What is a fair demand for my uninsured/underinsured claim?

Submitted by Anonymous (not verified) on Fri, 05/31/2013 - 13:03

21 Months ago I was rear ended while stopped at a red light. Very little damage to the vehicle but I was turned speaking to my son in the back seat. It was a hit and run. I initially treated the injury with Chiropratic care, steroids, massage therapy, and spinal injection. Long story short, the accident caused a bulging/herniated disc in my L4-5 region and I had to have surgery (lapindectomy?) to have a portion of the disc removed. After surgery I am doing physical therapy.

I am 39 (37 at the time of the accident) and over the last two years I have stopped playing basketball, golf, and many other physical activities. I dealt with almost constant pain and numbness in my legs over the last 21 months. It has affected my physical intimacy with my wife and created a very sedentary lifestyle. I have been diagnosed with a 10% permanent impairment. My total billed medical expenses are roughly $27,000 and I have about $1,500 in lost wages.

Because it was a hit and run I am making a one time claim against my insurer under my uninsured/underinsured policy and I am trying to determine where to start. I have about $12k of unpaid expenses (healthcare provider needs paid back. Auto medical paid the rest).

My initial thought was 3x total billed medical expenses + wages and unpaid medicals for a total of about $91,000. Am I way off?

Posted: 31 May 2013 01:43 Post Subject:

MY first question... what are your UM limits?

Posted: 31 May 2013 08:38 Post Subject:

My uninsured/underinsured limit is $100k

Posted: 01 Jun 2013 04:44 Post Subject:

What you also need to factor in is possible future medical treatment. I'd say $91k is a good starting point. I'd not expect to be offered that amount at any point, especially if this is your opening demand.

Posted: 01 Jun 2013 09:53 Post Subject:

At what point should I turn them down and go to an attorney? $65-70k? One other thing of note. I do have an IME initiated by my insurance company that confirmed the medical issues.

Posted: 02 Jun 2013 04:28 Post Subject:

It's up to you.... no one here can tell you what your injury is worth as it requires much more details. However, I'd you are probably in the correct range. Consider this... your attorney can't get more then $100k from your policy. The attorney keeps 33% of this which leaves you $66k. Do you think you could get $66k or more? If you can, they attorney would be a complete waste of your money. Feel free to do your best at getting at least $66k, If you can get this or more then an attorney will get be stealing money from you.

Also, if any medical expenses have not been paid then feel free to move forward with settlement but right before you do, contact the unpaid medical providers and see if they will reduce your bills. You can expect to get them reduced by 20% -50%.

Posted: 17 Jul 2013 04:47 Post Subject:

Update. I submitted my claim for about $92k with $27k total medical expenses, $3k lost wages, $10k unpaid medical (most reimburses my health insurance). I received the offer from my insurer today. $33k. They figured $24k of medical expenses, $3k lost wages, 10k Unpaid medical, and $20k pain and suffering. So where we disagree is pain and suffering.

Am I being low balled? Is this just part of the game that has to be played to get somewhere in the middle? Thoughts? I really feel about $60-65k is where I need to be. I have an IME ordered by my insurer that states all injuries are a result of the accident and my Doctor says I have a 10% permanent bodily PPI rating. Advice?

Posted: 18 Jul 2013 08:26 Post Subject:

Stick to your numbers and see if they will come up. If not, you may be forced to retain legal counsel and sue.

Posted: 21 Jul 2013 10:41 Post Subject:

But how do I respond? Another letter to say that I think there offer is too low? Do i write another demand letter? What?

Posted: 22 Jul 2013 01:56 Post Subject:

Do i write another demand letter?

Not so much a "demand letter" but one of two choices:

A) Ask how they arrived at their numbers. They owe you an explanation.

or

B) Lay out your reasoning for your numbers. Avoid getting "emotional" (i.e., omit things like, "I haven't been able to sleep at night thinking about the accident, etc). Unless you have medical documentation (such as visits to a sleep specialist, psychiatrist, etc.). Stick to facts and lay out your case. Medical Expenses $37,000 (itemize your numbers to be specific, whether paid by insurance or not), lost wages $3000 (again, be very specific) = $40,000. Pain and suffering ($40,000 x 2 = $80,000 . . . or x 3 = $120,000), and see what they respond with.

Understand that any expenses paid by your medical insurance are subject to being repaid to that insurance company by you.

