I was writing a check to pay my monthly car insurance bill when I hesitated and thought of the bureaucratic maze I was never aware of until my brother was in a major car accident. Immediately, I thought of the seemingly non-stop commercials on television for respective car insurance which stress low cost and savings but never bother to enter into the incomprehensible language and maddening process one is forced to go through should such insurance be needed, especially when medical care is involved. I wish my brother, who is five years younger than me, and actually uses the same car insurance company as myself, had been more exposed to the writings of Kafka, but I’m not sure even reading The Trial or The Castle would prepare one for what he’s had to endure. But then again, it’s not personal, that’s what many say, though it is very, very personal for the one who feels helpless and crazy once caught within the seemingly never ending web in which the legal and insurance professionals navigate with ease.
About a year and a half ago the phone rang at a bit before eight in the morning and I answered on the second ring. I was still half-asleep when I heard my brother cry out in pain and panic, “It hurts, it hurts, call 911, call 911.” And then silence, the connection broke off. I sat up and tried to figure out what was happening. I had no idea. My brother was obviously injured but I had no idea how, or even where he was. And, I thought, he must be scared and in shock or why wouldn’t he call 911 himself?
It was an emergency situation, of that I was sure, so I didn’t have time to waste. My brother lives alone, and works the midnight shift, and was most likely on his way home when the call came. I tried a couple times to reach him on his cell phone but it was out of service, nothing else to do, the hell with it, I called 911.
I explained the situation to the 911 operator, who, in turn, told me there had been a car accident one town over, the town where my brother and I had grown up, and that those in the accident were being transported to nearby Englewood Hospital.
Okay, so now I had a bit of information, but my imagination was still running wild as I began to accept the probability and resulting reality that my brother had been in a car accident, and a serious one at that. The phone rang again and it was a woman from the company where he works as a security guard. She confirmed what the 911 operator had said and now, within fifteen minutes of my brother’s panicked call. I was on my way to the hospital, with no clue about his condition.
I entered the emergency room and was directed down a corridor to the eighth room on the right where I found my brother lying flat on a stretcher like bed with wheels, his head and neck encompassed in a brace. He looked stunned, but his faculties were intact, and he seemed alert, recognizing me at once. Tears came to his eyes and I knew he was thinking of our mother who had died recently after a long, heroic battle against breast cancer. The nonverbal communication was clear, my brother was acknowledging he was scared and worried, and in pain, his world had changed in a second, and he thought of me as what was left of his family.
He looked okay, though that didn’t necessarily mean anything, and in truth, didn’t. A brusque, overworked doctor came into the room and started peppering my brother with questions, which my brother dutifully answered. Then the doctor asked my brother to roll over on to his left side, and as my brother did so, he let out a blood curdling scream of excruciating pain and automatically lay back flat again.
The emergency room nurse was actually the first one who came up with the correct diagnosis, which was confirmed by x-rays, that my brother had suffered a broken pelvis. The doctor confirmed that it was an exceedingly painful injury but there wasn’t much that could be done at the moment. Time, he would need time to recover on his own, but of course, he shouldn’t be expected to do much for at least a few months.
So, now that I knew my brother was not in a life threatening situation, and would eventually be okay, though that’s a relative term, I started to learn the details of the accident.
He was coming home from work, taking a route he had driven countless times, down the hill from the Palisades flanking the New Jersey side of the Hudson River and continuing down through the town where we grew up, using familiar side streets to avoid the morning rush of traffic. He came down a side street, one block over from where we lived as kids, traveling east to west, an area he knew well. There was a four way stop sign at the intersection where Jones Road crossed Linden Avenue, with Jones being the much more heavily used thoroughfare.
It’s not fair to judge, and serves no purpose, but I never trust other motorists and just assume other drivers are going to do stupid and dangerous things. Since I routinely expect to be cut off at any given moment by a careless driver, I never lose my temper over such antics, being prepared well in advance for them to routinely take place. My brother didn’t do anything wrong, or out of the ordinary, but it didn’t matter, one has no control over other drivers.
At the stop sign, my brother came to a proper, required halt. He then began making a lefthand turn on to Jones Road, and then there was a momentary shock of recognition that a car, one zipping north on Jones Road, was not slowing down at all and shot right through the stop sign, slamming into the door on the driver’s side of my brother’s car, crushing and crumbling it up into a twisted mess of metal and pinning my brother against the other front door of the car.
Frightful recognition, and then sudden realization of consequences. My God, this really happened. I’m sure my brother was having trouble comprehending the reality of what had just occurred. He automatically thought of me, since our mother was dead, and managed to dial my number on his cell. Why not call 911? Shock, combined with fear, and sudden pain, can certainly influence what should be a logical conclusion and action under normal circumstances.
My brother was trapped in the demolished remains of his car. EMS, the police, even firefighters were on the scene within minutes. While my brother lay dazed and immobile, rescue workers started prying him out of the car with the jaws of life. Once they could reach him, he was carefully pulled and eased out of the wreck, placed on a stretcher, and rushed to Englewood Hospital.
