VIDEO TRANSCRIPT: Hi, this is Robert Mansour, and I’m broadcasting to you today from my home office in Los Angeles, California. I wanted to spend a couple of minutes talking about one of the ways that you can be misinformed by friends and family.
I got a call from a client the other day and he says, “Listen, I was in a very bad accident some years ago, and I was hospitalized then I had physical therapy, and I was on crutches for a long time…” Basically, it was a big accident. And so I said, “Well, how can I help you?” He goes, “Well I settled with the insurance company a while ago and I didn’t’ quite accept the money yet, they haven’t sent me the check, and I haven’t signed any paperwork.” And I said, “So, why not?” He says, “Well, I wasn’t sure if I was okay, and I wanted to make sure I was okay first, before I signed any paperwork and I accepted their settlement.” And I told him I said, “That sounds very reasonable, so what’s the problem?” And so he says, “Well, we’re coming upon the three-year statute and I want to make sure we file the case in a timely fashion because they’re not returning my calls, and I can’t seem to get them to address the situation.” I told him, “Wait a minute, did you say ‘three-year’ statute?” He says, “Yeah, a buddy of mine says I have three years to file a lawsuit, and if I don’t file within that three years, I’m out of luck.” I said, “Actually, it’s two years.” That’s right, as I record this video the statute in California is two years, not three years, and this is the danger, one of the dangers of listening to friends and family - they could give you the wrong information. Not just the wrong information from an opinion point of view, sometimes they’ll make it sound like they know the facts. Here is the thing: When you’re involved in an accident that requires some kind of medical attention, etc., go talk to a lawyer who’s been doing this for a while. Get their information, get their opinion, get some guidance from them because then at least you can make an educated decision. This poor fellow who talked to me, he’s out of luck. It’s well past the two-year statute. He settled with the insurance company, but what do they care, they’re not there to protect his rights. They’re there to protect their money. So, once again, always talk to a professional at the outset of your case to make sure you get all the facts and all the information that is relevant to you and your matter. This is Robert Mansour, thank you very much for watching this brief video. (Keep in mind there are different rules for various legal matters so you should consult with an attorney.) When you submit a bill to an insurance company for payment, don't expect the insurance adjuster to simply accept whatever you send them. Whether it's a property damage claim or an injury claim, most adjusters will not accept the bills you send them. They will look for every conceivable reason to reduce the bill you sent them.
Many insurance adjusters will do everything they can to minimize payment on your claim. Some look for reasons not to pay your claim. Insurance companies do not make money by giving you money, they make money by holding onto their money. That means they will look for reasons not to pay or to pay you less than what you expect. Sometimes, you just get unlucky and get assigned an insurance adjuster who thinks everyone who makes a claim is trying to "game the system." Others are working for insurance companies that have company wide policies/culture and software programs designed to reduce claims and payouts. Here are some common insurance company arguments: 1) The property damage estimate is too high. 2) The property damage estimate includes items not involved in the accident. (Most adjusters don't actually go to the body shop - they send "estimators" who are arguably beholden to the insurance companies) 3) You treated with the doctor too long (most insurance adjusters don't have medical degrees last time I checked). 4) The charges from the doctor are too high. (This is usually based on software programs arguably designed to favor the insurance companies). 5) The frequency of your treatment was too frequent. 6) The frequency of your treatment was not frequent enough. 7) You waited too long to seek treatment. 8) You sought treatment too soon. You should have waited. 9) You did not have any diagnostic testing like an MRI or CT scan. 10) You should NOT have had diagnostic testing because it was "unnecessary." (and too expensive). 11) Some of the medical records don't specifically mention the accident, so the treatment was obviously unrelated (these are adjusters who can't see the forest from the trees). 12) Your injuries are pre-existing. If you think about it, the insurance adjuster's job is to "adjust" your claim. That means they have to legitimize their existence by "adjusting" the claim you present to them. If they don't adjust your claim, then it is reasonable to question why they are even employed by the insurance company. Therefore, in an effort to legitimize their position, they MUST adjust the numbers you send them. This is true whether it is a property damage claim or a medical claim. So if the adjuster's job is to "adjust" the numbers, which direction do you think they will adjust? To "increase" the claim or to "decrease" the claim? While there are rare exceptions, they will typically adjust the numbers downward. It is rare that I see an insurance adjuster simply accept the numbers as given to them. They also rarely "adjust" the number upward. For example, I've never had an adjuster say, "I know you sent me the bill for $5000, but I think the bill should be $10,000!" Can you imagine if an insurance adjuster did that? Therefore, by design, an insurance adjuster will "adjust" your figures downward. I have never seen it the other way around. Be prepared to be disappointed. It's just the way the game is played. Hiring an attorney won't magically help your case. You must work together. We always tell our clients that we need their help while we are representing them.
