You get in a car wreck.  But fortunately have purchased Personal Injury Protection or Medical Pay insurance.  So you believe you are fully covered.  That is, until the adjuster cuts off your benefits.  Usually with the help of a “medical review” sometimes performed by an actual doctor (who never sees or talks to you). 

Where do these all powerful medical insurance adjusters come from.  These people who are deciding whether we get treatment or not.

Here’s a typical example:

                      8                      E X A M I N A T I O N

9   BY MS. KOEHLER:

16        Q.   Where do you work?

17        A.   Allstate Insurance.

18        Q.   How long have you worked there?

19        A.   Eleven years.  November will be 11 years.

20        Q.   What’s your job title?

21        A.   Claim adjuster.

22        Q.   What’s your other job titles you’ve had since

23   you’ve been at Allstate?

24        A.   Well, I’m currently a senior claim adjuster, and

25   it’s been just claim adjuster prior to that.

 

                                                                     5

1        Q.   How long have you been senior?

2        A.   I believe it’s been two years.

3        Q.   What were you hired on as?

4        A.   Claim adjuster.

5        Q.   What’s your educational background?

6        A.   I have a B.A. degree from the University of

7   Washington.

8        Q.   In what?

9        A.   Psychology.

10        Q.   What was the year?

11        A.   1987 I graduated.

12        Q.   Any jobs other than Allstate after graduation?

13        A.   Yeah.

14        Q.   What else?

15        A.   First job out of college I worked for Northwest

16   Center for the Retarded.

17        Q.   In what capacity?

18        A.   I was an instructor for them.  The developmentally

19   disabled adults came to Northwest Center to work, and so I

20   helped them with their work.

21        Q.   How long did you work there?

22        A.   Two years.

23        Q.   Anywhere else?

24        A.   Yeah.  After that, I worked for Cascade Savings

25   Bank.

 

                                                                     6

1        Q.   As what?

2        A.   I was an escrow assistant there.

3        Q.   For how long?

4        A.   I started out as a temp through Kelly Services for

5   maybe four months and then worked there two years.

6        Q.   Why did you leave Northwest Center for the

7   Retarded?

8        A.   I wanted to try something new and try to get some

9   better pay.

10        Q.   What did you do after Cascade Savings?

11        A.   I worked for North — or sorry — Western Title.

12        Q.   As what?

13        A.   I was a receptionist there, and I also moved on to

14   do reconveyances.

15        Q.   How long were you working there?

16        A.   A year.

17        Q.   And then where did you go?

18        A.   I worked at a daycare center.

19        Q.   As what?

20        A.   A three-through-five-year head teacher.

21        Q.   For how long?

22        A.   About six months.

23        Q.   What was the name of it?

24        A.   You know, I don’t recall.

25        Q.   Then what did you do?

 

                                                                     7

1        A.   I went on to Country Companies Insurance.

2        Q.   When was that?

3        A.   When was that?  Let’s see.  It was about 1995.

4        Q.   What was your initial position?

5        A.   I was an assistant receptionist.

6        Q.   Why did you take on that job?

7        A.   Why did I take it on?

8        Q.   Uh-huh.

9        A.   I had temped there through Kelly Services, and it

10   was a good opportunity for me.

11        Q.   How long did you work there?

12        A.   About two years.

13        Q.   What was your last position worked?

14        A.   At Country Companies I left as a receptionist.

15        Q.   Then where did you go?

16        A.   Allstate.

17        Q.   So you went from being a receptionist to a claim

18   adjuster?

19        A.   Yeah.  I did handle minor claims at Country

20   Companies.

21        Q.   What was your job title at Country Companies?

22        A.   They had me down as receptionist assistant.

23        Q.   So at Allstate you were hired on as a claims

24   adjuster?

25        A.   Yes.

 

                                                                     8

1        Q.   What year?

2        A.   1997.

3        Q.   What department?

4        A.   PIP.

5        Q.   Which office?

6        A.   Marysville.

7        Q.   Have you ever left the office?

8        A.   Yeah.  Yes.  I’m in the Bothell office now.

9        Q.   Since when?

10        A.   About six years ago.

11        Q.   Prior to adjusting claims, what courses did you

12   take in insurance claim-handling?

13        A.   In insurance claim-handling, we took courses like

14   introductory to medical reports, a lot of online courses,

15   basic claim-handling classes on interpreting policy.

16        Q.   When did you take these courses?

17        A.   After beginning at Allstate.

18        Q.   So the years would be 1997?

19        A.   Yeah, when I started.

20        Q.   Did you review documents involving claim core

21   process redesign, CCPRs?

22        A.   No.

23        Q.   Do you know what the courses that you were taking

24   on were based upon?  In other words, do you know how the

25   courses that you were taking were developed?

 

                                                                     9

1        A.   No.

2        Q.   Do you know any of the motivation surrounding any

3   of the courses that you took?

4        A.   No.

5        Q.   Were you told any of the policies and procedures

6   of Allstate at the time that you began working there other

7   than work through classes?

8        A.   Through classes?  No, just started out doing like

9   training on the computers and things like that.

10        Q.   Did you actually have a training period before you

11   began working?

12        A.   Yes.

13        Q.   Where were you trained?

14        A.   We did — in Marysville.

15        Q.   Did you ever leave the state for training outside

16   of Washington?

17        A.   Yes.

18        Q.   When did you do that?

19        A.   In June 1998.

20        Q.   Where did you go?

21        A.   To Northbrook, Illinois.

22        Q.   How long were you there?

23        A.   Two weeks.

24        Q.   Was that for claims school?

25        A.   Yes.

 

                                                                    10

1        Q.   Did your job title change after 1998?

2        A.   No.

3        Q.   Did you ever go back to Northbrook?

4        A.   No.

5        Q.   Did you ever go to California?

6        A.   No.

7        Q.   Did you ever go to any state outside of Washington

8   for training other than Northbrook in 1998 for two weeks?

9        A.   No.

10        Q.   All of the training that you had in Washington,

11   was it at Marysville?

12        A.   Yes.

13        Q.   And online; am I correct?

14        A.   Yes, and then sitting-alongs with other coworkers.

….

 

                                                                    18

3   What medical training have you had?

4        A.   None.

5        Q.   What science courses did you take in college?

6        A.   I took human anatomy, physics, chemistry, organic

7   chemistry.  I took two physics classes that I recall.

8        Q.   Have you ever worked in a medical office?

9        A.   I temped for two weeks at an x-ray department at

10   the University of Washington.

11        Q.   I take it you perform no medical treatment or

12   services?

13        A.   Correct.

14        Q.   It was a receptionist job or something like that?

15        A.   Orderly.

16        Q.   Do you claim that you have any medical training or

17   background?

18        A.   No.