Many people are surprised to learn that the insurance company for the party at fault does not pay their medical bills as they become due. In other words, they won’t pay your medical bills until you are finished with your treatment in most cases. This can prove to be an unpleasant surprise for many people. Also, the treating doctors aren’t terribly happy about it because they want to get paid.
Keep in mind the insurance company for the party at fault doesn’t really have any obligation to you. First, they have to “investigate” and “determine” whether or not the accident was your fault or not. After that, don’t expect them to pay your medical bills whenever you present them. First, they will have to “determine” whether or not your treatment was reasonable in THEIR opinion. In some cases, they use databases or other computer software to make that determination. Then, they will look at every single charge you incurred to see whether or not they agree with the charge by the doctor. If they don’t agree, they will slash the doctor’s bills – in many cases dramatically, leaving you with a big hole to fill. So all the assurances of the world from the other party’s insurance company should mean nothing to you at the end of the day because there is no guarantee they’re going to pay your medical bills. In most cases, the adjuster alone determines your charges are unreasonable. Yes, this is the same adjuster without a medical degree. Hi, this is Robert Mansour. There are five common mistakes I see in personal injury cases that I want to share with you.
The first one: Giving far too much information to the adjuster during that very first phone call. Not a very good idea. No. 2: Failing to take pictures of all the vehicle damage, injuries, etc. You’ve got to document those things. No. 3: Waiting too long to go to the doctor if you’ve been injured. The longer you wait, the more the insurance company is going to say that you had no injury whatsoever. Also, not mentioning your injuries to the doctor. You go to the doctor but you forget to mention something or you figure you’re going to tough it out and not say anything to the doctor. A very common mistake. Finally, you have to have reasonable expectations when it comes to your personal injury case. This is not the lottery. No one is going to get rich. It’s all about fair compensation. If you have any questions about this or anything else, please contact my office. Thank you. I’ve recently been handling two personal injury cases that involved fairly serious injuries. The problem is that in both cases, the party responsible for the injury did not have enough insurance. In fact, in both cases, the responsible party had $25,000 in car insurance. Needless to say, my clients were not very happy about this fact but in both cases, they luckily had “uninsured” motorist (UM) coverage. In most cases, that also means “underinsured” motorist (when the other party doesn't have ENOUGH insurance). In fact, they had $100,000 in underinsured motorist coverage. That means if the other party doesn’t have “enough” you can turn to your own insurance company for additional coverage.
However, that probably still isn't enough to compensate them for their injuries. My clients were upset about this. However, the amount of UM coverage one has is completely within your control. Therefore, while you can’t control the amount of insurance the other party has, you can control the outcome to some extent by carrying a large UM policy. There are so many people driving out there without insurance or in some cases, not enough insurance, to it behooves you to explore adequate UM coverage. Ask your insurance company or broker about it. It’s probably the single most important piece of auto insurance coverage you can get. You don’t have to use the other party’s insurance company to pay for your property damage. Some insurance companies are actually telling clients to do that. You might call your company and they will tell you that you have to use the company of the responsible party to fix your car.
However, if you have your own insurance company’s comprehensive and collision coverage, you should be able to turn to your own insurance company and have them fix your vehicle. In fact, this is usually the best way to go. I’m not sure why the insurance companies are doing this (passing the buck), but I’ve been hearing this story more often than not. You have every right turn to your own company to fix your own vehicle. You will incur a deductible, but your insurance company will reimburse that to you eventually in most cases. There might be some rare cases where your insurance company won't impose the deductible. Just ask them if they'd consider waiving the deductible, especially when it's pretty certain they're going to recover the money from the opposing insurance company. After they fix your car, they will demand repayment from the other party's insurance company. If they can't resolve their claim, they might enter into arbitration - this is the process by which insurance companies resolve their property damage disputes. Suffice it to say that when they get repaid, they should reimburse your deductible to you at that time. You might have to check with them every so often about that. Believe it or not, sometimes they forget but they usually do remember to reimburse you. The sky is blue. We all know it. Insurance adjusters need more “information” before determining if the sky is blue! Well, I’m probably being silly here but only to make a point - there are some adjusters who stall by requesting additional information about everything! You can tell them you lost wages from your job. That won’t cut it. You can send them a letter from your employer. That won’t cut it. You can send them tax returns. Guess what? They want “more information.”
