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VIDEO TRANSCRIPT:
Hello everybody. This is Robert Mansour . Today I wanted to make a video about how uninsured motorists works. If you have uninsured motorist coverage on your auto policy, which I hope you do ... It a very important piece of insurance, you have to understand how it actually works. Let's say you have uninsured motorist of say, $15,000. What that means is, if the responsible party in the accident has zero insurance - doesn't have any insurance at all - at least you can turn to your company and say, "Hey...the responsible party was uninsured. Therefore, my uninsured motorists policy should apply." You will get coverage up to $15,000. Now that doesn't mean you'd get a check for $15,000. That means that they will pay up to $15,000. If your case is worth say, $5,000, they're not going to pay you $15,000, even though they are your insurance company. That's the limit - $15,000. Now, let's talk about how uninsured motorist policies also work. Uninsured motorist is often equivalent to something called underinsured motorist. What is underinsured motorist? Underinsured motorist, is when the other part has insurance, but they don't have enough. Let's say you have a serious injury, and let's say your case is worth say, $100,000 for the case of our discussion right now. Let's say the other party, the responsible party, had $50,000 in coverage. Well, what you could do is you can take the $50,000 from the responsible party, provided they offer it to you. And then what you can do is then you can turn to your company and say, "Hey...the responsible party only had $50,000. My case is worth more than that. I would like to tap into my $100,000 underinsured motorist policy." Now, often times you will see it on your policy. It'll say, uninsured/underinsured (UM/UIM). They often go together. How does that work? Well, your insurance company would then open a claim for you, or you would open a claim and they would help you with that. And then, they would say, "Okay, you got $50,000 from the responsible party. We think your case is worth $75,000. You might say, "Well, I think my case is worth $100,000. I should get all the money!" They say, "Well, we don't agree with you." You can see there could be a disagreement between your company and your evaluation, or your company might agree with you. Your company might say, "Yeah...your case is worth $100,000" or they might say, "You know what? You got $50,000 from the responsible party. That's enough. We don't think your case is worth anymore than $50,000. We think you've been adequately compensated." Here's the thing. Even though now we understand that you and your insurance company may have a difference of opinion. Here's how it would work mathematically. Let's say for example, you and your insurance company agree that your case is really worth $75,000. Don't forget you have a $100,000 policy available to you. If they and you agree, $75,000, what they do then is they subtract what you got from the responsible party. In our example, you got $50,000 from the responsible party. What that means, is they would say, "Okay, $75,000 value, minus $50,000 you got from the responsible party. We will give you $25,000." If you add the $25,000 to the $50,000 you got from the responsible party, that equals $75,000. Your insurance company effectively gets a "credit" for what you got from the responsible party. Now, that stands to reason. Remember, if the responsible party has zero, your insurance company's going to subtract zero. They're going to pay you the entire amount that you and your insurance company agreed to. Now, if you an your insurance company cannot agree to the value of the case and you think it's worth $100,000 or $200,000 or whatever, and they think it's worth $75,000 - well in that particular case, what most often happens is you might have to enter into something called "arbitration" with your company. You and your insurance company basically go to battle with one another - but in the context of arbitration, which is a little, bit less formal than going to court. You would hire an arbitrator that both sides agreed to. The arbitrator would hear the case. Usually this arbitrator is a retired judge in most cases. They hear the case. They listen to both sides just like a "mini trial" and then they make a decision that both sides have to live with. That's a little bit of an explanation as to how uninsured motorists and underinsured motorists work. I hope you found this video helpful. Thank you very much for watching. VIDEO TRANSCRIPT: Hi, this is Robert Mansour. I'm a lawyer in the Los Angeles area. One of my areas of practice is personal injury. I wanted to spend a few minutes with you on this brief video to talk to you about things you need to keep in mind when treating with doctors and physical therapists after your personal injury case.
What you want to make sure you understand is that the insurance companies are going to be evaluating your case partly on what's called the diagnostic codes, which means that what the doctor writes down as your diagnosis is going to be considered by the insurance adjuster. That's why when you go to the doctor you have to tell the doctor everything that's bothering you and with great specificity. So you can't just go in there and say, “Oh, my neck hurts.” Well, what is it exactly? “Oh, I have radiating pain into my shoulder and between my shoulder blades or my middle back, my upper back and my lower back hurt me” rather than oh, my back hurts me. What is it exactly that you're feeling? What are your symptoms? The doctor has to write all this stuff down. It's transferred into a diagnostic code that is written in your medical records. The reason this is important is because if something is not in your medical records it's like it never happened. So, if there's a diagnostic code that is missing or some complaints that you have that are not documented in those medical records, then it's like it never happened. The insurance company will not consider it. You see, the insurance companies are using software more than ever to analyze their cases. So a lot of major insurance companies now are using software products in order to evaluate these cases. What they do is they'll type in your age, where you live. They'll type in all the diagnostic codes. They'll type in all the treatment codes, any treatment that you received from any place. Also, they look in the medical records to see what kind of complaints you had. This is why it's very important to indicate in your intake forms when you go to the doctor. When you talk to the doctor, every time you see the doctor, you've got to mention what you're going through, what you're feeling. I had a client. She called me and she said, “I'm having a really hard time at work. I'm having concentration issues and also my back is killing me when I drive for more than half an hour.” I told her, “You need to tell the doctors about this. It needs to be written in your records.” The reason once again, if it's not in your records it's like it never happened. So, once again, please keep in mind that you're got to tell the doctor everything that's going on. Those diagnostic codes are very important. The way the accident has affected your daily life you want to make sure you tell the doctors and the physical therapists about that. You know, every time you go to the doctor they ask you. They say, “How you feeling?” You go to the physical therapist, “What's going on? How are you feeling? What's been going on since the last time we saw you?” That's where you tell them with great specificity what's going on so they can document it. Of course, if it's not documented then it's not going to end up in the software and the software will not analyze your case and the insurance adjuster will just treat it like it never occurred. I hope you found this video helpful. My name is Robert Mansour, and thank you very much for visiting today. If you want to learn more about my practice, you can visit www.valencialawyer.com, or you can call my office at 661-414-7100. Thank you very much for watching this video. After a car accident, it would be a good idea to sit down and make an exhaustive list of all the injuries you had after the accident. Be very specific. For example, if you tell the doctor that you had "shoulder pain radiating into your neck," the doctor might simply indicate that you had "shoulder pain." However, you actually have two injuries - one to your shoulder and one to your neck. Therefore, the doctors records and reports may simply reflect one area of your body when in fact two areas were affected.
