The Following constitutes a "conversation" between me, Judy Morris and
D whose name or identity I will not give, for reasons that will become
obvious.  The initial motivating subject concerned a remote link [that
happens to require an obtainable pass word] to the testimony given by
a Ms. Zuniga regarding the handling of claims by State Farm Insurance
in California after a recent earthquake.

On Editing:
I have removed a few personal and irrelevent remarks only, made a
slightly neater arrangement of text, made a few spelling corrections
and stuck in a comma or two.

The information, discussion and reasoning, however, presents generally
interesting considerations of truth, the peculiar matter of dismissal
of the testimony of claimants and former insurance company employees
because they might be said to be "disgruntled", as if such disgruntlement
were to make them automatic liars, as opposed to perfectly "gruntled"
claimants and former employees who can then be expected to be truthful.

Judy gives a clear explanation by example of how spin is put on truth
that easily turns it to falsehood.  This is a mechanism that must be
generally known, recognized and expected whenever an insurance company
is involved.

In putting the lie to the "spun truth" it is essential that no history
be permitted to be denied, suppressed or altered.  All of it has to be
considered and weighed.  Only the real liars would seek to suppress
relevent data in any way.  You can read how this comes out of the
Zuniga situation.

Personally, I happen to be far more than disgruntled: enraged is a better
description.  Being enraged is not one of my personal characteristics,
neither is being a liar.

      -- Bill Hammel

THE DISCUSSION:


D said:

>>
>> As an addendum to what I had written earlier....I did, in fact, contact a
>> prior collegue at State Farm for some info relative to Zuniga.  Ms. Zuniga
>> did leave the company's employ of her own choosing; however, this was
>> after she had *asked* (it was more like a demand) to be transferred to a
>> claims office nearer her home.  There were no openings in that office at
>> the time she wanted
>> to go, and she quit--in a snit.

Judy said:

Here's the "spin" UNUM and my ex-employer Harrington Hospital put on my
situation.

I don't remember the exact words but something to the effect that Dr.
Morris demanded extra help and time off.  When she didn't get it, she
decided to leave (but they made it sound like I left "in a snit.")

Here's what actually happened.  In August, Sept., October of 1996,
business and demands at the ER picked up by about a third, due in much
part to the HMO's demanding that we speak to the PCP on EVERY HMO
patient. Since Medicaid is subcontracted to HMO's this meant in almost
every case, we had to get the PCP on the phone, I would have to leave
whatever patient I happened to be treating at the time, run to the
nurses station to talk to these PCP's.  Many of the PCP's would not hold
on the line for more than 30 seconds. They would hang up and we'd have
to call back.  I couldn't use a portable phone because you simply can't
talk about one patient in front of another and plus I wouldn't have the
chart of the patient I was talking about in front of me and when you are
dealing with 6-10 patients at a time, you don't remember much about any
of them.

When we feel overwhelmed we have a physician call-in system to get a
second doc to come in.  There is a list that the nurses are supposed to
call from.  The list was grossly outdated, half the doctors on it didn't
even live nearby anymore (there were only about 10 on it).

The mandatory call-in doctor was frequently a surgeon or subspecialist
who would either refuse to come at all or say they could only see
patients in their specialty, which isn't very helpful in clearing up a
backlog of general medical and trauma patients.

One day in Sept. since the nurses didn't know who to call due to the
shitty list, between the nurses and me we called TWELVE doctors and they
ALL refused to come and help out.  Eventually a different doctor who is
a subspecialist had to come do a consult and helped out with a few
patients.  This type of thing had been a frequent occurrence all Summer
and we had brought it up repeated at the staff meetings, pleading for
help.

After that day, I wrote a long letter to the hospital CEO telling him
these conditions are unsafe for patients and staff.

He told me he didn't understand.  I wrote him a 12 pages letter spelling
out all the complexities and inadequacies that become multiplied when
the ER is busy.

In early October, on the verge of collapse I told my boss I needed 2
weeks off.  He said he couldn't give it to me because he had a meeting
in Europe later in the month and another doctor already had her vacation
scheduled.  He said "maybe in November."  I said "I don't know if I can
last that long."

The CEO had stated that he wished to be called to the ER to see what the
situation looked like that I was complaining about.  So one Friday when
it got busy enough to have to call in a second doctor, I called the
asst. CEO to the ER.  He couldn't be found. So I called the CEO.

By the time he got there I was overwhelmed.  Simultaneously, the nurse
told me that the first two doctors she had called refused to come in and
the radiologist stuck and MRI in my face showing me that a very nice
lady I was treating had a HUGE brain tumor.  I busted out crying and
collapsed into a chair, IN FRONT OF THE CEO OF THE HOSPITAL.

