Latest / Ask the Lawyer / 04/30/2026 Ask the Lawyer with Tom Peyton

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04/30/2026 Ask the Lawyer with Tom Peyton · Ask the Lawyer

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Speaker 1: The views and opinions expressed on this program do not
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Speaker 1: necessarily reflect the views and opinions of five eight whs
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Speaker 1: it's employees or WVRC media of courts.
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Speaker 2: Oh create equal.
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Speaker 3: When Lass come here in a caton can rock.
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Speaker 2: Up twenty two minutes past eight o'clock this morning. No
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Speaker 2: reason to fight the law. You can put the law
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Speaker 2: on your side. Tom Peyton in studio for you this morning.
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Speaker 2: Taking your phone calls and your text threes are four three,
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Speaker 2: four five fifty fifty eight. You can text threes are
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Speaker 2: four non three five five zers or eight. Peyton Law
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Speaker 2: Firm dot Com. Tom, Good morning, How you doing this morning?
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Speaker 4: I'm doing great, nice crisp, cool morning out there. Traffic
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Speaker 4: was smooth except for the was it exit fifty eight
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Speaker 4: Virginia Street. Yeah, that's the traffic person here just hits
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Speaker 4: the play button on hers for every.
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Speaker 2: Week when there's no accidents, it's basically the same thing.
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Speaker 2: There's going to be congestion downtown Charleston and around Oakwood,
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Speaker 2: Virginia Street and anymore Leon Sullivan Wade, depending on where
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Speaker 2: the construction is going over on that side of the.
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Speaker 4: Oh, yeah, right, so I never get that far in
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Speaker 4: the morning. Yeah, yeah, no accidents, so that's good. You know,
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Speaker 4: we've had some guests the last few weeks and talked
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Speaker 4: about some all local legal matters and some like politics.
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Speaker 4: Maybe just good reminder. I know a lot of listeners
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Speaker 4: listening regular so they know what we do at the
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Speaker 4: Peyton Law Firm. But you know our office is there
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Speaker 4: in Nitro, convenient, you know how fast are driving with
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Speaker 4: the traffics, like you can get there from Charleston in
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Speaker 4: fifteen minutes, maybe twenty. But we do other than the
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Speaker 4: answer questions on the radio. We do a lot of
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Speaker 4: consumer oriented work, which is kind of like everyday people work.
1:50
Speaker 4: So for example, we don't represent insurance companies, we don't
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Speaker 4: represent large corporations, but you know, i'd see our bread
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Speaker 4: and butter. What we like to do really is is litigation.
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Speaker 4: So that's as opposed to maybe we do transactional work.
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Speaker 4: We got some small business clients and try and serve
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Speaker 4: folks every day needs. You know, deeds wills, basically state planning,
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Speaker 4: do a decent amount of social security disability work. But
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Speaker 4: you know, our primary I guess you would say focus
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Speaker 4: is civil litigation. Do some criminal defense, but civil litigation,
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Speaker 4: meaning we get folks that come in that maybe been
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Speaker 4: in an automobile accident, they're having trouble figuring out how
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Speaker 4: to navigate the automobile insurance process, or somebody who's following,
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Speaker 4: or somebody who's had an insurance claim to not maybe
2:48
Speaker 4: they had heal damage and they had an adjuster come
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Speaker 4: out and only say they had one shingle damage when
2:56
Speaker 4: they're two or three different experienced roofing contractors are saying, well, no,
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Speaker 4: your whole You've got damage all over your roof and
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Speaker 4: it needs to be replaced. And of course we've got
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Speaker 4: a lot of that over the last not six months
3:09
Speaker 4: or so. H it's the fallout from the we had
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Speaker 4: a really bad hailstorm, oh a little over a year ago.
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Speaker 2: And that's what kind of national story too about it
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Speaker 2: certain insurance companies being very slow. We're refusing to pay
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Speaker 2: them that particular storm hell damage you have.
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Speaker 4: We've seen a lot of what I saw and what
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Speaker 4: I've seen with my clients and the cases that we're
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Speaker 4: handling is pretty swift action by the insurance companies right
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Speaker 4: after the storm, sending in adjusters from out of state,
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Speaker 4: that kind of thing. But then those adjusters leave after
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Speaker 4: kind of the first wave, and if you've experienced a
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Speaker 4: what we call casually lost damage to your property from wind,
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Speaker 4: hail or or some other reason that's covered under your policy.
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Speaker 4: You know, the insurance adjuster oftentimes almost always really initially,
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Speaker 4: they use sort of labor and material units when they
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Speaker 4: come up with their estimate, and it's based on statistics
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Speaker 4: of costs and labor rates, and that doesn't always reflect
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Speaker 4: what it will actually cost to get your property fixed.
4:16
Speaker 4: And so you many times have follow up a communications
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Speaker 4: you need to have with your insurance company, maybe they
4:23
Speaker 4: need to make a supplemental payment, something like that. And
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Speaker 4: what I've seen is after kind of that first wave
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Speaker 4: last year, within say thirty or sixty days after the
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Speaker 4: storm event, then we're I'm seeing a lot of clients
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Speaker 4: that are having difficulty or no communication with their insurance
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Speaker 4: companies any longer. I think we're just getting into these
4:43
Speaker 4: cases as far as discovery, meaning that's the legal way
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Speaker 4: in which you can investigate facts and circumstances after a
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Speaker 4: lawsuits filed and compel the opposing party to provide information
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Speaker 4: and answer questions under oath. But there's a lot of
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Speaker 4: I don't know if you'd say it's necessarily AI, but
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Speaker 4: a lot of automated things these insurance companies are using that.
