by rmrolley » Fri Mar 13, 2009 06:25 am
'm dealing with an unfamiliar situation, and would appreciate any useful advice from those of you who have been in my shoes before. In September 2008, i was involved in a significant auto accident. I was traveling at approximately 40mph, when a car pulled out of a private drive into my path. I had no time to stop, and the end result was a T-bone accident. Damage to my car was approximately $4000. I had my wife, and two children in the car ages 3 and 4. I went to the emergency room with head, neck, and shoulder pain, and was examined by the ER physician who after a series of x-rays, and a CT scan of my head and neck, diagnosed me with a moderate to severe cervical strain, and advised me to follow up with a spine specialist. 3 days later, I was examined by an orthopedic spine surgeon, who ordered his own imaging studies. He agreed in part with the ER doc, but also diagnosed bulging discs at the c5-c6, and c6-c7 levels. He gave me pain meds, muscle relaxers, and steroids, and advised me to not engage in any strenuous activity. I had several follow up appointments, and in about 6 months I was finally pain free. I was referred to another orthopedist for my shoulder/arm pain, and after an MRI, was diagnosed with a torn labrum, humeral head contusion, partially torn supraspinatus tendon, a mildly seperated AC joint, and a brachial plexus contusion. We opted to treat with the conservative approach first, including therapy, medication, and even arthrocentesis (injecting the joint with a steroid/anesthetic combination). After 6 months of treatment, with no significant improvement, my doctor said I would need an operation to fix the problem, and relieve my symptoms (pain, impingement, and the clicking/popping in the joint). I had the surgery last week which to my understanding was actually 2 procedures. Right shoulder arthroscopy with debridement, and also a sub-acromion decompression. I have 8 weeks of physical therapy and rehab ahead of me, and will have missed over a month of work. This whole thing has caused me an significant amount of pain, anxiety, stress, etc, and has also prevented me from performing necessary daily activities such as taking care of my kids, bathing/dressing myself, driving, etc. The injury was to my dominant arm, and is immobilized for the time being. I have been receiving calls from the at fault driver's insurance company, essentially asking me to settle for less than I believe I am entitled to. I have approximately $30k in medical bills so far, as well as the $4000 damage to my car, $400 for a rental, and $6k in lost wages and counting. I am considering hiring an attorney here, but before I agree to hand someone 33% of the money that I've suffered for, I was wondering if anyone has any good info, or useful tactics I can use to try to resolve this with the insurance company on my own. I have asked them to disclose the policy limits for their at fault driver, but they refuse to do so. I don't want to give an attorney 33% especially if the guilty party only carries the minimum liability coverage. What formula do these companies use to place a value on claims? Or more importantly, does anyone have a ballpark estimate on what this claim may be worth? I'm just about 100% sure that its worth more than the $50k they're claiming is their "maximum authority". I'm going to have more than $50k in bills by the time this is said and done! I would greatly appreciate any input that any of you fine knowledgeable folks may have to offer. Thank you in advance for any pearls of wisdom.
Posted: Fri Mar 13, 2009 08:48 am Post Subject:
I think the best advice for you right now is....'don't settle the claim until you recover completely' :)
You may settle the property damage claim with the insurer but also make it a point to them that you are not yet ready to settle the BI.
BTW, where are you residing? And, what is the statute of limitation for settling BI claims in your state?
~Jeremy
Posted: Fri Mar 13, 2009 10:56 am Post Subject:
'don't settle the claim until you recover completely'
hmmmm jeremy has a good point. you can consider this before taking any decision.
