After a reckless driver seriously injured Carey Wintergreen, 62, on his bicycle, he knew he’d have a long road to recovery. What he didn’t realize is that he’d have to fight his own health insurance company tooth and nail to avoid getting much of his compensation confiscated.
In July 2015 Wintergreen, a self-employed residential and commercial architect who lives in Lakeview, was biking from his home to check out the newly opened Bloomingdale Trail when he decided to stop off at the Home Depot near Diversey and Halsted. Pedaling southbound in the buffered bike lanes on Halsted in the sunshine, he put his left hand out to signal that he was crossing to the east side of the street, where the store is located.
“I had plenty of time to maneuver because there was no oncoming traffic,” Wintergreen recalled. “I looked behind me, signaled, looked forward, and looked back again – as I always do – to ensure that the driver behind me would yield.” But as he did so, a motorist in an SUV accelerated and tried to pass him, slamming into his extended arm.
Wintergreen suffered a smashed hand, broken wrist, and torn rotator cuff, as well as road rash and gashes that required stitches. “My hand was just a bag of [broken] bones,” he said. “It was the beginning of the worst year-and-a-half of my life.”
Wintergreen’s injuries required him to undergo surgery to rebuild his hand, which required several months of physical and occupational therapy, plus a second operation to repair his shoulder and bicep, followed by several more months of therapy. A bone still protrudes in his wrist, which prevents him from being able to properly rotate or flex his wrist.
However, Wintergreen isn’t certain he’ll undergo a third surgery to fix that problem, because it would require another six-to-nine months of therapy. “I’m not sure I can give up that much more of my life,” he said.
For much of the recovery period Wintergreen was in a cast and sling, and he had to go to therapy three or four times a week. “As an architect, I need to network at events and lectures and functions to bring in new clients, but I couldn’t really wear business clothes, and therapy was dominating my life,” he said. As a result, his practice suffered, and things didn’t begin to get back on track until spring 2016, when he completed his second round of therapy.
But in July 2016, disaster struck again. “I was feeling absolutely confident about getting back on my bike,” said Wintergreen, who doesn’t own a car. But as he was cycling on Lincoln near California, his front tire hit a chunk of concrete in the road. “Because of the wrist, I couldn’t maneuver around it and I went over the handlebars.”
Wintergreen’s nose was broken and his left hand was fractured again. Luckily, the bones were aligned and he didn’t need another hand surgery, but he was back in a cast and sling.
On top of his medical nightmares, Wintergreen has had to struggle with a major legal ordeal in order to get some compensation for his injuries. (He has requested that Streetsblog Chicago not publish the names of his attorneys.)
Blue Cross Blue Shield, Wintergreen’s health insurance provider at the time of the crash, covered most of his medical bills, although he has been responsible for about $12,000 in out-of-pocket expenses. Once his medical bills and records, plus a narrative of the case were sent to the SUV driver’s car insurance company GEICO, that company paid out the full amount of the motorist’s liability policy within a week. So simple even a caveman can do it, right?
Not quite. First of all, Wintergreen said the driver’s low-cost coverage only paid out about of fifth of what the cyclist's attorney determined he was owed for medical costs, pain and suffering, and lost earnings.
On top of that, Wintergreen said, Blue Cross tried its darnedest to put a lien on his settlement from GEICO so that, after legal fees, he would have received only a tiny amount of compensation. “In Illinois, at least, in any health insurance policy there’s going to be a clause that says that, in the event of a third-party recovery, your medical insurance is entitled to a portion of that recovery to repay them for what they’ve paid in your medical costs,” he explained.
“The irony is that if the same injuries had been caused by me [accidentally] riding my bike into a wall, Blue Cross would have paid for my medical expenses, and they would have received no compensation,” Wintergreen added. “I think it’s unconscionable that my health insurance went after me for a portion of my settlement.”
Last March Wintergreen and his attorney were able to negotiate a second settlement with Blue Cross. “They got some of the [GEICO] money, but not as much as they wanted,” he said. So the injured cyclist ultimately received modest compensation for his ongoing physical tribulations and lost earnings, albeit a small fraction of what he’d hoped for.
Wintergreen still hasn’t has the opportunity to ride on the Bloomingdale Trail. Due to his reduced income he wound up canceling his health insurance policy, but he missed the deadline to sign up for Obamacare. “I’m not riding right now because I don’t want to take a chance of being injured without insurance. But in my heart of hearts I know I will cycle again.”
