To Quiet the Little Voice - 1. Since when is that acceptable?

Prompt 254

First line

“Since when is that acceptable?”

The arbitrator sat motionless, waiting for a response. This entire case was a huge waste of time. These claims should have been paid as a matter of course. Situations like this are exactly why people have insurance.

***

Bright sunny days are not the sort should result in a catastrophic auto accident. Fog, rain, or snow, certainly, but on a beautiful August afternoon? That didn’t prevent a tractor trailer from wandering onto the wrong road and hitting an overpass, nor did it stop eight other vehicles from swerving, sliding, and otherwise scrambling to get out of each other’s way. Then add the fire apparatus, the ambulances, and the patrol cars along with a host of lookey-lu’s and the result was a royal mess. One victim sat overlooked for hours. Unfortunately he was one who would have made a full recovery, if he hadn’t fallen through the cracks.

James’ forte was falling through the cracks. When he was in grade school a minor learning disability went undiagnosed. High school saw him get the one homophobic teacher in the entire school for his most difficult class, as well as for a guidance counselor. College? The computerized grade system regularly deleted his grades.

After the extended lack of care James’ leg injury resulted in permanent damage. Adding insult to injury, all of the pertinent insurance companies refused to pay any of the bills. They all seemed to think the driver of the semi was at fault, and his insurance should foot the bill, with him personally taking up any slack. No wonder James had filed a grievance with the insurance review board.

The representative from Able Auto Insurance had actually made a decent case. The driver at fault should be responsible for any and all damage to James’ vehicle. If the driver had actually been at fault. The roadway was not marked as restricted in any way, either at the entries, on the road prior to the low overpass, or on the available maps of the area. GPS navigation systems fail to mention the low clearances as well. One aspect of the case settled, one cannot reasonably hold the old man responsible. No fault rules kick in and Able Auto will pay. Since they had pushed the issue this far, the arbiter thought, perhaps a non-cancelation/no rate hike provision should be included in the written decision. He added the idea to his notes.

The claim against the first responders for not finding and taking care of James was out of his jurisdiction. The most he could do with it was to refer it to compensation court.

“I’m waiting” intoned the arbiter slowly. The representative from Amalgamated Health squirmed in his seat. He hated his job and truly wished he would lose this case. He wouldn’t mind if he lost his job over it either. He couldn’t justify just walking away before he had secured another position, but he could handle a bit of time between jobs.

“Most of the cost of Mr. Roberts’ medical care could have been avoided had he sought immediate treatment. Had he done so there would have been no subsequent infection or disability. As such, costs for all the antibiotics, surgical treatment to drain said infections, the orthopedic issues caused by the infection, and the extensive rehabilitation costs all should be disallowed.”

“Objection!” shouted attorney at the complainants table. He was knowledgeable, young, and way too enthusiastic. One would think this his first arbitration.

“Young man, I appreciate your desire adequately represent your client, but it is not necessary to object. This is arbitration not a trial. Nor do you need to shout. My hearing is quite acute. Now, just say what it is you wish to say. This is a discussion, at the end of which I will draw my own conclusions.”

“Yes sir”. The young blond looked down sheepishly. James thought it made him look adorable. “My apologies. This is my first time as lead council rather than sitting second chair.” He straightened visibly and continued.

“While it may very well be true, all of these expences could have been avoided had treatment occurred immediately, Mr. Roberts can hardly be held responsible for the ineptitude of the first responders. He managed to extricate himself from a mangled vehicle, crawl to safety on the grass hillside, and apply direct pressure to an grievous wound, all while disoriented by a severe concussion. I submit Amalgamated Health should appreciate the possibility of additional cost to treat burns and the like were avoided.”

“Point noted Mr. Henriksen”. The arbiter turned back to the agent. “Your reply sir?”

“We should not be held responsible either” he replied lamely.

“If your company feels so strongly, I would suggest they file their own suit against whomever they consider IS responsible. But it clearly isn’t Mr. Roberts.”

“Mr. Arbiter, may we have a five minute break? My client is still recovering and sitting for long periods leaves him stiff and uncomfortable.”

“Certainly Mr. Henriksen. At my age a break or two is always a welcome thing. Everyone back here in, shall we say 20 minutes? Leaves time for me to get a decent cup of coffee. I recommend you NOT get any from the cafeteria.”

***

Settling himself again in the conference room, James smiled shyly as Henriksen placed two Danish on napkins next to coffee that smelled divine. He had literally run across the street to the quaint little coffee shop he had spotted on the way in. James had used the time to make his way slowly to the rest room at the end of the hall.

“Thanks Mr. Henriksen” he mumbled. The Nordic cutie seemed to be able to make him blush without trying.

“Please, call me Arnie. Mr. H is my dad.” He smiled back, a bit shy himself. I’m sorry if I seem a tad green. I do know my stuff. Dad would have been here but…”

“No apology needed. He could hardly control the flight being canceled at the last minute. This seems to be going really well.”

“That it does James. The arbitrator hasn’t said so, but I am certain the auto claim will be paid in full. The first responder thing will be remanded to compensation court I am sure. We only included it here to demonstrate you could not be held accountable. And as for this dude from Amalgamated? He seems to WANT to lose.”

“He isn’t very convincing is he?”

“Uh, James? I know this may sound very unprofessional, but could I buy you dinner this evening to celebrate? I am sure we are going to win this. You are dad’s client after all, not mine.” James blushed brighter than the red tie he had bought because it matched the new car he was planning on.

“I think I would like that.”

***

The arbiter smiled as everyone once again settled into their places.

“Shall we continue gentlemen? I believe we were all waiting patiently for Mr. Sorenson to explain to us WHY Amalgamated feels they should be exempt from paying this claim.”

“It’s not like I wanted any of this to happen” James mumbled.

“Hush” Arnie whispered. Then he turned and raised his voice.

“The entire point of paying for medical insurance month after month is to ensure having coverage for things like this.”

“It is an accepted precept all insured individuals exert due diligence in trying to keep health care costs down.”

“And just what was NOT diligent in my client’s actions?”

“Well…um…you see….”

“Speak up Mr. Sorenson. I am beginning to lose my patience. Either make a case here or I will issue a decision on what I have heard.”

“Damn it! The truth is the company bean counters found out Mr. Roberts is gay. He is considered a potential high risk for extensive medical bills in the future. The upper level muckety mucks feel fighting this claim will force him into changing carriers.”

“And since when is that acceptable?”