Posted: Fri Mar 13, 2009 11:57 am Post Subject:
as well as the $4000 damage to my car, $400 for a rental,
The auto claim and your injury claims are totally separate, your vehicle should've been taken care of long long ago...has it not? Nothing about the vehicle damage (amount of repair) has anything at all to do with your injury don't mix the two...I have approximately $30k in medical bills so far,[and $6k in lost wages and counting
First off you need not even think about talking settlement until that arm is rehabbed and gotten back to as good as it's going to get...which is minimally per your post anotherIhave 8 weeks of physical therapy and rehab ahead of me
So more or less (assuming your therapy goes well ) you will likely have 6k in lost wages and 35k or so in meds right? I totally understand you not wanting to hand out 1/3 of your money...first off I would tell her to call back after your PT on your arm is done, and she has all of those bills and reports...then after she had time to review all your medical records...IMO you always make them make the first offer..there is no magic table used to determine injury evaluations...although some companys do use a software system that's not worth a crap (IMO)....be sure she understand the things you couldn't do (ie mow grass, kids etc) she owes for that as well...and if your state allows and you're married your wife also has a claim for loss of consortium and companionship...remember when she makes a offer it will be at the bottom of the 'range' they have come up with for your injury...set on it a day and then counter offer....I'm just about 100% sure that its worth more than the $50k they're claiming is their "maximum authority".
Are you sure that's not the maximum policy limit on the at fault driver? You need to find that out...also do you have UIM (UNDER Insured Motorist) coverage on your vehicle? or even med pay?Without knowing anything at all about your age, occupation, prior health, area etc. assuming you were a young healthy productive guy...I'd say 75-100k (including bills)..but I really and truely without seeing every medical report and reading each piece of paper in the file this is only a guess...
IMO you need to find out what they mean by 'authority' and if that means that is ALL they CAN pay...there are ways an adjuster will let you know the limits without coming right out and telling them...this may be what she is doing...if the 50k is the authority this adjuster has to settle claims, she can always get that increased or bounce it to her supervisor...that's why i'm wondering if maybe 50k isn't the BI limit on their policy holder...have they offered that 50K?
What does the other driver seem like re: if you got an excess judgement? would you be able to collect anything?
Posted: Fri Mar 13, 2009 02:30 pm Post Subject:
Until this point, I was a very healthy 30 year old professional guy with an essentially unremarkable medical history. No prior problems, illnesses, etc. I'm a physician assistant for a group of surgeons, so I obviously cannot work using only my non-dominant arm. I live in the Cleveland, Ohio area, as does the other driver. By my estimates, if I complete therapy in the minimum projected time of 8 weeks, I will have roughly $35k in meds, $8k in lost wages, plus the property damage losses which have already been paid. I specifically asked the adjuster if the $50k offer was policy limits, or just as high as he was willing to go. He specifically said that they will not divulge the policy limits, and that the $50k was what he claimed was as high an offer as he was permitted to make. I told him he wasn't even in the ballpark. I advised him not to contact me anymore, and that I would contact him in writing once my treatment was complete and I have final numbers for my losses to present to him. I did make mention of possibly retaining an attorney if negotiations were fruitless on my own. He went on the defensive and got a little nervous when I said that, but didn't come right out and change his mind. The guilty party does appear to have assets should their limits be so low. They own a nice home, cars, and I would be willing to wager that they have some money in the bank. The statute of limitations to file a personal injury lawsuit in the state of Ohio is 2 years, but I couldn't find any info on the timetable to actually settle it. From an expert point of view, do you think an attorney is my best course of action here? This is a case of undisputed liability with several witness statements. Will this adjuster eventually give in? Perhaps with the threat of an attorney, filing a lawsuit, or maybe even filing a complaint with the state of Ohio board of insurance? I don't want to have to resort to such messy tactics, but I am going to do whatever I have to do to protect my own best interests here. Thanks again for the feedback!
Posted: Sat Mar 14, 2009 07:18 am Post Subject:
Since the statute of limitation is two years, I think you have got ample time in your hand to complete the treatment and then settle the claim. I’d still say that the atty should be your last resort. Get all your bills together and negotiate the claim with the adjuster. If she doesn’t budge then you might need a legal representation.
~Jeremy
Posted: Sat Mar 14, 2009 12:38 pm Post Subject:
plus the property damage losses which have already been paid.
This part is over and done with...it's two separate coverages...so you can't ''add'' anything about the vehicle into the equation...(neither can the ins company)...I ''suspect'' a limits issue..however if they were offering limits they should have told you this...but this company/state may operate differently...Will this adjuster eventually give in?
It's really not a matter of 'giving in' if the limit is 50k they can't offer anymore...Perhaps with the threat of an attorney, filing a lawsuit, or maybe even filing a complaint with the state of Ohio board of insurance?