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Speaker 4: You know, a lot of app people are handling proper
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Speaker 4: damage claimed on apps and sending pictures and you get
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Speaker 4: responses that are repetitive and clearly you can see they're automated,
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Speaker 4: and you tell you tell and sent text saying A
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Speaker 4: B and C and two days later you get a
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Speaker 4: response say, well, we need a B and C and it's
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Speaker 4: that's not appropriate and I don't think complies with Western
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Speaker 4: your law, uh, statutory and regulatory. So so if you're
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Speaker 4: still having we're still taking cases. I've probably analyzed two
5:45
Speaker 4: or three of those over the last two or three weeks.
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Speaker 4: So if you've got a case involving your own insurance company,
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Speaker 4: you might give us a call. We can take a
5:53
Speaker 4: look at your materials, your communications and see if if
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Speaker 4: it's a case we can take on. A lot of
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Speaker 4: folks are going through the Insurance Commissioner's office, which is fine,
6:01
Speaker 4: and you know the the insurance company as a disclaimer
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Speaker 4: at the bottom of their decision letters it says if
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Speaker 4: you have a problem, you can call the Western Insurance
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Speaker 4: Commission's Office. There's not quite as much teeth there in
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Speaker 4: that it's kind of administrative process where what you can
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Speaker 4: receive is limited. Obviously don't get a jury trial in
6:19
Speaker 4: an administrative process. But if you if you've got an issue,
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Speaker 4: let is no Usually we get the get you just
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Speaker 4: send the documents in. Then we kind of take a
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Speaker 4: review and see if it's something we can handle. If
6:30
Speaker 4: we handle that type case, almost universally, it's what they
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Speaker 4: call contingency fees, so we'll take it on and it's
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Speaker 4: no cost to you unless we recover you know, we
6:40
Speaker 4: get a successful result for you. And normally every case
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Speaker 4: is different, but uh, normally we're able to get a
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Speaker 4: result where you know, our clients get sufficient funds in
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Speaker 4: their pocket after lawyers fees and costs are deducted to
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Speaker 4: get all the repairs done that they need on their
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Speaker 4: home or there where they're vehicle. So we're doing a
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Speaker 4: lot of those and then and so you don't you know,
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Speaker 4: if you've got a claim that is against your own
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Speaker 4: insurance company, but it might not be you know, one
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Speaker 4: hundred thousand dollars claim. It might not be a fifty
7:14
Speaker 4: thousand dollars claim, might be a ten thousand dollars dispute,
7:17
Speaker 4: maybe even a little bit less. The way the law
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Speaker 4: is set up when you have to see your own
7:25
Speaker 4: insurance because you don't buy insurance to have to sue
7:28
Speaker 4: them and fight with them, and they're your own insurance company,
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Speaker 4: is as a duty to act in good faith and
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Speaker 4: alert you to policy provisions that might provide benefits under
7:38
Speaker 4: a certain circumstance. So it allows you to get, if
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Speaker 4: you win, your lawyer's fees back at times. And so
7:44
Speaker 4: that's how we're able to handle those type cases and
7:47
Speaker 4: still make it a success for the client on a
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Speaker 4: contingency fee, meaning success meaning you know, our clients just
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Speaker 4: want to get their property fixed and get it back
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Speaker 4: in the condition, be in like it was before the storm.
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Speaker 4: So we're taking on a bunch of a bunch or
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Speaker 4: quite a few of those cases. I don't know how
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Speaker 4: many we have now, probably a dozen or so active.
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Speaker 4: Not everybody has a case, but we're glad to screen
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Speaker 4: it out and it's a free no charge for that
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Speaker 4: and see if it's something we can we can handle.
8:19
Speaker 4: Then we do an awful lot of automobile accident cases,
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Speaker 4: and it's a little different. You know, somebody you're driving
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Speaker 4: to Charleston and a semi doctor, trailer rear inga or
8:32
Speaker 4: or somebody else is just not paying attention and hits you,
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Speaker 4: then it's their fault. But in essence, you're going to
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Speaker 4: be dealing with their insurance carrier the entire time you
8:42
Speaker 4: you probably, other than on the scene at the scene
8:44
Speaker 4: of the collision, you probably won't have any interaction at
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Speaker 4: all with the person who caused the accident. You're dealing
8:50
Speaker 4: with their insurance company, and those are a little different
8:53
Speaker 4: because it's not your own insurance company. But you know,
8:56
Speaker 4: if you have a property damage claim, we can certainly
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Speaker 4: give you some advice or information. It's hard for us
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Speaker 4: to take those on a contingency fee when it's somebody
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Speaker 4: else's fault because you don't ordinarily get lagger's fees awarded
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Speaker 4: on top of that. But certainly we've done hundreds and
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Speaker 4: hundreds of automobile accident cases and naturally you've got property damage,
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Speaker 4: which every with every one of those. Even though we're
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Speaker 4: handling the bodily injury claim, we always try and help
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Speaker 4: the folks. Here's how you can get her rental, and
9:27
Speaker 4: here's what they're alligated to pay you when you have
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Speaker 4: a total loss your vehicle and I think people appreciate
9:32
Speaker 4: the fact that we we just kind of do that
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Speaker 4: as a gratuitous service if we're handling the injury type case.
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Speaker 2: Is there in a particular different way. This happened to
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Speaker 2: a friend of mine, This was years ago. It has
9:42
Speaker 2: no bearing on any thing in reality today that I know,
9:45
Speaker 2: if that's happening. It's just a circumstances that I knew
9:47
Speaker 2: happened before. She got into a car accident. And I
9:51
Speaker 2: think it was pretty obviously not her fault. But the
9:54
Speaker 2: person who she was in an accident with was a
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Speaker 2: was a man who became enraged the accident, I mean
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Speaker 2: very threatening to the point where she didn't want to
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Speaker 2: get out of her car, you know, to to you know,
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Speaker 2: talk to him, to try to get information and stuff
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Speaker 2: like that. She was like trying to call the police
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Speaker 2: and stuff like that. It was it was a harrowing
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Speaker 2: experience for her. And does that really change anything on
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Speaker 2: the ground as far as that goes from a legal
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Speaker 2: standpoint goes should I mean in this day and age,
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Speaker 2: if you have cell phones, I guess you just record
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Speaker 2: everything you can if possible, But.