Here is exactly what we tell all our personal injury clients: By hiring a lawyer, your case won’t automatically be successful! We can’t guarantee anything, but without your help we will be at a deficit. To some extent, we have to be strategic about our approach. Unfortunately, insurance companies have created an atmosphere that demands such an approach. Here are some things to keep in mind. Please review this checklist on occasion as things may change as your case progresses. 1. Keep our office advised of your current address and phone number. 2. Please get back to us promptly by email or phone if we try to reach you. Sometimes we need time-sensitive information. 3. Inform this office and your doctor(s) of any prior motor vehicle accidents or medical treatments. If you have an aggravation or exacerbation of a previous injury, they should know about it. 4. Contact our office when you have any questions regarding your claim. Do not speak with a representative of the opposing insurance company. You may of course talk to your own insurance company regarding property damage issues but keep it confined to property damage. 5. Keep all medical/doctor appointments with your doctors, as well as any medical specialists to whom you are referred. Gaps in treatment will be used against you. If you miss an appointment, try to reschedule it. 6. If you are unable to work, do not leave your doctor’s office without written verification of your working status from your doctor – in other words, get a “note” from your doctor! Lost wages from work are dependent upon your doctor’s written verification of your work status. It is your responsibility to get this information from your physician. We cannot do so. Without such notes from the doctor keeping you off work, your claim for wage loss, if any, will be severely hampered. 7. If you are going to allege lost wages, we will also need verification from your employer of the dates missed and your rate of pay. If you are missing work due to the accident, your employer (the person offering verification) should know WHY you are missing work. They need to know it is accident-related. Provide us with the name/address/phone of the person who can assist us with verification of your lost earnings. If your claim is significant, providing tax returns from the past 2 or 3 years is helpful to show the decline after the accident. They won’t pay for lost wages unless they have verification from your employer AND your doctor. They don't pay lost earnings because you are a nice person. We may ask you for help if your company refuses to cooperate with our office. 8. If you see additional doctors after our initial interview you must inform us of their name, address, and telephone number. We don’t automatically find out about these things. 9. You may have sought treatment with facilities that have no relationship with my office (especially before hiring my office). We can obtain your records from these facilities, but in most cases, a direct request from you (their patient) is more effective. By law, they should comply. Please try to obtain the medical records AND billing from these facilities. Some may insist the attorney’s office obtain the records and bills. 10. Keep track of your mileage and prescriptions and submit them to us. It helps to keep a journal of doctor’s appointments and mileage (parking charges) incurred. This can be a simple sheet of paper and/or receipts from parking lots. If your mileage is very minor, this effort may not be worth it. 11. If you receive any documents by mail regarding your case (from ANYONE), please forward them to our office. This includes health care insurance, letters from insurance companies, collections agencies, etc. Keep our office completely in the loop. We are not necessarily copied on correspondence you receive from others. 12. Your “diagnosed injuries” may affect the evaluation of your case. Therefore, you MUST tell your doctors (written and orally) about ALL your injuries. Doctors cannot read your mind. This is EXTREMELY IMPORTANT. Break your injuries down to smaller components. For example, saying “my shoulder pain radiates into my neck” will simply be considered only a “shoulder” complaint by the insurance company. Your neck pain may not be considered. If you just say “my back hurt” that will count as “one” injury when in fact, you might have “upper back pain” and “mid back pain.” That’s two injuries – not one! Keep your doctors aware of your progress or lack of progress during each visit. The rule you should keep in mind is this: Most insurance companies are using software to analyze your case. If something is NOT mentioned in the medical records, it simply won’t be “inputted” and basically doesn’t exist as far as the insurance companies are concerned. The insurance company wants to minimize your complaints whenever they can. Also, mention ALL YOUR INJURIES to every doctor you see…even if they are not treating you for that particular injury. For example, your chiropractor and orthopedist should both be aware of ALL your complaints. Inconsistencies in their records/reports may be used against you. 13. How an accident affects your life may also affect the evaluation of your injury case. You must also report any daily activities (work, school, household, etc.) that are affected by your accident. The doctors MUST document these issues or they simply won’t be considered by most insurance companies. Just like in the previous paragraph, the insurance adjuster will not input your information into their software if the information is missing or unverified by the doctor’s chart notes and/or report. We know this is a lot to keep in mind. However, we truly believe that our clients are better off if they are “informed” participants in their case. After years practicing personal injury for the defense and plaintiff, I share these guidelines with you so we can truly work as a team. Of course, your health is the most important thing, but we also want to maximize your chances of having a successful personal injury claim. Call (661) 414-7100 if you want advice regarding your own personal injury case. |
Attorney Robert MansourRobert Mansour is an attorney in Santa Clarita, California who has been practicing law since 1993. After working for 13 years for the insurance companies, he now counsels victims of personal injury. Click here to learn more about Robert Mansour. Categories
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