I can't imagine any adjuster that has the authority to settle a 50k BI getting shook up at all about a law suit...seriously (as an adjuster) people throw the 'lawyer' card out daily...in some cases I wish they would follow thru :roll: (not yours I mean unreasonable people)...never have I known an adjuster that was bothered by that 'threat' in fact as you know the injured party is paying the attorney and you'd have to get that offer raised to 75k just to break even with the offer you already have on the table....the dept of ins. wouldn't help in this case, as the adjuster or company (from what you have posted) has done nothing wrong (not in any fair claims practice violation) the dept of ins. doesn't get involved with a value of a BI dispute...I don't want to have to resort to such messy tactics, but I am going to do whatever I have to do to protect my own best interests here.
I totally get that and you must protect yourself and family..From an expert point of view, do you think an attorney is my best course of action here?
IMO not yet...what do YOU think the value of your claim is? If it were me and I was going to get an attorney I would not do so until I got the highest offer I could get from the ins carrier IN WRITING. I would then put into the contract with the attorney that they did not get a fee for the amount (or significant less percentage ) that I had already negotiated, only what they were able to negotiate ABOVE that amount...An attorney would be able to do an asset check on the other guy and figure out how likely you are to collect on an excess judgement (should this be the case)....again do you have UIM BI on your policy?Posted: Sat Mar 14, 2009 02:17 pm Post Subject:
using the final ESTIMATED figures for meds + lost wages, I've arrived at roughly $43k in damages. the adjuster is essentially telling me that he believes that my pain, suffering, and loss of quality of life are only worth $7k. that just does not sound right to me. I'm no expert, and I'm obviously biased in this case, but I would think that it should be worth at LEAST double what they're offering, maybe more. regarding your question of UIM coverage, the answer is yes I do carry it. The limits on my policy are 50/100 for this coverage. I'm trying to avoid a claim against my own policy out of fear that they will raise my rates, or try to subrogate against the settlement I receive from the at fault party. in this case, wouldn't the 2 just cancel eachother out? Again, I don't know how these things work, as I've never been in this situation, and thankfully have never been sued. thanks for the tip about keeping my own negotiated settlement excluded from any potential attorney percentage. I was just under the impression that those vultures skimmed 33 % off the top before their client gets a cent. I've done quite a bit of research over the last several weeks of being stuck in the house. this is by far the most knowledgeable/intelligent advice and information I've come across thus far. thanks again.
Posted: Sun Mar 15, 2009 06:41 am Post Subject:
IMO you need to find out what they mean by 'authority'
The term "authority" is usually used by independent adjusters that get authority from the carrier they are working for. I used it from time to time to let a claimant know that I couldn’t go any higher. In your case this may be all the authority they have at this time from the insurance company and is the reason they are offering it. It is not to say that their authority can’t be raised once the circumstances of the claim change (higher medical bills, lost wage documentation etc.). I have also heard it used by staff “underlings” that are attempting to settle a claim for a supervisor.
Seeing that they are willing to offer 50K this early in negotiations (first offers are never their best unless it happens to be limits) I would say you are sitting in a good position. Letting them know that you will contact them once you are “healed” was your best move. Once you are done treating, send them certified mail all your medical bills and records along with documentation regarding lost wages (make copies). Don’t just send them a notebook piece of paper signed by your boss with a dollar amount; ask them what they will need to consider your lost wages. Usually you can send them your tax info if you are a salary or hourly employee. If you are a contract worker or are in sales, it becomes a little more difficult. Don’t make a demand with your letter; make them come back with a better demand once they have all of your information. Right now they are hoping that you will jump at 50K as they know that the claim will be worth more down the road, or they wouldn’t be offering it.
I agree with Lori, an adjuster is not (or should not) be bothered by the threat of an attorney. Many times an attorney makes negotiations go smoother for an adjuster, since the personal feelings are taken out of the matter and becomes about dollars and SENSE. If an adjuster got nervous every time someone threatened an attorney, they need to find a new line of work.
It is also refreshing to see someone willing to do the footwork to keep 33% of their settlement. Maybe the insurance company won’t have to pay out as much in a settlement, but you could end up with more in your pocket. Because Friedman, Domiano & Smith (Cleveland reference) isn’t always looking out for your best interests. I know, I know neither are insurance companies.
