I got a call today from a very frustrated caller. She was injured after another car ran a red light and t-boned her vehicle. Unfortunately, she fell into the same trap many fall into after an auto accident - she assumed the insurance company would "take care of everything." After all, that's what the adjuster told her over the phone.
She didn't have health insurance so she contacted the responsible party's insurance company to ask for help with her medical care. A few days later, she got a letter from the insurance company that stated she could go to "any doctor or health care provider of her choosing." She was also told to present her bills to the insurance company after she concluded her treatment. They said they would "be there for her." She didn't consult with a lawyer, so she simply assumed she could go get whatever medical care she wanted, and they'd kindly pay for it. Big mistake!
Just because an insurance company says you can choose any health care provider you want doesn't mean they are going to pay for that health care. Their letter was technically correct. She could indeed go to "any provider" she wanted. I asked her, "Does the letter say they will pay for all your bills - no questions asked?" Of course, they didn't say that.
So she went and incurred nearly $10,000 of medical care on a soft tissue case (sprains and strains). Now she owes $10,000 to various doctors, and the insurance company for the responsible party has offered her a whopping $500 for her case. They said her medical treatment was excessive and unwarranted. This of course was no shock to me, but she couldn't believe it.
Truth be told, her bills were probably far too high, but that's not the lesson here. Here is the lesson: Don't get medical treatment and simply assume the other party's insurance company is going to pay for it. Insurance adjusters rarely accept the medical bills you send them at face value. Remember, their job is to "adjust" your bills (that's why they're called insurance ADJUSTERS.) Here's the big surprise - they ALWAYS adjust your bills downward! Expect them to slash your bills by at least 33% to 50% (sometimes more). So don't go racking up $10,000 in bills and assume they will pay. In fact, you should assume the opposite - assume they WON'T pay.
Keep your bills low and reasonable. When in doubt, find other ways to pay for your care so you're not stuck with a stack of bills while fighting with an unreasonable insurance adjuster. If you have health insurance, consider using it. If you have medical payments coverage under your own auto policy, consider using that too. You need to be mindful of your bills. Keep track and periodically ask your health care providers how much your bills are. Don't let the bills get out of control. There is nothing rude or wrong in asking about your bills. Your health care is not an "all you can eat" buffet.
It's a good idea to contact a personal injury lawyer and run your questions by them. Don't assume the insurance company is going to pay your bills. You may dig yourself into a financial hole. Talk to an experienced attorney about your options. Feel free to call us at (661) 414-7100 to see if we can help you.
by Robert Mansour
Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia, Saugus, Canyon Country, Newhall, Stevenson Ranch, Castaic and surrounding communities.