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Speaker 4: Where you need to write, you need to document me
10:24
Speaker 4: If like I was. Actually I was in a trial
10:29
Speaker 4: a little over a month ago. I guess we'd cut
10:32
Speaker 4: out early that day from the trial because the judge
10:34
Speaker 4: had to go serve actually on temporary assignment at the
10:37
Speaker 4: Supreme Court and here or argument, and I was reared it.
10:41
Speaker 4: On the way home. I saw it. Actually it was
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Speaker 4: some Department of Highways pothole repair on the interstate, and
10:48
Speaker 4: they'd closed one lane, but actually they were eked out.
10:51
Speaker 4: The workers had kind of eked out into the middle
10:53
Speaker 4: lane that wasn't closed. Everybody's slamming on their brakes and
10:56
Speaker 4: trying to get over, and I heard the if you've
10:59
Speaker 4: been in an accident interstate where everybody's stopping quickly, you
11:02
Speaker 4: hear that squeal from and you don't know whether it's
11:05
Speaker 4: in front of you or behind you. But I looked
11:06
Speaker 4: at my rearview in near and I actually saw it coming.
11:09
Speaker 4: And I've left maybe three car links between me and
11:14
Speaker 4: the car in front of me, so I was able
11:16
Speaker 4: to hit the accelerator really quick right before I was hit.
11:19
Speaker 4: I got hit pretty good. But I think the fact
11:22
Speaker 4: that i'd start my car moving and I drive the Tesla,
11:25
Speaker 4: so you know it does start really quickly. I mean
11:30
Speaker 4: doesn't there's no delay. You hit that accelerator, you're moving forward.
11:33
Speaker 4: So I was kind of moving forward when I got hit,
11:36
Speaker 4: but we pulled over. It was a young, young fella.
11:38
Speaker 4: I don't know. It was certainly a situation you wouldn't anticipate.
11:43
Speaker 4: I'm not sure if he was distracted or what. But
11:45
Speaker 4: you know, we got out. No disabling damage any vehicle,
11:50
Speaker 4: either vehicle. He got his insurance information out. Take pictures,
11:53
Speaker 4: take pictures of license plate, take pictures of the scene.
11:57
Speaker 4: We didn't wait for the police, and you don't. I mean,
12:01
Speaker 4: I didn't have an injury that was disabling or anything
12:04
Speaker 4: like that. I was able to keep moving on. So
12:07
Speaker 4: when you get in those situations, and of course situation
12:10
Speaker 4: you're referencing if you've got somebody threatening or hostile, I mean,
12:13
Speaker 4: just sit in the car and wait. If there's any
12:20
Speaker 4: dispute or any you get any inkling that there might
12:22
Speaker 4: be a dispute about how it happened, or that it
12:24
Speaker 4: actually happened or something like that, then you need to
12:28
Speaker 4: call the police and wait for the police. Because the
12:31
Speaker 4: police will do song it's on a public street or
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Speaker 4: a public road, they'll do it. What's called a uniform
12:36
Speaker 4: traffic crash report, and if you've been in an accident,
12:40
Speaker 4: you've probably seen one. Of course I've seen a thousand
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Speaker 4: of them probably, But there's just basic information. The police
12:46
Speaker 4: have to document their owner of the vehicle, driver of
12:50
Speaker 4: the vehicle, the insurance that they hopefully have their proof
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Speaker 4: of insurance with them, and then the officer will note that.
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Speaker 4: You know, if you don't have that information, it's just
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Speaker 4: another hurdle we've got to you've got to get over.
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Speaker 4: We can certainly help because there's no database that's publicly
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Speaker 4: available just to access who someone's insured with for automobile insurance.
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Speaker 4: So you want to wait and get the police there
13:21
Speaker 4: and make sure that you let them document what happened,
13:25
Speaker 4: even if they get it wrong. I means a lot
13:27
Speaker 4: of times vehicles are moved if it's not too bad
13:30
Speaker 4: an accent. You know, police are busy, and if it
13:33
Speaker 4: doesn't appear somebody has a catastrophic injury at the scene,
13:36
Speaker 4: sometimes they're investigating me. They're not going to do an
13:38
Speaker 4: accident reconstruction for example, if you like in my case
13:44
Speaker 4: or my situation. But you really want to get that
13:46
Speaker 4: documentation because it gives you a leg up. But you
13:49
Speaker 4: don't if it's a very minor accident and you're off
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Speaker 4: the road. Just nowadays with cell phones take pictures. You
13:57
Speaker 4: never have too many pictures, and.
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Speaker 2: There's nothing illegal about that. As long as no laws
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Speaker 2: are broken or anything. You're able to between two individuals,
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Speaker 2: come to that agreement, exchange the information, and move about
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Speaker 2: your day without naturally having to get the law involved.
