by pumatracker » Sat Aug 23, 2008 10:07 pm
My husband and I were involved in an accident in January 2008. We were on the highway going 40mph. A lady pulled out from a stop sign in front of us and we T-boned her pku, totalling our vehicle. The police came, she admitted fault and her insurance company agreed to admit fault. But that's as much as they have done so far. Our insurance company had to haul away the vehicle, reimburse us for rental, pay PIP for Bruce's injuries and totalled out our vehicle for us, waiving the deductible because it was not our fault. The other insurance company wouldn't answer our calls even, just stonewalled us. Now they're being subrogated by our insurance co for all of their expenses, which is fine. But there's more to this story.
My husband, in addition to the soft tissue injuries sustained, has bipolar affective disorder, and after the accident his doctor put him on medical leave due to "acute exacerbation of BAD symptoms due to the accident." He was on medical leave for 5 months and then he lost his job (he was a science teacher for a private high school). When the doctor finally released him, he applied for and received Disability through Social Security.
Our insurance company paid for the therapist, the chiropractor as well as the Psychiatrist; their evaluation was that the costs were directly attributable to the accident and therefore legitimate.
Now I am dealing with an insurance company that won't answer letters or phone calls except to say "We don't have all the information we need." This after 2 months, and I had our adjuster fax all the records to them. In addition, I have tried and tried to get an attorney to help us with this and NOBODY will touch it.
I sent a demand letter for $18,000 in lost wages (8 months worth, since this is August), his medical bills X 4 for pain and suffering, reimbursement for the difference in the car rental (ours paid $30 a day and it actually cost more), the meds co-pay and reduced earning capacity until age 62. OK, this last part is probably not going to fly, unless I can get an attorney--which I can't, it seems. I don't get it.
My husband, in addition to the soft tissue injuries sustained, has bipolar affective disorder, and after the accident his doctor put him on medical leave due to "acute exacerbation of BAD symptoms due to the accident." He was on medical leave for 5 months and then he lost his job (he was a science teacher for a private high school). When the doctor finally released him, he applied for and received Disability through Social Security.
Our insurance company paid for the therapist, the chiropractor as well as the Psychiatrist; their evaluation was that the costs were directly attributable to the accident and therefore legitimate.
Now I am dealing with an insurance company that won't answer letters or phone calls except to say "We don't have all the information we need." This after 2 months, and I had our adjuster fax all the records to them. In addition, I have tried and tried to get an attorney to help us with this and NOBODY will touch it.
I sent a demand letter for $18,000 in lost wages (8 months worth, since this is August), his medical bills X 4 for pain and suffering, reimbursement for the difference in the car rental (ours paid $30 a day and it actually cost more), the meds co-pay and reduced earning capacity until age 62. OK, this last part is probably not going to fly, unless I can get an attorney--which I can't, it seems. I don't get it.
Posted: Sun Aug 24, 2008 12:08 am Post Subject:
If they are not returning calls etc...document date time, etc...call every day, after a week of this file a complaint with your states dept of ins...
I don't doubt you can't get an attorney, while your husbands problem was made worse by the accident, it was not CAUSED by the accident...which frankly is ''worth'' much less..and this type of 'injury' hard to prove...
You might also want to check on what could do to his disability payments....
I sent a demand letter for $18,000 in lost wages (8 months worth, since this is August) That's fine, if you can prove them, only up until he lost his job will likely be all that is considered.
his medical bills X 4 for pain and suffering,
Seriously doubt that will fly...where did you come up with that?reimbursement for the difference in the car rental (ours paid $30 a day and it actually cost more), the meds co-pay and
These are easy and should be paid without issue...reduced earning capacity until age 62. OK, this last part is probably not going to fly, unless I can get an attorney--which I can't, it seems. I don't get it.
Seriously doubt that will fly at all but hey worth a try...Posted: Sun Aug 24, 2008 11:28 am Post Subject: accident
Hey LORI.....wouldn't the insurance company treat this as ( I think you made a comment or two about this one..) a 'pre-conditioned' issue? Kind of sounds like what someone I know was going through. To make a long story short, and to give you the 'gist' of it..here it is. Someone I know had hurt his back about 6 or 7 years ago.....messed up his spine some how. He gives alot of people the "poor me" attitude. Anyway.....he tried to get benefits from DPW for this injury..telling them it just "all of a sudden happened and because of this he can't drive." he FAILED to tell DPW he can't drive because he lost his DL because of DUI's, etc. To make a long story even shorter (LOL), he's just trying to 'bluff' his way to whatever he can get. Now..PLEASE don't think this is what I think this is what YOU are doing, PUMATRACKER. I'm just saying insurance companies look at ALL
'aspects' of different things, when accidents happen.