The other driver was a well-dressed Korean gentleman in his mid to late fifties, immaculate in an expensive grey suit. He didn’t speak English well, in fact, not well enough to sustain a simple conversation. While the emergency workers were trying to get my brother out of what was left of his car, a policeman was questioning the man who went through the stop sign.
“What happened?” the policeman asked.
“I drive,” was all the Korean gentleman said.
Then another ambulance was called to take the Korean gentleman to the hospital to make sure he hadn’t suffered any injury, which he hadn’t, since I saw him later sitting in a cubicle off the corridor of the emergency room and he looked out at me, not knowing who I was, of course, with a complete lack of comprehension about where he was and why.
Now I’m at the point where I’m thinking of the actor Jack Webb as Sgt. Joe Friday on the television show Dragnet, saying, in his trademark monotone voice, “Just the facts, Ma’am. Just the facts.” The facts in my brother’s situation with injuries from his accident are simple, but proving what’s true against an immense bureaucracy and entities making moves based on perceived self-interest and the bottom line is an entirely different matter. In fact, listening to my brother attempt to explain all the different doctors, insurance companies, workers’ compensation, COBRA (Consolidated Omnibus Budget Reconciliation Act), a temporary continuation of group health coverage that otherwise might be terminated, and this and that, I was becoming more and more confused and lost trying to follow the intricacies and consequent developments of something that never should have been so complicated.
I could probably write what happened on my own, but I have a timeline of events, due to my brother, who has a brilliant memory for dates and keeps good records.
Those are great attributes my brother has, much better than my disorganized sense of organization with details, but when official documentation is involved, especially from third parties, you need actual tangible, verifiable records, and the legal process is not synonymous with timely resolution.
So, let’s see, here we go, three months before he was in the car accident he was injured in a mishap at his part-time job where he suffered a calcareous chip to his left ankle. He was referred to a doctor, through his health insurance from his full-time job, I think, and fortunately, an x-ray was taken.
In mid-September, a month before the car accident, my brother was given the okay to return to work, meaning his full-time job, on restricted duty, and then in the final week of September, he was given the green light to resume his regular work duties.
So, my brother was injured on his part-time job, and as a result, couldn’t perform what was required for his permanent job, but it came down to “So what?” and “Tough luck” — you are not entitled to compensation.
Okay, so my brother took an unexpected hit financially. And then he was back at work and the car accident occurred a month later, in October. His car insurance company, as far as I know, referred him to a doctor at an orthopedic group, and the doctor confirmed my brother did indeed have a broken pelvis. On his second visit, in mid-November, my brother mentioned his left ankle hurt and the doctor advised him not to put weight on it and return in four weeks. The pain from the broken pelvis was apparently, and understandably, so extreme, the ankle was an afterthought.
My brother dutifully returned in December and complained that his ankle still hurt. That’s when an x-ray was finally taken and another doctor at the orthopedic group looked at it and immediately said my brother had suffered a “non-union” fracture — whatever that is — and required surgery. The next day my brother came back with the x-ray taken when he suffered the chip in his ankle from the July injury, and the doctor confirmed the necessary surgery for the “non-union” fracture to his ankle was definitely from the car accident. The doctor explained the procedure my brother needed would require a bone graft and placement of two screws during surgery on his left ankle.
Hope no one’s lost yet, though I can certainly understand how one might be. My brother subsequently returned to see the doctor who was to do the surgery for a preparation visit, all systems were go, and then, a week or so later, the orthopedic group informed my brother that his car insurance company had refused to cover the surgery, arguing that his ankle injury was not sustained in the car accident but when his ankle was first hurt three months prior to that.
And then, the delays started. My brother definitely needed the surgery, but the car insurance company wouldn’t cover it, and my brother’s health insurance, which is based on the number of hours worked per month, expired because my brother was injured and unable to work, so he was forced to pay for COBRA to cover the surgery. I’m so lost now, unfortunately, I have no idea who paid for the 15 or so physical therapy sessions my brother needed to go to once the cast was removed and he no longer needed crutches.
Okay, enough, time to get back to the beginning where I was writing a check to pay my car insurance bill, the same car insurance company that denied coverage for my brother’s ankle surgery. It’s been almost two years now since the car accident and my brother, who was forced to get a lawyer, recently squared off against a lawyer representing the car insurance company in an arbitration hearing. “Don’t get angry,” many advised my brother. “It’s routine, nothing personal,” which may be true, but that doesn’t make it right.
The ruling should be coming down soon about whether the car insurance company or my brother is responsible for paying for the surgery and other related costs. Sgt. Friday, studying the facts, would conclude, I think, or hope, that the sequence of events prove conclusively that the July x-ray shows no ankle injury requiring surgery, and that the x-ray after the car accident in October, though not taken immediately, reveals the injury requiring surgery — before and after x-rays, actually, but the adversarial nature of the impersonal legal system continues to grind along, so this essay has no conclusion, except that my brother is back working, though with two permanent screws in his left ankle.