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Speaker 4: If there was no laws, that's right. You want to
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Speaker 4: make sure that you know when somebody brings out their
14:12
Speaker 4: insurance certificate, make sure that it's covers the right policy period,
14:18
Speaker 4: the time period when you're ax and habit. If it doesn't,
14:21
Speaker 4: I would probably maybe wait for the police because it's
14:26
Speaker 4: going to be tough to You can compel folks to
14:30
Speaker 4: provide their insurance information. That's one of the basic rules
14:33
Speaker 4: of civil litigation. There's a in the investigatory or discovery
14:37
Speaker 4: process that specifically says I can request the insurance information
14:45
Speaker 4: from the opposing party, which might ultimately pay for any
14:50
Speaker 4: judgment we were to get from a judge or jury,
14:52
Speaker 4: and they have to produce that. But you have to
14:56
Speaker 4: be in a lawsuit before that applies. So I mean,
15:01
Speaker 4: we don't just run out and file lawsuits most of
15:03
Speaker 4: the time because we like to gather records, et cetera,
15:07
Speaker 4: and try and see if we can resolve the case
15:09
Speaker 4: abs in a lawsuit. Most of our clients don't want
15:11
Speaker 4: to be in a lawsuit, and you want to have
15:13
Speaker 4: that opportunity to try and resolve them first. So if
15:15
Speaker 4: you don't have the insurance information, we got nobody to
15:18
Speaker 4: really deal with. So we're going to end up in
15:20
Speaker 4: a lawsuit if nothing else, for the primary purpose of
15:25
Speaker 4: compelling that other person to provide the insurance information. And
15:30
Speaker 4: there's no problem. I mean, don't take pictures of other
15:32
Speaker 4: person's license, play spection sticker, car even them. I've had
15:41
Speaker 4: a few cases over the years where there's a dispute
15:43
Speaker 4: about who was really driving the other yes, and for
15:46
Speaker 4: various reasons, maybe one person doesn't have a valid driver's
15:51
Speaker 4: license or is excluded under the insurance policy, and then
15:54
Speaker 4: we've got a controversy there that if good documentation we'd
16:01
Speaker 4: be able to overcome rather quickly. So Julie just gathering
16:04
Speaker 4: some basic evidence with a cell phone or something like that.
16:08
Speaker 2: I was so scandalized the first time I used to
16:09
Speaker 2: visit a friend of mine that lives in Manhattan, and
16:12
Speaker 2: I used to visit up there. I mean I went
16:13
Speaker 2: for a decade straight, once or twice a year, and uh,
16:17
Speaker 2: I got to the point where I would drive to
16:19
Speaker 2: New York. I got sick of flying, I got sick
16:20
Speaker 2: of taking the train whatever, so I just drive. It's
16:22
Speaker 2: not really that far up a drive. And so the
16:25
Speaker 2: one thing that he taught me, being a native New Yorker,
16:28
Speaker 2: and he did this all the time, he always carried
16:29
Speaker 2: around tons of cash, which I alwaysought, Man, why you
16:31
Speaker 2: hear a par around tons of cash in New York?
16:34
Speaker 2: This is your insurance. He's like, if you if I'm
16:36
Speaker 2: you get in minder fender benders all the time. If
16:38
Speaker 2: you get in a minor fenderbinder, you're not You're not
16:40
Speaker 2: fouling a claim. You're getting out of the car and
16:41
Speaker 2: you're saying, oh, that looks like a five hundred dollars
16:43
Speaker 2: thing was your fault. Like most of the time you're
16:45
Speaker 2: negotiating it right there on the side of the street,
16:47
Speaker 2: exchanging cash and then just going about your day. And
16:49
Speaker 2: to me, that was the most scandalous thing, was like,
16:51
Speaker 2: is that even legal? How can you do that? But
16:53
Speaker 2: of course it's fine. I mean generally speaking, you can
16:55
Speaker 2: do that, and it's just you have no recompay. Oh
17:00
Speaker 2: that's right, I mean you're not.
17:01
Speaker 4: So so when a case is settled through an insurance
17:07
Speaker 4: carrier or even absent one, if if it's a serious
17:11
Speaker 4: matter and there's maybe a business is paying. Businesses sometimes
17:15
Speaker 4: you know, have self insured retentions or deductibles and so
17:19
Speaker 4: they can pay out of it their pocket versus going
17:22
Speaker 4: through insurance sometimes. But you know there's there are documents
17:28
Speaker 4: signed in exchange for that money, so that that like
17:31
Speaker 4: if you were the one paying that money, I say, well,
17:34
Speaker 4: here's five hundred dollars, let's just I'll call it even,
17:37
Speaker 4: and everybody goes on. Well, the next thing to that
17:38
Speaker 4: person has to go to the er because they start
17:41
Speaker 4: hurting really bad the next day and didn't feel it
17:43
Speaker 4: because of the adrenaline at the time of the accident. Well,
17:46
Speaker 4: you know you're not going to be able to hold
17:47
Speaker 4: them to that five hundred dollars exchange. So, uh, it's
17:52
Speaker 4: not the safest thing to do if you think you
17:56
Speaker 4: might have some and then and if you've done that
17:59
Speaker 4: and not gotten there in urance information, which I've seen
18:01
Speaker 4: happen multiple times with my clients and.
18:04
Speaker 1: You're back to where.
18:06
Speaker 4: You know, we were talking about a few minutes ago,
18:08
Speaker 4: when you can't figure out what insurance comes to have
18:11
Speaker 4: and maybe they're ghosting you and're not responding to court.
18:13
Speaker 2: In retrospect, to have a feeling that takes the place
18:15
Speaker 2: of even having insurance. A lot of the times, there's
18:17
Speaker 2: probably a lot of uninsured drives.
18:18
Speaker 4: They may not be insured. And of course, if everyone
18:22
Speaker 4: in West Virginia has uninsured motors coverage, if you have
18:25
Speaker 4: automobile insurance, so it's mandatory, so you get a I mean,
18:30
Speaker 4: there are folks that just don't have insurance. They maybe
18:33
Speaker 4: had it but it expired or there's other reasons, or
18:38
Speaker 4: an uninsured driver is also a driver that you can't identify.
18:42
Speaker 4: So if you have somebody that's a hit and run
18:44
Speaker 4: and it's you've got to have some objective evidence that happened,
18:50
Speaker 4: not just say this person well, or at least witnesses.