Posted: Sun Mar 15, 2009 02:50 pm Post Subject:
Oh man I'm so irritated...i lost my entire (long) post deleted a moronic/spam from this thead !! :x :twisted:
Ok, deep breath lori calm down...here we go again..
:roll:
RM, I just about jumped for joy when I saw that you have UIM! NO you cannot be rated up for a uim claim, and NO they do NOT cancel each other out and NO you will not be subrogated for it...(do you have med pay too by chance or PIP)?
First off I agree with you your claim is worth way more than 50k..i personally would be countering with 125-130k and be thrilled to settle in the 90's...I do not though think you should settle until you are finished with treatment...but you know you own body...
Are you dealing with a company adjuster (they work the insurer) or an independent (an adjuster the company adjuster hired)?
I still think that 50k is an odd offer unless it is policy limits...some adjusters aren't smart enough to tell you this....so you can have the info and move on....
''Authority" is used by seasoned adjusters too, but if they are talking about their personal authority (dollar amount they can spend without approval from higher ups)...first of all that is easily increased and second of all (if a company adjuster) i think that was just plain stupid to say...and your response should be , 'then put me thru to someone with more authority, and now please!" if an independent adjuster then they should've explained that too you again they can get that easily increased with documentations, which they should have by now..
OK, IMO what you should do now is...contact this adjuster....ask them point blank are the policy limits 50k, and before they can say anything tell them you have UIM and so if that's the case, it's not a giant deal but you need know ASAP so you can contact your carrier to get a UIM claim going...If they tell you yes those are the policy limits, ask them to send you this offer in writing stating it is the policy limits as well ..tell them as they surely know you cannot agree to it or sign a release until you get permission from your carrier...If they won't tell you or say no that is not the limits. Ask them if they have all the medical and employment information they need (go over them) except for the PT bills which should amount to $blah blah...bringing the total medical costs to $whatever and lost wages of $whatever....then add that the amount of loss of life enjoyment you have suffered, not to mention the pain and suffering have hugely impacted your life and you feel that 150k (or whatever) is more in line with making you monetarily whole as you can be...tell them you will follow up this conversation with a letter (get the address) as well as an email (if applicable) , send the letter certified...if it's an independent adjuster get their address and the company adjusters address and email address as well...make sure you cc the company adjuster...then set down and write them a letter basically going over the medical costs, loss of income, what you had to pay someone to haul you around, mow your grass, feed your kids etc...then explain how this injury has impacted your life and your family...(unable to effectively parent, etc) this is where you pour on the ''sad soap''...expanding and making it a little more personal like this in your first post, with more info
This whole thing has caused me an significant amount of pain, anxiety, stress, etc, and has also prevented me from performing necessary daily activities such as taking care of my kids, bathing/dressing myself, driving, etc. The injury was to my dominant arm
You also need to find out and address any probable future care. and what that will cost...also any permanent disability to that arm? ..most certainly you're going to have trouble with this arm most of your life, but aren't there good chances that 5 yrs from now you may need the debridement again? talk with your doc and see what they normally see down the road with these types of injuries...include that in your letter...ending it with something like 'per our telephone conversation on blank/blank i feel that a fair settlement of this injury is 150k (whatever you said) and then something like, 'This offer withdrawn/expires on (put the actual date ie april 30, 2009 30 or 60 days whichever you decided) please respond within that amount of time, or contact me if there is a reason you are unable to do so or require any additional information from me....send it certified return receipt requested..make sure you have the adjusters address, if it is an independent adjuster get the company adjusters name and address and cc a copy to them as well (have the cc: on your letter)....Now, UIM...lets say that their limits ARE 50k...first off do NOT accept or sign a release UNTIL you get your companys permission/authority...if you don't get this from your company you could screw up your UIM claim and throw it all away...ok, you find out they have 50k in limits...tell them you will contact them after you have talked to your carrier...ask them to send a letter stating this is their offer and also their insured's limits...call your carrier and advise you need to file a UIM claim (do you have med pay or PIP too?)....Your carrier will get all the medical information, they will likely want to run an asset check before they give you permission to sign the release with the other carrier...after that is done, and you have their ok, you can sign the release and get the 50k from the other guy..They will evaluate your claim maybe immediately offer up your policy limits of 50k...or they may offer 25 or 30 and you try to negotiate that up to your limits (ending up with 100k if both pay limits)....
