You might think your personal injury medical bills are $50,000 or more. However, you might be surprised when the insurance company offers you $23,000 for your case.
You see, when it comes to presenting your damages in a personal injury case, it's not what you are billed that matters. It's what your health care provider accepted as payment in full. Therefore, even if a doctor bills you $1500 but accepts $250 from your health insurance company, all you get to present in your case is the $250 he or she accepted as payment in full.
Even if your doctor doesn't accept your insurance, you don't get to present whatever number you want and assume the insurance company is just going to accept what you send them. So if you send the $1500 bill to the adjuster, they might reject it. Remember, the insurance adjuster's job is to "adjust" your bill, so they will argue your doctor's bill is not "reasonable." In fact, if your doctor bills you $1500 but routinely accepts $250 for the same care provided, you might have a potential problem on your hands. The insurance company may argue his reasonable fee is actually $250 since he routinely accepts that amount for similar treatment.
Several important California court decisions have come down the pike in recent years. Each case continues to reinforce the basic fundamental issue that all plaintiffs must now accept - your bills are not what you think they are. You have to find out what your health care providers accepted as payment in full and that is what the adjuster will consider.
So if your hospital bill was $4000 but Medicare paid $900, then you're stuck asking for the $900. In many cases, you may find your "big" personal injury case isn't as "big" as you once thought. To complicate matters, your health insurance providers (including Medicare, Medi-Cal, etc) may insist on their right to reimbursement.
As such, more and more plaintiffs are finding that presenting a personal injury claim is much more difficult than they thought it would be. Medical bills are known as "economic" damages. More insurance companies are slashing these economic damages since medical providers are accepting a fraction of their bills as payment in full in most cases.
Therefore, it is becoming increasingly important to focus on your "general damages," often known as "pain and suffering" damages. These damages are not about bills - they are about HOW an accident affected your life. You must document how the accident affects your daily life activities, school activities, work etc. "General damages" are becoming more and more important as economic bills are being slashed and reduced. Don't lose sight of your general damages.
Make sure your attorney and doctors are well aware of HOW the accident has affected your life. Make sure these issues are documented in your medical records. As I always warn my clients - If something isn't in your medical records, it's like it never happened!
by Robert Mansour
Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia, Saugus, Canyon Country, Newhall, Stevenson Ranch, Castaic and surrounding communities.