18:55
Speaker 4: I've had them where somebody's running other person off the
18:57
Speaker 4: road and there wasn't in a wreck and there wasn't
19:00
Speaker 4: and it's a collision, And in that case, you really
19:03
Speaker 4: need to have witnesses other than yourself to say it happened.
19:07
Speaker 4: But if there's physical contact tractor trailer swerves over and
19:13
Speaker 4: hitch a side, swipes and just keeps on going, then
19:17
Speaker 4: that would be an uninsured motorists claim, which is your
19:19
Speaker 4: own insurance. But they step in and adjust the claim
19:24
Speaker 4: as if they were insuring the other driver. Hey, we
19:26
Speaker 4: got a call.
19:27
Speaker 2: We have a call that's caught in on the air color.
19:29
Speaker 2: What's your first name? You're on the air with Tom Payton, Bob.
19:32
Speaker 2: Hey there, Bob.
19:33
Speaker 4: What's one one this morning? Bob?
19:36
Speaker 3: I wanted to ask Tom a question about dealing with
19:40
Speaker 3: insurance company. This is I guess health insurance. My wife's
19:47
Speaker 3: eighty eight and fell February the night and broke her hip,
19:56
Speaker 3: her femur and did well. It's kind of a unique
20:01
Speaker 3: break because it kind of shattered the large part of
20:05
Speaker 3: the top of the femur. Of course, she's eighty eight.
20:10
Speaker 3: We have Humana insurance and course of eighty eight. She's
20:16
Speaker 3: going to need a lot of therapy. Now. My cousin
20:22
Speaker 3: works in insurance, she's been working in insurance for forty years.
20:28
Speaker 3: And she asked me when I told her, she said,
20:31
Speaker 3: who do you have insurance with? And I said, we
20:33
Speaker 3: have Humana, and she said, oh my, well, Humana started
20:44
Speaker 3: immediately trying to kick her out of therapy, even though
20:48
Speaker 3: her courage is one hundred days of therapy with no cope,
20:55
Speaker 3: and they wanted her out of therapy home. I guess
21:01
Speaker 3: in about two weeks. Well that was February of the ninth,
21:06
Speaker 3: and she's still in therapy, but they kicked her out
21:10
Speaker 3: of paid therapy and we have to pay about seven
21:16
Speaker 3: thousand dollars a month. That's sweet, and she's still not
21:21
Speaker 3: out of therapy. I just wondered if you had any
21:25
Speaker 3: trouble with Humanita trying to kick people out in situations
21:31
Speaker 3: like that just to save a little money.
21:34
Speaker 4: Well, and it's probably a Medicare advantage plan through human
21:37
Speaker 4: with your yes right, So if once you hit retirement age,
21:41
Speaker 4: or if you've been disabled for you're on SO Security
21:44
Speaker 4: disability insurance and your disability has been in place for
21:47
Speaker 4: more than two years, those are the ways in which
21:49
Speaker 4: you can get Medicare. And then Medicare advantage plans are
21:53
Speaker 4: plans that you purchase that are generally governed by the
21:59
Speaker 4: Medicare rec elations it gets. I mean, they're supposed to
22:04
Speaker 4: cover what's medically necessary. Sometimes when you get long term care.
22:11
Speaker 4: It's tricky. You really got to rely on your doctor
22:14
Speaker 4: to get the proper information to humanita ata. Those are
22:19
Speaker 4: the kind of the main ones that that I see,
22:22
Speaker 4: and if it's medically necessary, generally they're supposed to to
22:25
Speaker 4: cover it. Now, if you've got you know, there should
22:29
Speaker 4: be a written A lot of times folks get you know,
22:33
Speaker 4: verbal well, this isn't authorized that kind of thing. There's
22:35
Speaker 4: going to be something in writing behind that and what
22:39
Speaker 4: people call an EOB or explanation of benefits letter or
22:43
Speaker 4: maybe even a more comprehensive narrative letter in response to
22:47
Speaker 4: the doctor, keep one of the keys. If you've got
22:49
Speaker 4: a good treating physician. I know that they have hospitalists
22:52
Speaker 4: that will come in and to the rehab facilities. But
22:55
Speaker 4: if you've got a primary care doctor that's following her
22:57
Speaker 4: that maybe she goes to see when she can or
23:00
Speaker 4: or here maybe the doctor comes to the facility, you know,
23:03
Speaker 4: you might see what they can do as far as
23:05
Speaker 4: corresponding and getting information to the insurance company, because they will.
23:10
Speaker 4: I mean, just like for example, an MRI that's a
23:12
Speaker 4: really specific scan. If you have me NFL players, professional athletes,
23:17
Speaker 4: they get MRIs instantly you know, for every every element
23:21
Speaker 4: they've got. But you go in and say your knee hurt.
23:24
Speaker 4: See how hard it is to get an MRI right
23:25
Speaker 4: off the bat, because you know insurance companies they'll want
23:29
Speaker 4: you to go to physical therapy first or do this
23:31
Speaker 4: different conservative treatment first, and sometimes, frankly, I think that
23:35
Speaker 4: makes the problem worse. And they needed to do an
23:37
Speaker 4: MRI right.
23:38
Speaker 3: I had that as she had one hundred days therapy.
23:44
Speaker 3: And the way I read it, some person sitting behind
23:51
Speaker 3: a disk in Lexington just decided arbitrarily that she should
23:58
Speaker 3: be out of therapy. She doesn't need anymore, but she does.
24:02
Speaker 3: She's she's in therapy now and probably got two or
24:08
Speaker 3: three more weeks of therapy coming. But how how can
24:13
Speaker 3: they just basically arbitrarily decide she doesn't need any more
24:19
Speaker 3: therapy just to save money. And that's what it's about.
24:22
Speaker 4: Sure, they're using statistical data, and well here's the and
24:27
Speaker 4: that's the You see a lot in the workers compensation.