How much more pt are you going to have? when do you go back to work?
Let us know if any other questions we'll be happy to help...
Posted: Sun Mar 15, 2009 06:00 pm Post Subject:
Hello again! The adjuster is employed by the insurance company itself (Nationwide). In our last conversation, I made it clear to him that I was not prepared to accept ANY settlement at this time simply because I am nowhere close to recovering to the condition I was in prior to the accident. In the meantime, do I continue to attempt to get him to reveal the BI limits, or do I just forget about this guy until I'm ready to start talking business? I'm in no hurry to rush to a quick settlement. My operation was less than 2 weeks ago (3/3), and I haven't even had my first follow up appointment with my surgeon, nor have I been cleared yet from my physician who is treating/following my neck injuries). I go back to see my surgeon tomorrow morning, at which time I'm hoping he will tell me what I want to hear as far as beginning therapy. The original plan was to begin the PT 2 weeks post-op, which would be this coming week. His order was 8 weeks of PT 2-3x per week for a total of 22 sessions. This is at the minimum. I was granted medical leave from my job for a period of up to 12 weeks. That order is effective until June 6, 2009. I'm hoping, and maybe its a serious case of wishful thinking, to get out of this sling, start the therapy, and cut down the pain, discomfort, and weakness, and be able to return to work sometime mid to late April. Ultimately, it is going to be up to my surgeon when to release me from "total disability" status, and allow me to return to work, even if it is with restrictions. I'm not the type of guy who likes to sit around doing nothing for 12 weeks, and I'm also among the minority who actually ENJOYS going to work! I will say this, based on 7 years of being employed as a surgical physician assistant, I know that the probability of future issues arising from the operation are greater than 40%. Permanent scarring and adhesions inside the joint, as well as visual scarring on the outside of the body, arthritis, and the potential for further debridement are among the most common. The orthopedist treating my neck injury said there is a slight chance of my cervical spine injury requiring surgical intervention years down the road. I have 2 bulging discs (not herniated or compressing the spinal cord....yet). His diagnosis was a severe strain of the anterior longitudinal ligament, and spondylotic changes of the c5-c6, and c6-c7 discs/vertebrae. He said this condition could potentially result in a degenerative condition of those levels years down the road, possibly requiring surgery. We both agreed that operating and fusing my neck at the age of 30 wasn't even an option right now lol. I'll take my chances on that one!
Now, addressing the PIP/Med Pay coverages. I DO carry med pay coverage, however the limits for it are very low at $5k. I don't believe that PIP is available in the state of Ohio, but even if it were, i do not carry it on my policy. Another thing I failed to mention in my previous posts is that 90% of my meds have been submitted through, and paid by my non-auto health insurance plan. I noticed on my E.O.B.'s that the amount paid by the plan is significantly lower in most cases than the charges submitted by the providers. In figuring my meds damages, I used the amounts that the providers actually billed for, and not what was paid by the plan. Is this acceptable, or do I use the amount that my insurance company (aetna) actually paid? Personally I feel like using the negotiated reduced figure wouldn't be an accurate representation of the seriousness of my injuries, and I'd be setting myself up for a significantly lower settlement. I feel that whatever price I (or my insurance company in this case), negotiates with my health care providers is really between us. Again, maybe I'm wrong here, but Nationwide had their chance to pay my bills starting 6 months ago when asked to, and they refused. I started receiving collections letters, so I immediately started going through my own insurance. I wasn't about to lose my house because the guilty party's carrier wasn't paying what they were obligated to.
My biggest fear here is that I know that I'm never going to be back to 100%. I don't want to have to tell my son in 2 or 3 years that daddy cant show him how to throw a baseball or swing a bat because I wont be able to use my arm in that way. Everyday all I do is sit around and think about all the "what ifs", and its pretty scary. I know you have a lot of threads to reply to on here, and typing with my left hand is a job in itself! I will wrap this up, and look forward to your response. Thanks again.
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