(By the way, this brain tumor patient has been seen moments earlier,
before the MRI, by the only neurologist we have on staff, who happened
to be in the ER, and told me the symptoms were a minor neurological
abnormality called mononeuritis multiplex - a type of Bell's palsy.
I didn't believe him and made her get an Emergency MRI anyway.)

Meanwhile other staff doctors has been derelict in their duties,
refusing to admit patients that needed admission, requiring me to phone
around and beg other doctors to admit them, not seeing patients in the
ICU for FOURTEEN hours after admission (this patient had meningitis that
was not being treated because of this).

I reported one of them to the CEO but of course nothing happened.  I
didn't report all the other incidents because I was too exhausted myself
and didn't want to piss these doctors off more because I would still
have to deal with them.  I did however keep copies of the records of
these cases.

Eventually, the straw that broke my back was getting notified that I was
getting sued for malpractice for a patient who died a year and a half
before (and I later found out, there was nothing I, nor anyone else
could have done to save him).  Nonetheless, I'm named in the lawsuit.

If I had been home I would have gone in the garage, sat in the car and
waited to die.  Fortunately, I was at the hospital, because I had gone to
read the chart.  First off Medical Records didn't want to give it to me.
Then, because the Director was on his "European Vacation" I told the
second in command (sobbing hysterically) that I wouldn't be in for my
weekend shifts.  All he could say was "Are you sure you won't be better
by tomorrow?

But fortunately the next call I made was to my Dad who told me to get on
the next plane to Florida.

I didn't LEAVE in a SNIT but when I started thinking about how I'd been
treated, the incompetence, the administrations lack of response of my
concerns and the concerns of other doctors for patient's safety, THEN I
GOT MAD.

In the mail when I got back from Florida was the CEO's response to my 12
page letter.  Basically he cited a bunch of statistics saying that the
average wait to be seen in an ER in Boston is 6 hours, our average was
ONLY 4. That I should MAKE THEM WAIT.  And some other stuff about how
the hospital was looking into making long term changes but could not pay
for the SHORT TERM solution I was demanding - a reliable doctor backup
system for when it gets too busy.

Whatever this Zuniga person's testimony, if there are claimants whose
stories mirror her accusations, I would certainly trust her more than
the Corporate Spin doctors.  Apparently my boss is going around telling
my ex-coworker that I got a hefty settlement from the insurance company.

D said:

>> The cases you have cited have all been settled; however, it would only
>> be fair of you to remove Ms. Zuniga's *declarations under oath* from your
>> website....In a subsequent deposition, her prior testimony was, in fact,
>> impeached...and she recanted her allegations set forth in the declarations. 

[Note in editing: Ms. Zuniga's declarations are not on my pages; I do,
 however, have a hyperlink to the site (in Calif., I believe) that
 contains them. - Bill]

Judy said:

YOU CANNOT ERASE HISTORY.  We have NO idea WHY MS. Zuniga changed her
testimony.  If it's been impeached, fine.  Then show BOTH the original
and subsequent testimony.

Why don't we all just FORGET that BILL CLINTON told us back in January
that he "did not have sex with that woman."  It's ALL IMPORTANT.

D said:

>> I can lay hands on her subsequent deposition; however, I have absolutely no
>> desire to do so.
>>

Bill said:

> Your position, if I understand you correctly, is that you personally know
> Ms. Zuniga is a liar and that she has herself admitted to being a liar;
> decline to give or cite such documentation, and would like me in "fairness"
> to remove my link to this other site, essentially because I am supposed
> to believe you without proof.  My simple response is no.

Judy said:

D - you admitted you don't PERSONALLY KNOW Ms. Zuniga.  Maybe it's
even more important to know that some STATE FARM employees or former
employees are KNOWN to LIE, even under oath.  If she would lie in court,
why wouldn't she lie in the course of her work at State Farm.

Bill said:

> If your assertion is proved, I may either delete the link or link to
> the proof.  There is no guarantee that either is truthful.
> Perhaps Ms. Zuniga is a liar about her experiences.  Even if that
> were true, it does not mean that what she described is *not* true.
> 

D said:

>> Like I said before, *some* cases do slip through the cracks--there are cases
>> that are wrongfully denied in ALL aspects of the insurance industry, for
>> whatever reasons.  

Judy said:

The denials that Bill and I are concerned about are not "anecdotal" and
"slips throught the cracks."  They are part of a malicious campaign in
certain divisions of some insurance companies to FORCE people with
legitimate claims to have to sue, because they know that most lawyers
and claimants will cave in for far less than they are owed.  Just try
suing +++++.  Do you think your denial was a "minor error," a "mistake,"
a "poorly trained employee (which the parent company is responsible for
anyway)"  If so, how come when you corrected them, they still didn't pay.
You had to use your "pull" to get paid.  Most of us aren't buddy buddy
with Insurance Company executives. What are WE supposed to do?