24:30
Speaker 4: We have regulations that governing workers compensation in West Virdia
24:34
Speaker 4: that set kind of guides or standards. Well, you know
24:37
Speaker 4: this isn't warranted for this type issue, or you don't
24:41
Speaker 4: need that much but that's based on statistics, and there's
24:45
Speaker 4: exceptions to all the statistics, and so's sometimes it's hard
24:49
Speaker 4: to get over top of that, over that hurdle. But
24:52
Speaker 4: here's here's what I would say, Bob. If you've got
24:54
Speaker 4: first of all, it's helpful to make them put in
24:57
Speaker 4: writing whatever their decision is. If they're not providing a
24:59
Speaker 4: benefit that you think is something that's medically necessary per
25:04
Speaker 4: her treating medical professionals haven't put in writing that I
25:09
Speaker 4: would file at least. You know, these are claims government.
25:12
Speaker 4: They're complicated, they're governed by federal law. You're not like
25:17
Speaker 4: a homeowners insurance claim I was talking about earlier with
25:19
Speaker 4: heal damage or even an automobile insurance claim. It's it's
25:23
Speaker 4: more complex as far as hiring lawyers and getting them
25:25
Speaker 4: to take these type cases. But you can file a
25:28
Speaker 4: complaint with the Western Insurance Insurance Commissioner's Office and they
25:32
Speaker 4: aren't necessarily they aren't going to be probably as aggressive
25:35
Speaker 4: as if you retain private counsel. I mean, if you
25:38
Speaker 4: can afford to pay private counsel for something like this.
25:41
Speaker 4: But I file a complaint with Western Insurance Commission's Office.
25:43
Speaker 4: They are good about uh, one, they'll they'll send your
25:47
Speaker 4: complaint out to the insurance carrier. The carrier will have
25:51
Speaker 4: to respond within a certain amount of time with their explanation,
25:56
Speaker 4: and then you know, maybe the insurance Commission's office can
26:01
Speaker 4: help get you covered, because sometimes it sends it up.
26:03
Speaker 4: You're talking about somebody maybe in a call center, looking
26:05
Speaker 4: at a screen about what their guidelines are, creating a
26:08
Speaker 4: hurdle for your wife's coverage. Sometimes when you get it
26:11
Speaker 4: to the insurance Commissioner's office, it gets to a different
26:14
Speaker 4: level and they look at it and say, oh, yeah,
26:15
Speaker 4: well we missed this or this was in the record
26:18
Speaker 4: the doctor you know, said X, Y and Z, and
26:22
Speaker 4: so that now qualifies, and then you'll get some coverage.
26:24
Speaker 4: Or I'm not sure about your particular situation, if there's
26:27
Speaker 4: if you have an insurance policy that only covers a
26:30
Speaker 4: certain amount of like i've seen them, for example, they
26:33
Speaker 4: only cover chiropractic care so many treatments in a certain
26:37
Speaker 4: amount of time, and that's just what you're that's what
26:39
Speaker 4: you bought and that's what you've got. But at least
26:42
Speaker 4: you'll get a coherent explanation when they respond to the
26:45
Speaker 4: Insurance Commissioner's office and the Insurance Commission's office will tell
26:48
Speaker 4: you whether you know it's well, they've got a legitimate
26:51
Speaker 4: response and we really can't help you anymore, or they
26:55
Speaker 4: can take it through an administrative process.
26:57
Speaker 3: And have you, in your practice over the years shid
27:01
Speaker 3: any situations with h Man or where you thought they
27:06
Speaker 3: were being too.
27:10
Speaker 4: I guess conservative and authorizing treatment. Yeah, I've had I'm
27:16
Speaker 4: not sure about human I've had have had some other
27:20
Speaker 4: health insurance deny claims that I thought were unreasonable. There's all,
27:25
Speaker 4: and there's almost always universally an appealed process through the
27:28
Speaker 4: insurance company too. In terms, so you can always ask,
27:31
Speaker 4: well I want to appeal that decision. You've got to make
27:32
Speaker 4: them put in the writing and then go through their
27:34
Speaker 4: process if that fails. What I've done, I mean, I
27:38
Speaker 4: can think of a couple in the last six or
27:40
Speaker 4: seven years. One was where they wouldn't pay for a
27:43
Speaker 4: uh you know, uh neonatal treatment or pregnancy related treatment,
27:49
Speaker 4: and we we we appealed or fould a complaint with
27:52
Speaker 4: the Western Insurance Commission's office. Ultimately we got it resolved
27:55
Speaker 4: a couple of times. But I've not dealt with your
27:57
Speaker 4: particular situation and I can't necessarily say it was a
28:01
Speaker 4: Humana issue. Then now, if I'm handling a car wreck case,
28:06
Speaker 4: and you know, even if it's somebody else's fault, you
28:09
Speaker 4: almost universally want to still process those claims to your
28:13
Speaker 4: own insurance. And then if we recover that same amount
28:16
Speaker 4: from the at fault drivers insurance auto insurance, then we
28:20
Speaker 4: have a deal where there's not it's not a deal,
28:22
Speaker 4: but there's policy language that requires us to pay back
28:25
Speaker 4: your health insurre and we handle all that, all that
28:29
Speaker 4: for you. But I've had that situation a lot of times,
28:33
Speaker 4: Well we're not going to pay for that treatment. Well,
28:35
Speaker 4: maybe my client needs a surgery or an MRI or
28:38
Speaker 4: something like that. And so then we'll work with our
28:42
Speaker 4: client's treating physician to make sure we've got the right
28:46
Speaker 4: documentation and demonstrate why this is medically necessary, because we
28:51
Speaker 4: want our clients to get the treatment they need so
28:53
Speaker 4: that can get better.
28:55
Speaker 3: At first, they only agreed to pay with for two
29:01
Speaker 3: weeks for an eighty eight year old lady with a
29:05
Speaker 3: bad break. They agreed to pay for two weeks therapy.