Some insurance adjusters drive me crazy by requesting lots of unnecessary information. It seems that regardless of how much documentation you give them, they always want more. In my opinion this is nothing but a stall tactic. These are people who can’t see the forest from the trees. You’ll provide them with adequate information regarding lost earnings but unless you have a video of you sitting at home in pain, they just won’t believe you. These insurance adjusters are making life difficult because they are trying to postpone the settlement of your case. They realize in their heart of hearts the additional information is not going to make any difference in their offer. Nevertheless, they will string you along and they will continue asking for additional documentation! Not all adjusters are so myopic. Many of them get it. Usually the ones who have been doing it long enough actually know what they are doing. However, some give others a bad reputation….just like some lawyers give the profession a bad reputation. When I worked for a major insurance company, there were some adjusters who wouldn’t give their own mother a nickel. Then when a jury awarded the plaintiff money, these same adjusters called the jury “crazy.” I think some adjusters simply confuse the standard of proof in a civil case with that required in a criminal case. They need proof “beyond a reasonable doubt” when in fact, a “preponderance of the evidence” is the actual standard. Just like my Mother told me, “Some folks are difficult just to be difficult.” Sometimes, insurance company adjusters will deliberately delay a settlement. They are getting a steady paycheck, and often have no incentive to settle your case. Sometimes, they hate their job, so they’re going to get even by making your life miserable. They know that they have all the time in the world, while you are the one who is under time pressure. After all, in most cases you need to file a lawsuit within a certain period of time. Some insurance adjusters simply try to run the clock against you. Even if you have good insurance, you may find that it is very difficult to get them to make payments and reimburse doctor bills. They are in no hurry. Usually the other party’s insurance won’t pay your bills until you’re done treating. Sometimes, they won’t even return your call. They understand that you are getting dinged by doctors and bill collectors. They figure the longer they take, the more desperate you will become. The more desperate you become, the more likely you will be to accept their low-ball offer.
The insurance company is going to be reasonable with me.
Many people try to handle their own personal injury case. There is nothing necessarily wrong with that. However, the mistake occurs when they believe that if you simply write the insurance company a nice letter and act a reasonable fashion, they will be reasonable with you! Sounds fair, doesn’t it? Well that’s not usually how it works. Insurance companies have seen their fair share of scams and people who exaggerate their claims. They have, in many cases, become hardened to personal injury claimants. They give everyone a hard time. Mother Theresa can make a claim, and they probably will hassle her. I have to give the insurance company a statement. Another mistaken belief some people have is that when the opposing party’s insurance company calls, they have to give a recorded statement. That’s not true. You don’t have any legal obligation to give a statement to the other party unless there is a lawsuit pending, and your deposition is taking place. The insurance company for the guilty party is going to pay my bills. Some people also believe that the insurance company for the other party is obligated to pay your medical bills as they are due. Most of the time, you’re going to have a very difficult time getting them to pay anything at all. If they offer to pay ALL your bills, go get your camera and take a picture. That would truly be a Kodak moment! There is an interesting trend that I must discuss today. I got another call from a potential client. He is confused because the insurance adjuster for the responsible party wants to have “coffee” with him. The adjuster wants to “talk” things over with the client. This tactic is usually done a few days after the accident. Trust me…the insurance adjuster doesn’t just want to “talk” to you. They aren’t interested in exchanging recipes, talking about family, or any other chit chat. So why do they want to meet with you?