Posted: 22 Jul 2013 04:30 Post Subject:

Update. I submitted my claim for about $92k with $27k total medical expenses, $3k lost wages, $10k unpaid medical (most reimburses my health insurance). I received the offer from my insurer today. $33k. They figured $24k of medical expenses, $3k lost wages, 10k Unpaid medical, and $20k pain and suffering. So where we disagree is pain and suffering



Those numbers don't add up. $27k + $3k + $10k = $40k. First, there is a difference $3k in medical expenses but even then if you us their numbers they are offering $33k on $37k in actual medical expenses. Why? That is, why is their offer less then even your actual out of pocket expenses?

Posted: 22 Jul 2013 08:23 Post Subject:

I had 10k in Medical pay that has already paid for some of the Medical expenses. The total Medical expenses were roughly $27k billed, not the negotiated rate. $10k was paid for by my auto Med Pay and my health insurance paid another $6,500 or so my actual out of pocket expense has been about $3k. Suffice to say I want 10k for my medical expenses (the $6,500 plus the $3k) which they agreed to. They also agreed to $3k lost wages. So the big difference is I asked for $80k pain and suffering (about 3x billed medical expenses) and they offered $20k.

Posted: 22 Jul 2013 08:38 Post Subject:

I'm not sure I follow that but it seems like both you and the other carrier are deducting what your health carrier paid. Perhaps there is a state or two where this is allowed but in most (if not all), this is incorrect. Your health carrier has a right to be paid back. They may not ask for the money and you may not pay them but the at fault person's carrier cannot take an offset because those medical expenses were paid. In additional, the other person's carrier also cannot base their pain and suffering (general damages) on the reduced amount. If this went to court the fact that someone else paid the bills is not admissable.

If your auto carrier has no right of recovery the same is true. However, after the amount owed (on the full amount of the bills) is determined, then and only then woudl the amount paid by your auto med pay be taken off the top of the _settlement/judgement_.

I mention this as I see no other reason why a $33k offer would some how be reasonable when there was $40k in medical expenses (liability and pre-existing conditions not withstanding).

Posted: 22 Jul 2013 09:42 Post Subject:

I'm doing a poor job explaining. It was a hit and run accident so I'm dealing with my own Insurance company. The total billed medical expenses were $27k for everything. Between my auto insurance negotiated rate/MedPay and my health insurance there is only $3,500k outstanding that I owe. I also owe $6,500 to my health insurer to reimburse them. So the "costs" after negotiated rates were like $20,000 ($10k MedPay + $6.5k Health + $3,500 owed = $20k). I asked for $10k in medical for the $3,500 I owe and the $6,500 to pay back my health insurer.

Posted: 22 Jul 2013 10:31 Post Subject:

It was a hit and run accident so I'm dealing with my own Insurance company.

Okay, I understand now. But same thing. They are acting as the other carrier.

Forget how much was paid and how much is owed... and I'm still confused:

The total billed medical expenses were $27k for everything

after negotiated rates were like $20,000 ($10k MedPay + $6.5k Health + $3,500 owed = $20k).



The amount keeps going between $27k and $20k. Through out the crazy number yhe medical providers billed.... what was considered reasonable by your med pay and health carrier? Add that in with your out of pocket amount. So you get $20k? If so, forget that $27k number... it's meaningless.

If the above is correct then your actual loss is $20k in meds plus $3k in loss wages for a total of $23k. Your carrier offered you $33k, or an additional $10k in pain and suffering.

Posted: 23 Jul 2013 12:43 Post Subject:

Essentially yes, but they offered $33k in new money (after MedPay) so an additional $20k for pain and suffering. Given that do you feel the offer is fair. If not what are my next steps other than legal action?

Posted: 23 Jul 2013 12:59 Post Subject:

Essentially yes, but they offered $33k in new money

It may not be new money.

I can't speak specifically for your state but usually how it works is in court your total medical bills are considered. That is, they are told that you has $27k in medical expenses when they decide what you should be paid. If they use that number do you really think someone would only give you $33k? I doubt it. Let's just pick a reasonable number and say they would award you $40k. From what you posted it does not sound like your carrier has a right to subrogation for what they paid out under Med Pay. You can ask the adjuster who handled the Med Pay (it should be a different person but may not be) if they will seek recovery or not. The UM adjuster may like to think he/she gets to take an offset for what was considered under MP but I'm betting they don't. Again, the main part to remember is that a jury probably does not get to hear that your MP paid $10k. They should be under the impression that you need to pay $27k in medical expenses when determining what you should be awarded.

If the above is correct then you need to go to the UM adjuster and perhaps even point this out when explaining that their offer is _way_ too low.

Keep this in mind.... _you_ paid a premium to your carrier for that $10k in MP coverage. _You_ paid a premium for that UM coverage. So your carrier got paid for both of those coverage. So don't feel bad about them paying out twice.

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