You have to segment your injuries into sub-parts. For example if you say "I have back pain," that may be simply be considered as one area of injury. However, your back can be broken up into three regions, the mid back, the low back, and the upper back. Also, you might have pain in your shoulder blades, or your waist area or your tailbone. Again you have to be very specific because each of these things can be considered a separate injury. If you don't segment your injuries into sub-parts, you are allowing the adjuster to devalue your claim because the specific injuries are not listed. For example, if you say "my arm hurts," this may be problematic because the "arm" can involve pain in the fingers, the wrist, the hand, forearm, the bicep, the tricep, the shoulder, or the elbow. You see, the arm can be broken up into so many different regions that can be considered separate injuries. If the doctor only writes down "patient's arm hurts," then you have shortchanged your case by failing to mention all the subcategories of your arm that were also injured. Most doctors are not this specific, so you might have to be. The doctors need to be very exhaustive in their documentation by segmenting your body into as many parts as possible and your injuries into as many sub-parts as possible. Otherwise, the insurance adjuster will be inputting incomplete information into their analysis software and therefore undervaluing your claim. That is why it is a good idea to make a very detailed list of all the injuries you have from the accident. Do not only mention the injuries that currently bother you, but mention every single thing that bothered you from the very first day. Otherwise you might miss something. Also make a very detailed list of how the accident affected your daily life. Do not only mention how your daily life is currently affected, but also talk about how your daily life was affected shortly after the accident. Be very specific about any limitations you might have had. You can include simple things like vacuuming, doing chores, gardening, lifting, bending, playing with the kids, and anything else that was affected, including your work. These effects on daily life may also affect the value of your personal injury case. Every time you go to the doctor, they will ask you how things are going. You want to make sure you mention to the doctor any limitations you're having and make sure they are noted in the records and in the doctor's reports. If they are not mentioning your records, it's almost like it never happened. If you need help with your Santa Clarita personal injury case, please call my office for a free consultation at (661) 414-7100 There has been an issue that has come up twice in the past week that I think needs to be addressed. If your vehicle is a total loss, the law provides that the responsible party (or their insurance company) is supposed to compensate you for the reasonable value of your car. My client was recently offered $750 for his car. He was furious. He said, "How am I supposed to buy a new car with $750?" I told him the law doesn't provide him with a NEW car. The law says he gets the "reasonable value" of his car when the accident occurred. I explained his car had 300,000 miles on it and was over 10 years old. He originally bought it as a salvaged title for only $1700 nine years ago. We checked Kelly Blue Book online and found $750 was indeed the ballpark value. He said, "I had no car payment before, and now I'm going to have one!" He was very upset.
I explained that just because his car was a total loss, he doesn't get to buy a brand new car and have no payments as a result. I explained he would actually be in a better position than he was before the accident if the law was designed that way. Some people believe the defendant (and his insurance company) should be punished for his/her actions. In other words, to "punish" the at-fault driver, the law should make him buy a new car for the victim. People are often surprised the law only provides for the reasonable value of their car on the date of the accident - NOT what you bought it for. If they have to go buy another old $750 car, so be it. I have the same conversation with prospective clients on a regular basis. It goes something like this, "John, I know they are only offering you $1000 but your car was 100 years old and was barely functional. It had over 200,000 miles on it! The insurance company is NOT going to give you $15,000 to go buy a new car if your car was only worth $1000! If they did that, then EVERYONE and their brother would go get into an accident with the hopes of getting a new car!" As for car payments, that's just a reality of life if you finance any car. If you take the $1000 offer and you go buy a $25,000 car, you are going to have a car payment. There is no way around it." After the clients realize the law doesn't provide them with a new car, then they get upset. I wish I had great news, but the truth is that accidents are unfortunate events. I don't have any clients who really "enjoyed" being involved in an accident. No one ever says, "Wow, that was a great experience. The insurance company gave me everything I want....including a new car even though I was driving an old clunker!" So here is the lesson, if you get into an accident, just realize you are only supposed to get the reasonable value of your car ON THE DATE OF THE ACCIDENT - not how much you bought it for years ago. Even then, they may lowball you. So do your research and find out what a fair offer is. They are NOT going to buy you a new car unless your car was new. Robert Mansour used to work for the insurance companies as a defense lawyer. Now he represents victims of serious accidents. He serves Santa Clarita, Valencia, Saugus, Canyon Country, Castaic, Newshall, and surrounding areas. Call (661) 414-7100 for a free consultation. |
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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