29:09
Speaker 3: We filed acclaim and got another ten days, and that
29:13
Speaker 3: wasn't enough, and they cut her off after another ten days. Well,
29:18
Speaker 3: we appealed again and got another ten days and then
29:24
Speaker 3: they said no more. So I don't know.
29:28
Speaker 4: So their most recent letter, but they said they were
29:30
Speaker 4: file a complaint with the insurance commissioner and see where
29:32
Speaker 4: it goes.
29:33
Speaker 3: They called the insurance commissioner, told them a story and
29:38
Speaker 3: they whoever I talked to it the insurance Commissioner's office
29:43
Speaker 3: didn't seem very interested in.
29:47
Speaker 4: Yeah, well, I know who you're talking to. But you
29:49
Speaker 4: can fill out a complaint form and that will get
29:55
Speaker 4: an official ball rolling.
29:56
Speaker 1: Men.
29:56
Speaker 4: They'll they'll tell you, they'll do the intake and they'll
29:58
Speaker 4: get back to it. Yeah. I wouldn't a phone call,
30:02
Speaker 4: you know, I don't know who you talk to.
30:03
Speaker 2: It's only somebody talk you out of it. When you
30:04
Speaker 2: can take it, take agency yourself and fib the come
30:06
Speaker 2: sure man.
30:07
Speaker 4: If insurance commisser says well, we don't have your sticktion
30:09
Speaker 4: over this or something, then they'll need to tell you
30:10
Speaker 4: in writing. But you've got to get the ball rolling
30:12
Speaker 4: formally by filling out man, I do them on. You
30:15
Speaker 4: can do them online and submit them. If you got
30:17
Speaker 4: your computer savvy at all, you can do that. You
30:20
Speaker 4: can print, fill it out, fax it in, or mail
30:23
Speaker 4: it in. It's no cost to file it. It doesn't
30:25
Speaker 4: take a whole lot of time, and so I would
30:28
Speaker 4: encourage you to do that. Bob.
30:29
Speaker 3: Okay, we might have to do that. Thank you, Tom.
30:32
Speaker 4: We're welcome, appreciate the call. But if that turns out
30:34
Speaker 4: bad and that you don't get a result, I'll be
30:36
Speaker 4: glad to take a look at it for you see
30:37
Speaker 4: if it's something we can take on you take a.
30:39
Speaker 2: Break, yep, we got to take a break up. At
30:40
Speaker 2: least a phone line open for you if you want
30:42
Speaker 2: to get in where Bob left off. We have a
30:43
Speaker 2: few minutes when we come back. Three zero four three
30:44
Speaker 2: four five fifty eight fifty eight three four five fifty
30:46
Speaker 2: eight fifty eight. Text machine is up and running. Three
30:48
Speaker 2: zero four nine three five five zero your eight. We'll
30:50
Speaker 2: take a break and be back right after this. You're
30:51
Speaker 2: listening to ask the Lawyer. It's on painting from the
30:53
Speaker 2: Peyton Law Firm, Payton Law Firm dot com on five
30:55
Speaker 2: ad wchs The Boyster, Charleston.
30:57
Speaker 5: I'm Michael Jeruge and I'm running for State Senate. My
31:00
Speaker 5: faith and family guide everything I do. They shape my
31:03
Speaker 5: values my work and the way I serve others as
31:06
Speaker 5: your state Senator. Those same principles will guide every decision
31:09
Speaker 5: I make for our community. I want our kids to
31:11
Speaker 5: have real opportunity right here at home.
31:14
Speaker 6: In politics, a lot of people talk about faith and
31:16
Speaker 6: family values. Michael Gerrouge lives them. Rooted in his faith,
31:20
Speaker 6: active in his church, and proud to be raising his
31:23
Speaker 6: four children right here in Kannall County. Paid for by
31:26
Speaker 6: Michael Gerrouge for Senate.
31:28
Speaker 7: I'm doctor Stephen Eschinoer, Eagle Scout, Army colonel, emergency physician,
31:33
Speaker 7: and a father of six, including four by adoption. Because
31:35
Speaker 7: in West Virginia, we take care of our own. I've
31:38
Speaker 7: spent my life serving in uniform, in the er and
31:42
Speaker 7: on the farm. Now I'm ready to serve in the
31:44
Speaker 7: State Senate, fighting for better health care, real jobs, and
31:48
Speaker 7: the conservative values that make West Virginia home. I'm doctor
31:51
Speaker 7: Stephen Eshnauer, proven Conservative, ready to serve.
31:55
Speaker 6: Paid for by Eishenhower First Senate.
32:12
Speaker 2: You're listening to the Voice to Charleston five hs and
32:16
Speaker 2: the voice of you. If you want to call in
32:17
Speaker 2: this morning, you can talk to Tom Payton. He has
32:19
Speaker 2: just a couple of minutes left here on the airwaves,
32:21
Speaker 2: ready to talk to Tom Peyton from the Peyton Law Firm,
32:23
Speaker 2: just like Bob did before that. Three zero four, three
32:25
Speaker 2: four five fifty to fifty you can text three zero
32:26
Speaker 2: four nine three five five zeros or eight. We'll try
32:28
Speaker 2: to get in and out on that real quick.
32:30
Speaker 4: Yeah, we got a couple of things, current events going
32:32
Speaker 4: on in the legal field. So one thing just kind
32:34
Speaker 4: of sad thing really, But and I you know, I
32:38
Speaker 4: haven't watched the video, read the headlines, and now I've
32:42
Speaker 4: listened to my friend's attorney, Scott Summers, talk on your
32:45
Speaker 4: station a couple of different times. But it's the John
32:48
Speaker 4: Lucas fellow that unfortunately was killed when he was hit
32:52
Speaker 4: by an am villaince that was being driven by EMS personnel.
