Why You Need An Experienced Lawyer To Deal With Shady Insurance Companies And Their Doctors

Posted by Christopher Shumate | Jul 20, 2016 | 0 Comments

Haruki Nakamura played safety for the Carolina Panthers in 2013.  During a preseason game against the Pittsburgh Steelers, Mr. Nakamura suffered a concussion.  Following the injury, he suffered severe headaches, blurry vision, and mood swings, which are all common symptoms of severe concussions.  The injury ultimately ended Mr. Nakaumura's career.  

Mr. Nakamura applied for benefits through the NFL's Player Retirement Plan.  In 2015, it was established he suffered chronic post concussion syndrome, and he was eligible for total and permanent disability benefits of $10,000 per month.  Dr. Michael Collins (director of the UPMC Center for Sports Medicine) determined the form Panther's safety is permanently disabled and likely has no hope of improvement sufficient to resume employment as professional football player.

Prior to the 2012 season, Mr. Nakumura took out a one million dollar insurance policy with Lloyd's of London.  Thereby, he paid premiums to protect his interests.  In a typical move, the insurer has denied Mr. Nakamura's claim.  The basis: the insurer claims he failed to establish the 2013 concussion had solely and independently led to his permanent disability.  The insurer utilized a paid defense expert (Dr. Manish Fozdar) to dispute the medical evidence favoring Mr. Nakamura.  Dr. Fozdar opined the concussion was minor, stating such would not lead to major depression.  He further opined the Plaintiff showed clear evidence of symptom exaggeration.  

The Defendant's examination raises several concerns.  First, Dr. Fozdar and the insurance company refused to allow Mr. Nakumura to have an advocate present during the exam.  This casts immediate doubt upon the legitimacy of the exam.  Second, Dr. Fozdar's opinions are contradictory.  He opined the Plaintiff was basically faking it / not disabled, while simultaneously warning him to consider the long term effects of concussions in considering a return to football.  Obviously, Dr. Fozdar understood the opinion he was paid to provide, but is smart enough to throw in the warning about concussions for the sake of malpractice.  

Dr. Manish Fozdar, who was hired by the insurer, disputed Dr. Collins's finding. He called the concussion that Nakamura sustained “minor” and said that it “does not lead to the development of major depression.” He added that Nakamura showed “clear evidence of postconcussive and cognitive symptom exaggeration in the absence of significant emotional factors.”

And now for my two basic points: 

First: You need an experienced lawyer to deal with shady insurance companies.  

     I sit in my office in Charlotte and talk with prospective clients routinely who naively thought the insurance company would "do the right thing".  Here is a simple truth: That will never happen.  Whether your claim is accepted or outright denied, the adjuster / defense lawyer / etc. (Insurance Company) will lie, cheat, and steal from you.  How do I know this?  I know this because I started my career as a defense attorney.  Simply put, I couldn't stand working for them.  

Second, You need an experienced lawyer to deal with shady insurance company doctors: 

      The sad reality is that many doctors have simply sold their medical licenses to insurance companies.  They will say / do practically anything an insurance company tells them to do.  Whether it's a workers' compensation claim or a civil claim (such as this), Charlotte is filled with physicians who are on approved lists for insurers.  These "experts" are routinely used in cases to challenge the credible evidence favoring a Plaintiff's claim.  These doctors perform sham exams and render ridiculous medical opinions.  While it's a sham (and a shame), this is a procedure we have to deal with and navigate as personal injury attorneys to protect our clients.  You need an attorney that understands how these claims work, who these doctors are, how to combat these practices, etc.  

I regret to hear Mr. Nakamura is experiencing this process.  However, I'm absolutely not surprised.  Any experienced workers' compensation / personal injury attorney would explain this sort of nonsense if fairly typical.  I wish Mr. Nakamura the best of luck as he proceeds.  

About the Author

Christopher Shumate

Mr. Chris Shumate is a native of Gastonia, North Carolina, and worked various jobs while pursuing his undergraduate and Juris Doctor education, including several heavy manual labor and skilled trade positions. In his practice, Mr. Shumate often encounters circumstances where these prior experiences are helpful in representing you. Upon graduating law school from the University of South Carolina, Mr. Shumate joined one of the Carolinas' larger defense firms, where he represented a diverse set of employers and insurance companies in civil cases and workers' compensation claims across the Carolinas. Chris utilized this experience to obtain a working knowledge of the insurance industry, and build personal contacts used today in representing you. Mr. Shumate ultimately decided he wanted to focus his law practice on assisting those who have been injured, and doing so with the focus on a personal relationship that is uncommon in the bigger firms. Mr. Shumate's also has a passion for assisting those facing the challenges of the criminal legal system. By representing individuals in a variety of criminal and traffic matters, Mr. Shumate works to achieve the best possible result for each client regardless of the charges levied by the prosecution. Chris has tirelessly pursued his mission of helping people from all walks of life throughout the Carolinas with a variety of legal matters. If you are interested in learning more about Chris Shumate and The Shumate Law Offices, please contact us at 704.371.5059. We look forward to assisting you to achieve a positive result in your legal concern. Education J.D., University of South Carolina B.S., University of South Carolina Jurisdictions Admitted to Practice N.C. State BarS.C. State BarU.S. District Court Western District of North Carolina Professional & Bar Association Memberships N.C. Bar Association S.C. Bar Association Mecklenburg County Bar N.C. Academy Of Trial Lawyers American Association For Justice


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