer Wants Woman's Crash Settlement", St. Louis Post-Dispatch, 15
August 2005
Note: This article is no longer online at the newspaper's web site,
but several other sites seem to have copies, including
http://www.wakeupwalmart.com/news/20050816-spd.html
|
greenetree
Supporter
Username: Greenetree
Post Number: 6558
Registered: 5-2001
| | Posted on Monday, January 16, 2006 - 7:50 am: | |
Not surprising from a company known for its heinous treatment of employees. They've been clever enough to write some aspect of physical work into every job description so that they don't have to hire overweight people who are more prone to health issues.
Now, no company wants to pay high costs for illness-prone employees. That's why so many huge corporations the size of Walmart have Employee Health programs, designed to help employees lose weight, quit smoking, etc.
The problem is that many people who have options do shop elsewhere. But folks with limited income, the kind who also work at Walmart, don't have a lot of places they can go where prices are that low. I personally think that Walmart is despicable but I'm not sure what the answer is for people who find places like Kohl's or Target too expensive. Walmart preys on these people.
And, unless you are Trump or Bloomberg, even those of us with good jobs and savings are pretty much one catastrophic illness away from our own financial ruin and Walmart days. |
cmontyburns
Citizen
Username: Cmontyburns
Post Number: 1683
Registered: 12-2003
| | Posted on Monday, January 16, 2006 - 8:56 am: | |
It is very common for a company to ask for repayment once a covered employee gets a large settlement to pay for care. Awards for damages are meant to cover past, present and future health care. Since Wal-Mart already paid for her care, and now she has (in theory) been reimbursed for it through the settlement, they want their money back.
There's nothing inherently Wal-Mart about this at all. Not to say we don't have a broken system here, we do. I think it was an injustice that she got so little (just like I'd think it was an injustice if her case went to trial and she was awarded $10 million). We need a more equitable system for dealing with such cases.
|
Duncan
Supporter
Username: Duncanrogers
Post Number: 5582
Registered: 12-2001
| | Posted on Monday, January 16, 2006 - 9:17 am: | |
All this so you can buy a Kenney Chesney CD for 8.99. Or a box of All Bran cereal for 1.99 |
Eats Shoots & Leaves
Citizen
Username: Mfpark
Post Number: 2857
Registered: 9-2001
| | Posted on Monday, January 16, 2006 - 10:29 am: | |
Jeesh, I may not like a lot of what Wal-Mart does, but you need to listen to CMonty on this one--it is not only common, it is probably in your health care plan also. Consider yourself fortunate if you do not have this policy in your plan.
It is one way that insurance companies keep down the cost of care, so that your costs are lower each month. The problem is not Wal-Mart per se (although they did not buy a Cadillac plan, for sure); it is with the way that medical insurance in general works in America. |
upondaroof
Citizen
Username: Upondaroof
Post Number: 506
Registered: 4-2003
| | Posted on Monday, January 16, 2006 - 10:38 am: | |
I don't understand why health insurance is involved. What about auto insurance. Doesn't the auto insurer pay for your medical costs? Unless in Missouri, auto insurance is optional. |
Arnomation
Citizen
Username: Arnomation
Post Number: 454
Registered: 7-2003
| | Posted on Monday, January 16, 2006 - 1:07 pm: | |
http://www.walmartworkersrights.org/
This is pretty funny. It's like a low-budget JibJab |
The Libertarian
Citizen
Username: Local_1_crew
Post Number: 1361
Registered: 3-2004
| | Posted on Monday, January 16, 2006 - 1:50 pm: | |
seems fair to me. the insurer covers the cost of your health care. if you receive money through a lawsuit to pay for that healthcare, the insurer should receive that money.
|
Dave
Supporter
Username: Dave
Post Number: 8417
Registered: 4-1997
| | Posted on Monday, January 16, 2006 - 2:10 pm: | |
She's already giving all the money from the settlement. Wal-MartŪ wants another $50,000 out of her pocket. |
susan1014
Supporter
Username: Susan1014
Post Number: 1281
Registered: 3-2002
| | Posted on Monday, January 16, 2006 - 2:34 pm: | |
And WalMart wants money that was given to her in the expectation that she needs long term care.