D said:

>> Sorry if I have frustrated you.  I suspect I, too, would feel pretty
>> ticked if someone told me how fairly +++++ LTD handles their
>> disability claims....

Judy said:

D - write a letter to UNUM and ask them if they ever lie or use
fraud or extortion to deny cases and watch what they say.

UNUM has over 5000 employees, and as I said, pays probably 80% of their
claims.  I'm sure most of those employees are honest, but if only 10%
are involved in these claims denial schemes (my list of people who
rubber stamped my denials, told further lies, or were otherwise involved
and should have known better especially since I wrote them detailed
letters multiple times is past 40 now.)  Anyway if only 10% are bad, if
only 10% of claims are fraudulently denied, that adds up to lots of
profits for the company, and LOTS of misery for the claimants who are
already dealing with some other loss, tragedy, sickness or accident.

Bill said:

> If you think that your experiences, whatever they may be,  with +++++ are
> somehow unique or some kind of slipping through the cracks as you put it,
> or that only +++++ treats claims unfairly, you are grossly naive about an
> on the average, patently corrupt and fraudulent industry.
> 
> If I can find insurance companies that I am convinced are not fraudulent
> they already are and will be posted at the top of my insurance page
> 
>         http://graham.main.nc.us/~bhammel/ins.html

Judy said:

If you want to know how bad STATE FARM IS - read Clinton Miller's Book
"How Insurance Companies Settle Claims"  He's a leading authority on
insurance bad faith and after reading his book, I noted that an
overwhelming majority of legal cases he cited were from STATE FARM.

They probably have this book in the Library of any medium or large
courthouse.  Here's my post about this book:

If you want to know why I'm so angry, I again recommend this book

 by Clinton E. Miller, JD - ISBN 0-938065-43-2
 James Publishing, PO box 25202, Santa Ana, CA 92799
 Phone (714) 755-5450
 or James Publishing, 3520 Cadillac Avenue,
    Suite E, Costa Mesa, CA 92626
 
 I got this and two similar books from the library at the local
 courthouse.  It is written in plain English.
 
 I'd love to talk to Mr. Miller if anyone knows how to reach him.
 He doesn't get into ERISA or GAG orders.  Maybe he wasn't even
 aware of their huge impact, although this book is very current.
 Most cases cited are from the 1990's.
 
 He still assumes that Insurance Companies will try to avoid being
 sued for BAD FAITH and UNFAIR CLAIMS SETTLEMENT PRACTICES.  My
 experiences tell me that UNUM doesn't care.  I'd like to have any
 ideas about what it's called when an insurance company INTENTIONALLY
 uses the LEGAL SYSTEM as a means of EXTORTION by forcing litigation
 (and it's inherent costs, time delays, emotional expenditures and
 the general public's fear of litigation and the courts) of valid claims
 due to protections of ERISA LAW.  Also UNUM knows that with the
 realities of ERISA, many claimants CAN'T find lawyers.  Even though
 he says in his book there is an IMPLIED-IN-LAW covenant that both
 parties should have counsel on an EQUAL basis and that the insurer
 has a fiduciary duty to advise the claimant of such.  In other words,
 if UNUM wants to contest our claims, they are obligated to pay for
 our lawyers UP FRONT so we have equal bargaining power.
 Chapter 4, Page 6.
 
 Pay special attention to

 Chapter 8 - Techniques not found in Claims Manuals

 Lowballing, Stonewalling, Intimidation, non-disclosure, hardship
 defense, FRAUD, unreasonable delays, intentional poor claims anagement,
 biased investigation, economic pressure, unfair leveraging, claims
 maze, rubber ball express, FABRICATED DENIAL, setting up the claimant,
 retaliation, extortion, attacking the claimant and on and on.
 This chapter reads like it must have been taken from the UNUM Claims
 Manual.
 
 And just as I suspected, Mr. Miller's opening paragraph
 "THE FOLLOWING TECHNIQUES ILLUSTRATE UNFAIR CLAIMS PRACTICES.  THE
 TACTICS OUTLINED IN THIS CHAPTER ARE UNETHICAL, SOMETIMES IMMORAL,AND
 USUALLY ILLEGAL."
 
 Because of ERISA, UNUM receives no more than a slap on the wrist
 (or less) for using these techniques.  If you have any ideas, please
 tell me - There are public policy, racketeering, extortion, and abuse
 of process issues here.  But if anyone has any ways that you know to
 MAKE THEM STICK, let me know.

And remember people, we are the lucky ones, we caught on.  What of
those legions of people too intimidated, sick, gullible (and their
lawyers - adjusters are experts at adjusting lawyers too) or isolated
to be able to do anything about it. 
 