Unfortunately, some insurance companies are encouraging their adjusters to wrap up their personal injury cases as quickly as possible by meeting claimants in coffee shops or other locations in an effort to get them to settle their case. Generally, they will meet you and present you with a check of some small amount – usually much less than you deserve. They will ask you to sign a release (so they can close their file). Some people who don’t know better end up signing these releases, and they can’t come back if they later discover their injury was worse than they thought or the “settlement” doesn’t even cover their medical bills. Some insurance adjusters dangle the check in front of you like a carrot. Please understand there is no “emergency” and you don’t have to settle your case right away! In California, as of the writing of this blog entry, you have two years to file suit after an incident has occurred. Therefore, you don’t have to settle anything right away, much less within a week of the accident! Consult an experienced attorney first. It’s in your best interest. Let them dangle the carrot. You certainly don’t need to take it unless you’ve explored your options with a lawyer. As a personal injury lawyer in the Santa Clarita, CA area, one of the things I always have to make sure I do as a lawyer is clear any and all liens that might be attached to a person’s injury case. Therefore, before I make a demand from the other party’s insurance carrier, I have to make sure all those parties and entities that might have a lien are resolved. Here are some things to consider:
1. Did my client’s car insurance company pay any money for the medical treatment? Many of my clients have something called “Medical Payments Coverage” under their own insurance policy. In some cases, this “MPC” coverage pays for the medical bills. If so, I have to make sure that we address their reimbursement. Sometimes, they are willing to waive reimbursement under the right circumstances. 2. Did any of my client’s medical providers work on a “lien” basis? If so, they need to be paid for their services. If the doctors work on a lien, that means they provided care with the anticipation they will be paid from a potential settlement. 3. Did my client’s health insurance company pay for any care? If so, most health care companies have the right to reimbursement. Therefore, those issues need to be addressed as well. Before making a demand for settlement and/or actually settling my client’s cases, I have to address all existing and potential liens on the case. Otherwise, my clients might be facing an unpleasant surprise later. After an automobile accident, the insurance company for the other party will probably call you and ask you to give a recorded statement. As a general rule, I am not in favor of giving these kinds of statements, especially so early on in the case. The sad truth is that the insurance adjuster doesn’t really have your best interests at heart. They will generally sound very sympathetic and express their desire to help you in any way possible. They will try to encourage you to give them a recorded statement, sometimes only a day or two after the accident has occurred. In many cases, they are trying to box you into a story.
In some cases, the insurance adjuster will try to use your statements against you. They can easily get the police report and find out what happened so there is really no pressing need to speak to you. Keep in mind you may not yet fully appreciate the extent of your injuries so soon after an accident. If you don't report injury (the existence of an injury or the extent of an injury) then a later claim of injury may appear contradictory to your earlier statement. Some insurance companies actually have a policy that any information gained from the recorded statement can be used later to deny the claim or pay out less than the claim actually deserves. As the old saying goes, "anything you say can be used against you." I usually tell my clients not to panic. There is no “fire in the barn” or other emergency that makes it necessary to give a statement so early on in the case. I tell my clients to politely decline and tell the adjuster that you will call them when you are prepared to give a statement. There is no need to get into an argument with the adjuster. If you have a lawyer, then you don’t need to speak to anyone at all and your attorney will handle it. I spent much of my career as a defense attorney for the insurance companies. In my years of experience (as a defense lawyer and plaintiff's lawyer), I have rarely found it to be helpful to give a statement to the opposing party’s insurance company so early on in the case. Your first order of priority is protecting your interests and making sure that you get the medical care that you need. There are times when giving a statement is necessary or prudent. If you are talking with your own company, then you probably have to cooperate with them. They are usually on your side as they have a duty to you that the other insurance company simply doesn't have. However, you should still be careful what you say as it may come back to haunt you. Speak to an experienced lawyer first. You have nothing to lose. Learn what your rights are first before you make a decision to speak with the insurance adjuster. |
Categories
All
Archives
April 2024
|