A system that may force her to sell her adaptive van and divorce her husband in order to get the care she needs is a badly broken system. I think that that should be clear to those of any political persuasion. We may disagree on the solutions, but I ask if anyone really thinks that our healthcare system is without major flaws? |
Dave
Supporter
Username: Dave
Post Number: 8419
Registered: 4-1997
| | Posted on Monday, January 16, 2006 - 2:41 pm: | |
The same people who are OK with this outcome want to privatize social security. |
The Libertarian
Citizen
Username: Local_1_crew
Post Number: 1362
Registered: 3-2004
| | Posted on Monday, January 16, 2006 - 3:03 pm: | |
i dont want to privatize social security. i want to abolish it |
Dave
Supporter
Username: Dave
Post Number: 8420
Registered: 4-1997
| | Posted on Monday, January 16, 2006 - 3:05 pm: | |
that's why Libertarians wield such awesome political might. |
cmontyburns
Citizen
Username: Cmontyburns
Post Number: 1688
Registered: 12-2003
| | Posted on Monday, January 16, 2006 - 3:31 pm: | |
Wal-Mart didn't decide her damage award. In fact, a jury didn't even decide -- it sounds like lawyers decided.
Her lawyer should have explained to her that her insurance company and/or employer were entitled to recoup their expenses from the defendant. Again, Wal-Mart didn't run this woman over, the defendant did. He was found to be at fault, and he is paying her restitution. Since Wal-Mart/her insurer had already reimbursed her for some of the exact same expenses she successfully got someone to pay, they are entitled to get their money back.
Sounds like she had a shoddy lawyer. |
The Libertarian
Citizen
Username: Local_1_crew
Post Number: 1363
Registered: 3-2004
| | Posted on Monday, January 16, 2006 - 4:03 pm: | |
that's why Libertarians wield such awesome political might.
your obsession with insulting me is cute.
you stalk me in almost every thread just to childishly name call or to throw out some non-sequitor insult.
when are you going to actually contribute or is this all you have? |
Meandtheboys
Citizen
Username: Meandtheboys
Post Number: 2639
Registered: 12-2004
| | Posted on Monday, January 16, 2006 - 4:14 pm: | |
maybe he's just hoping you'll go away? |
The Libertarian
Citizen
Username: Local_1_crew
Post Number: 1364
Registered: 3-2004
| | Posted on Monday, January 16, 2006 - 4:21 pm: | |
i wont, so he is wasting his time. |
TomR
Citizen
Username: Tomr
Post Number: 939
Registered: 6-2001
| | Posted on Monday, January 16, 2006 - 6:02 pm: | |
Anybody else wondering about the backstory on this one?
Total, and in all liklihood, permanent disability, and the settlement is only $900,000.00, which presumably includes the $470,000.00, for past medical expenses.
There's more than meets the eye on this one.
TomR |
Bob K
Supporter
Username: Bobk
Post Number: 10299
Registered: 5-2001
| | Posted on Tuesday, January 17, 2006 - 4:30 am: | |
TomR, my initial reaction was that either the trucker had limited insurance company and no assets or the responsibility for the accident was questionable and this was a compromise settlement.
Also, the attorney taking over 50 percent of the settlement for his/her fee and costs is way excessive.
It is btw common for health insurers and workers' compensation insurers to put liens on settlements, although this one looks pretty extreme. |
sac
Supporter
Username: Sac
Post Number: 3035
Registered: 5-2001
| | Posted on Tuesday, January 17, 2006 - 7:11 am: | |
Basically, the health insurance system in this country is a mess and this example shows some of that, to the extreme.
Unfortunately the political barriers to really getting it right are formidable. (Dare I say insurmountable?) |
argon_smythe
Citizen
Username: Argon_smythe
Post Number: 728
Registered: 5-2001
| | Posted on Tuesday, January 17, 2006 - 9:09 am: | |
Shopping at Wal-Mart made me mad enough to never shop at Wal-Mart again. What a sh*thole.
|
ess
Citizen
Username: Ess
Post Number: 900
Registered: 11-2001
| | Posted on Tuesday, January 17, 2006 - 12:12 pm: | |
This story aside....Wal*Mart and its foul and inhumane business practices make me ill. I refuse to shop there either. I am glad there are other options in this neck of the woods. |
cmontyburns
Citizen
Username: Cmontyburns
Post Number: 1691
Registered: 12-2003
| | Posted on Tuesday, January 17, 2006 - 12:53 pm: | |
Just wondering: Does that mean you also don't shop at all the local business that employ minimum-wage workers and don't offer health care benefits?