32:58
Speaker 4: I guess out of Kanall County, well one person and
33:00
Speaker 4: only one person can drive. I think there was a
33:02
Speaker 4: passenger and there was I remember the initial story when
33:06
Speaker 4: it came up that morning. It was man wielding a
33:10
Speaker 4: knife and they were trying to get away from him
33:12
Speaker 4: or something. And now it sounds like maybe again I
33:16
Speaker 4: haven't seen the video, but I believe Scott Summers when
33:19
Speaker 4: he goes on the radio and says, what Scott is
33:22
Speaker 4: a lawyer. He's actually just a few miles down the
33:25
Speaker 4: road from us in PoCA, and I found him to
33:28
Speaker 4: be He's a mild mannered person but honest. So when
33:32
Speaker 4: he says here's what I saw happened on that video,
33:35
Speaker 4: I don't question him at all. I know he's avocate,
33:37
Speaker 4: he's representing the family of mister Lucas, but I believe him.
33:42
Speaker 4: But it turns out that maybe you know this was
33:44
Speaker 4: all on I guess there's dash cameras or maybe even
33:47
Speaker 4: internal cameras and recordings in the cab of the ambulance,
33:49
Speaker 4: and it just sounds like a really bad situation where
33:52
Speaker 4: mister Lucas was under the vehicle for a while while
33:55
Speaker 4: continue to operate and then drive away. But there was
33:59
Speaker 4: a lot of uproar because still today nobody's been arrested.
34:04
Speaker 4: I don't know, this happened maybe two weeks ago like that,
34:07
Speaker 4: so and it minimally sounds like there was false information
34:16
Speaker 4: provided by the folks in the ambulance at the time.
34:22
Speaker 4: And then you know, I don't know where mister Lucas
34:26
Speaker 4: was standing or what he was doing when he was hit,
34:29
Speaker 4: but not to not to stop and render aid is
34:33
Speaker 4: is problematic as well. But the uproar has been, well,
34:36
Speaker 4: why I haven't nobody's been charged yet? And the feeling is, well,
34:41
Speaker 4: these are government workers through the county system that you know,
34:45
Speaker 4: each county has the prosecutor. In this case it's miss
34:48
Speaker 4: Resnick is the w Resnick is the is the county prosecutor.
34:53
Speaker 4: And and but what mister Summerson was, she's taking a
34:57
Speaker 4: reasoned approach gathering evidence so she can prosecute the case properly.
35:01
Speaker 4: And you know, I don't know, I mean, we don't.
35:04
Speaker 4: It's speculations, say, well, how would another person be treated
35:07
Speaker 4: if they were driving and then hit somebody, kill them
35:10
Speaker 4: and then lied about it, would they be arrested already?
35:13
Speaker 4: I don't know. My inclination is kind of probably, But
35:18
Speaker 4: every case is different, and mister Summers feels confident that
35:21
Speaker 4: the prosecutor is doing what she needs to do. But
35:23
Speaker 4: when there's a crime committed, a lot of especially in
35:26
Speaker 4: the federal level, sometimes they'll do any felonies. Ultimately, unless
35:30
Speaker 4: there's an agreement, they have to go through a grand
35:33
Speaker 4: jury process and be indicted, and a lot of times
35:36
Speaker 4: in the federal level, they'll just do direct indictments. So
35:38
Speaker 4: if they've got somebody that committed let's say a drug deal,
35:41
Speaker 4: they won't arrest them. They'll just leave them out there
35:43
Speaker 4: and then they next grand jury session they'll indict them.
35:46
Speaker 4: Then they arrest them as a result of the indictment.
35:49
Speaker 4: Doesn't happen as often in the state court system, but
35:53
Speaker 4: an initial arrest, like in this particular case, would be
35:59
Speaker 4: you know, when somebody's arrested, do you have to post bond?
36:01
Speaker 4: So if you got some concerns somebody's gonna run off
36:05
Speaker 4: or abscond, I mean not really absconding if they are
36:07
Speaker 4: on bond, I mean they're free to leave and they
36:08
Speaker 4: can go to Mexico or Belize or wherever. Uh, and
36:12
Speaker 4: they're not on bond, So then they'll once once a
36:15
Speaker 4: warrants issued, then they'll have to be tracked down. So
36:17
Speaker 4: that's that's a concern. I mean, obviously the prosecut doesn't
36:21
Speaker 4: feel that's a major concern because she would have probably
36:24
Speaker 4: issued a warrant had them arrestaurant in more bond. So
36:29
Speaker 4: but anyway, maybe next week. We also have the Voting
36:32
Speaker 4: Rights Act decision from the U. S. Supreme Court yesterday
36:34
Speaker 4: which is kind of complex, but maybe we'll break it
36:36
Speaker 4: down on a on a kind of a common sense aspect.
36:40
Speaker 4: Next week can talk about a little bit.
36:41
Speaker 2: I kind of need that, so I look forward to that.
36:43
Speaker 2: That's Tom Payton from the Patent Law Firm online, Payton
36:45
Speaker 2: Lawfirm dot com. P E Y T you in Peyton
36:47
Speaker 2: Lawfirm dot com in Mitro, West Virginia. Three's aer A
36:50
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36:54
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Speaker 2: six Every Thursday right here at eight twenty ask the law.
36:59
Speaker 2: You're on five adws HS the Voice of Charleston. Tom
37:01
Speaker 2: will see you or Harvey next week. Yeah, look forward
37:03
Speaker 2: to take care of That is Tom Payton from the
37:05
Speaker 2: Paton Law Firm. Up next, it's gonna be me. I'll
37:07
Speaker 2: be walking down the hallway on five eighty love filling
37:10
Speaker 2: in for Dave Allman. I'll see you. Then. You're listening
37:12
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