Judydoc

--------------------[More]

Judy said:

By the way, I remembered reading a write-up on the CEO of Progressive
Insurance.  I don't remember what it said, but I actually wrote to him
thinking he had integrity based on some quotes from him.  I never heard
from him, but that's OK, I've never heard anything bad about
Progressive.  Of course if you want to check for sure, Bill, just go to
any search engine and put in Progressive Bad Faith Claims or Progressive
Claims Denied and see what you come up with.

[I did do just a search, which could not be conclusive in any way and
 netted absolutely nothing. - Bill]

Bill said:

> I'm not just "pretty ticked", I am quite enraged at what has been done
> by SF with calculation, deliberation and malice.
> 
> Any frustration that you can cause me is less than nothing compared
> to the extent of damage that SF has caused both me and my partner.
> We each had lives and businesses.  Do read the quotes at the top the
> insurance page - they are not there for nothing.
> 
I echo Bill's statements.  Yup, according to UNUM and State Farm we are
just a couple of disgruntled claimants because we didn't get what we
feel we were "entitled" to.  UNUM, in every letter to me tells me how
FAIRLY they've treated me, read every complaint, but there's just no
merit to any of them.  

But at least you are engaged in this dialogue.  I didn't speak out
against my hospital because 1) I needed my job, or thought I did, 2) I
was complaining internally and being ignored, 3) I didn't realize at the
time how the business mentality, and the people who run these places
will PRETEND to care, knowing that in many cases, people will knuckle
under and do as they are told, or they leave, in which case, any
complaints they have can be dismissed as coming from "disgruntled
ex-employees."

That's all I have to say.

Judydoc

------------------------------------------------------------------------

The Opening Post from D

> Subject: State Farm Cases w/Zuniga Decs
> Date: Tue, 15 Sep 1998 09:56:19 EDT
> From: D
> To: bhammel@graham.main.nc.us
> 
> Judydoc had told me that you are *disgruntled* w/ State Farm.  I accessed your
> website with the intent to read some of the information contained therein.
> 
> I have just now completed review of the the declarations give by Ms. Zuniga.
> There is some truth in what Ms. Zuniga says--however, most of her
> testimony--especially as regards the automobile accidents that she never
> handled--is pure fabrication.  Relative to the EQ claim, it appears that at
> sometime, over the course of this claim, Ms. Zuniga left the employ of State
> Farm.
> 
> My own personal feeling, after having read her declarations, are that Ms.
> Zuniga left State Farm under other than pleasant circumstances.  Ms. Zuniga's
> testimony smacks of an embittered ex-employee out to create a great deal of
> trouble for her ex-employer.  Not an uncommon occurrence in this country these
> days.  Inasmuch as her declaration specifically states she is giving it as an
> "expert witness", I submit that Ms. Zuniga has little qualms in accepting
> monetary reward for "getting back"--whatever her reasons for doing so may be.
> 
> How would I know this?  Prior to my becoming disabled, I was a State Farm
> employee.  I worked for the company in various capacities--in the Automobile
> Company--for 25 years.  I started in a clerical position, became a claim rep
> early on, and then went into claims management.  The manner in which Ms.
> Zuniga describes how State Farm instructs its employees to handle automobile
> claims is little more than outright lies.  I, too, was a *claims trainer*,
> having trained, literally, hundreds of claim reps--as a matter of fact, I had
> a reputation for training claim reps throughout the region in which I worked.
> Claim reps leaving my department for promotional/lateral transfer requests
> were immediately accepted by other management personnel for their departments.
> 
> After having read her "testimony under oath" (and, I'm sure there would be
> little difficulty with impeaching a great deal of her testimony), I will
> attempt to investigate the reasons for her leaving the company--we both worked
> out of the same regional office in Westlake Village, CA.  Although I do not
> personally know many of the people named in her testimonies, many of the names
> are familiar.
> 
> I have not had the opportunity to read your personal claim....it may be one of
> the links I'm having problems accessing due to *password* probs.  You may well
> have a perfectly legitimate claim--they do slip through the cracks.
> 

[Note in editing: no pages of my site have passwords, though there are a
 few links to remote sites that do.  The passwords are, however,
 obtainable. - Bill]

> But, as regards the Zuniga declarations....because I have personal, indepth
> knowledge of State Farm's training and automobile claims
> procedures--especially within the very region and offices in which Ms. Zuniga
> worked, I cannot accept what I have read here.  And yes, I have personal
> knowledge of any *new* claims procedures that might have been implemented in
> 1993.  I was employed by State Farm (in a claims management capacity) until I
> left, due to disability, in February, 1995.
> 
> D
>

Next correspondence from D