|
ess
Citizen
Username: Ess
Post Number: 901
Registered: 11-2001
| | Posted on Tuesday, January 17, 2006 - 1:15 pm: | |
Cmonty - no. I think Wal*Mart's issues go way beyond what you have mentioned. Further, I have had to deal with them when my company was trying to get a new product on the shelf. They were difficult to deal with, to say the least. |
The Libertarian
Citizen
Username: Local_1_crew
Post Number: 1371
Registered: 3-2004
| | Posted on Tuesday, January 17, 2006 - 1:29 pm: | |
Further, I have had to deal with them when my company was trying to get a new product on the shelf.
a-ha!! |
sylvester the investor
Citizen
Username: Mummish
Post Number: 103
Registered: 6-2004
| | Posted on Tuesday, January 17, 2006 - 7:21 pm: | |
This isn't a "walmart" issue. Its vanilla insurance 101. Read your policies people.
I'm not a fan of walmart as a store to shop in (just personal taste) but I can't stand it when people feel the need to talk about it likes its a cancer.
Walmart is a business, get used to it. If people don't like what they get there, they can go work somewhere else.
|
TomR
Citizen
Username: Tomr
Post Number: 941
Registered: 6-2001
| | Posted on Tuesday, January 17, 2006 - 9:05 pm: | |
Bob K,
The fees and expenses do seem on the high side, but I guess in Missouri the fees were OK, and the expenses were whatever they were.
I was thinking more along the lines that if the husband knew that the insurer wanted to recoup any payments for medical expenses (which he did) how did he get the judge to sign off on the settlement without some provision for repayment of the medical expenses?
Sounds a little hinkey to me.
TomR |
Rastro
Citizen
Username: Rastro
Post Number: 2220
Registered: 5-2004
| | Posted on Tuesday, January 17, 2006 - 11:06 pm: | |
The big question in the case (and that Randy Cassingham, the author of StellaAwards has been wondering) is why the judge put the money into a trust, rather than making it available for the family. My personal thought (this came out on the mailing list a few weeks ago) is that the judge was actually trying to protect the family from having to repay the money to Walmart. Since the judgement was so low (relative to the loss), perhaps he was trying to find a way for the family to keep the money. If it's a trust, they don't have direct access to it.
I also don't think Walmart will follow through on this. While it seems cruel, the attorneys for Walmart have a responsibility to work in the best interests of the company. Until someone from PR comes down and tells them it will cost more in bad PR than hey could possibly recover, they will pursue this... |
cmontyburns
Citizen
Username: Cmontyburns
Post Number: 1693
Registered: 12-2003
| | Posted on Wednesday, January 18, 2006 - 9:45 am: | |
...but the bottom line will have been that Wal-Mart paid the costs for an incident that someone else was liable for. The person who was hurt got paid for medical bills that they themselves hadn't paid. (That person, in turn, chose to give a big chunk to their lawyer.)
Why doesn't Wal-Mart deserve to get its money back?
|
greenetree
Supporter
Username: Greenetree
Post Number: 6567
Registered: 5-2001
| | Posted on Wednesday, January 18, 2006 - 10:40 am: | |
For that line of reasoning, why should companies provide health insurance at all? Unless it is a job-related injury or illness, companies do not cause the illnesses for which they pay from sinusitis to cancer.
Now, by providing insurance, companies are betting that the benefits will outweigh the costs in terms of keeping workers and their families healthier, saving money on temps or replacement hires when these people come back to work more quickly after proper medical care. On occassion, the company will not recoup its payout with returned labor but will spend money on someone who does not return to work.
Like now. It may be legal but it sucks and is immoral. And for those of you who say "this is a business, it's capitlism", there are plenty of Fortune 500 companies who realize include community and employee responsibility and work/life balance as part of their corporate policy.
Why doesn't Walmart deserve to get their money back? Because they don't need it, it will break this highly stressed family, Walmart is in the strong financial position it is because of people like Debbie Shank, who work there for low wages and are dependent on them for low prices. Because it is the responsible thing for Walmart to let it go as part of pay back to the community and people who have made them so extraordinarily wealthy.
It will set no precedence that endangers Walmart's financial future; I just don't see 1000s of employees throwing themselves in front of buses so that they can get free lifetime medical care without having to ever work again. |
Dr. Winston O'Boogie
Citizen
Username: Casey
Post Number: 1881
Registered: 8-2003
| | Posted on Wednesday, January 18, 2006 - 10:54 am: | |
are you sure? for 1000s of employees, the bus might be an attractive alternative to a lifetime of soul-sucking days stocking everyday low priced goods on a Wal-Mart shelf. |
cmontyburns
Citizen
Username: Cmontyburns
Post Number: 1694
Registered: 12-2003
| | Posted on Wednesday, January 18, 2006 - 11:31 am: | |
Greenetree: The person hired a lawyer to recoup medical fees, and to get compensated for pain and suffering. The defendant admitted guilt, and PAID to compensate the person for medical fees (among other things). Wal-Mart had already paid those fees. The person was being reimbursed for something they never paid for in the first place.
If Wal-Mart announces that it is going to let this family keep money that rightfully belongs to Wal-Mart, it won't be seen as a great act of charity. Even though it will be.
The family had either a shitty lawyer, or a shitty case, or both. Wal-Mart isn't the one that screwed them. |
cmontyburns
Citizen
Username: Cmontyburns
Post Number: 1695
Registered: 12-2003
| | Posted on Wednesday, January 18, 2006 - 11:35 am: | |
"Because it is the responsible thing for Walmart to let it go as part of pay back to the community and people who have made them so extraordinarily wealthy."
I'll look for you protesting outside all the local restaurants whose owners are living quite comfortably, but pay minimum wage and provide no health insurance to employees. Why do they somehow owe less to their employees than Wal-Mart -- which provides health care for thousands of employees and pays, on average, above the minimum wage?
|
greenetree
Supporter
Username: Greenetree
Post Number: 6570
Registered: 5-2001
| | Posted on Wednesday, January 18, 2006 - 11:47 am: | |
Well, I have one or two pressing issues in my life right now that prevent me from protesting outside of anywhere. I haven't even had a manicure in a couple months, fergodssake.
But, FYI, if there is a business that I perceive to be treating its employees or customers unjustly, I do indeed vote with my wallet. |
cmontyburns
Citizen
Username: Cmontyburns
Post Number: 1696
Registered: 12-2003
| | Posted on Wednesday, January 18, 2006 - 12:07 pm: | |
As do I.
(Unless it's a purveyor of something particularly delicious, such as Coldstone. If they're employing 8-year-olds, I don't want to hear about it.)
|
Rastro
Citizen
Username: Rastro
Post Number: 2227
Registered: 5-2004
| | Posted on Wednesday, January 18, 2006 - 1:07 pm: | |
Comnty, because of the way that the judge handled the settlement, it is not clear whether the settlement is for medical bills that have already occurred, or for ongoing care down the road. Given that it was set up as a trust, it appears that the judge meant it for future expenses. In which case, Walmart is not entitled to its money back.
But if it was meant for all expenses, not just future expenese, Walmart is, IMNLO (in my non-legal opinion), only entitled to the money that they received from the settlement. After all, Walmart is providing health insurance, which would cover the epxnses after the "primary" (in this case the settlement) is exhausted. |
Smarty Jones
Citizen
Username: Birdstone
Post Number: 171
Registered: 10-2005
| | Posted on Thursday, January 19, 2006 - 12:30 pm: | |
"Regardless, the lawsuit left Shank's lawyer Graham, incredulous. 'I can't believe that they've done this'"
Did he mean that He couldn't believe they agreed to pay him $500,000 for winning this case? Is he incredulous at the fact that his portion of the winnings aren't available for Walmart to pursue, and only the victims compensation is? That has ME incredulous.
Shank's mistake is this lawyer, who is doing a terrible job on their behalf.
Wal-Mart's mistake is being self-insured. Insurance is a tough, nasty business, and bearing risks to having hheadlines like these (regardless of right/wrong) is downright ignorant.
Anyone who thinks an accident was anything but the truckers fault is insane, under any circumstances; unless the truck was parked in a Truck Stop, turned-off, in a legal parking space, turned off, with the driver inside having a burger. Otherwise, Truckers drive like Maniacs and take no responsibility over the safety of their lane-switching, turns and blind spots. (Kind of like the Maplewood Commuters leaving the train parking lot between 5-6 PM)
I'd be shocked to find a situation where the trucker was not at fault. |
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