Posted: Sun Aug 24, 2008 02:23 pm Post Subject:
Hey LORI.....wouldn't the insurance company treat this as ( I think you made a comment or two about this one..) a 'pre-conditioned' issue?
Absolutely, it would be pre-existing condition, that was (maybe) aggravated by the accident, but not caused by it....Again absolutely SD, 'big brother' has records on every claim you ever make, with an insurance company, whether you collect on it or not.....so take myself as an example...if i got into an accident, x-rays would show, bulging disc, fractures, etc...if i tried to say that happen in this loss, it would be quickly dismissed, as the 'index' system would likely show that this has been an on going problem of several years..thus the accident might aggravate this condition, it certainly did not cause it, thus making it 'worth' substantially less...pain and suffering or bodily injury claims wise...
Posted: Sun Aug 24, 2008 02:56 pm Post Subject: pre-existing conditions
Thanks for both, I suspected this was the case (if it wasn't CAUSED by the accident, it's irrelevant somehow). In any case, I asked for lost wages until his Disability started (August). I used the x4 multiplier because he is now pretty much incapacitated, has ongoing anxiety/panic attacks, is on depression meds and some other med that "regulates" something in his brain and whose side effects are that he has no short term memory and no libido (8 months now--and we've only been married 4 years). He was OK before that, saw his doctor once every 4 months, now he's a mess. I have seen precedent for granting awards for exacerbation of BAD symptoms, so after research I put the demand letter together. Although as I stated before, without an attorney, none of this will be considered and we'll walk away from this accident sick and broke (we have eaten up our savings until the Disability was finally awarded). Amazing system we live in.
Posted: Sun Aug 24, 2008 04:41 pm Post Subject:
Although as I stated before, without an attorney, none of this will be considered and we'll walk away from this accident sick and broke (we have eaten up our savings until the Disability was finally awarded). Amazing system we live in.
NO that's not true, you don't have to have an attorney to settle a BI claim....Has there been any offer of settlement as yet from the 'at fault' carrier? Also he's still due something for aggravating a pre-existing condition...I'm so sorry, I know this must be very very rough on YOU....hang in there, we'll do all we can to assist in any way we can...Posted: Mon Aug 25, 2008 12:53 am Post Subject:
No offer, no communication, nothing. hence the demand letter, to light a fire under their feet. We told them at the beginning of June we were ready to settle and offered to help in any way we could, getting records, whatever. Dead silence, except that when I called and left a message I would get a message back saying they can't do anything until they have all the medical records. I told them to contact my carrier, since they paid all the PIP, and you would think I was giving them a new idea, they were so surprised they could do that. I was a general liability agent for 10 years, and although it's been awhile I'm not completely in fog-land when it comes to how insurance works. I was surprised they were surprised. Since then I have contacted my carrier and they told me they sent the info weeks ago and they have already subrogated the other co for everything they've paid out. It occurs to me that means that adjuster can access the info pretty easily.
Posted: Mon Aug 25, 2008 01:58 am Post Subject:
I have seen people wait like two years for a settlement, if this accident happened in January, you may have quite a wait left yet.
Posted: Mon Aug 25, 2008 09:31 am Post Subject:
No offer, no communication, nothing. hence the demand letter, to light a fire under their feet.
I think you seriously now need to go ahead and file a complaint against the insurance company.
However, I'm curious to know what your insurance company is doing in this regard. Haven't I read in your first post that the claim is now into subrogation?
~Jeremy
Posted: Mon Aug 25, 2008 11:09 am Post Subject:
I told them to contact my carrier, since they paid all the PIP, and you would think I was giving them a new idea, they were so surprised they could do that
I'm surprised your carrier released it other that for the subro...with the privacy laws like they are we can't tell anyones name! She should have ask/sent you a medical authorization release so she could get all the med info...also these documents and proof could be states away in their subro dept and not with the adjuster...If i were you I'd call her back and ask, "Do you want me to send these to you directly or do you have everything you need now to consider this bi claim? If not EXACTLY what do you need or want so I can get it...I'm getting tired of this run around and will be forced to file a complaint with the DOI if I don't get some cooperation from you soon!"Jeremy,
they have already subrogated the other co for everything they've paid out
Puma, let us know how it's going and if we could be of further assistance to you...What state are you in by the way? Also is your screen name for real? Do you track cougars?
Posted: Mon Aug 25, 2008 12:59 pm Post Subject:
First of all, thank you all so much for the encouragement, I have been spinning in circles for months now and it's such a blessing to actually get a friendly, helpful response.
When we first submitted the claim we were sent a packet asking for the names etc of all physicians etc and a medical release form, so getting our files was appropriate. I think I should get a copy myself, now that I think about it.
When I was an agent (awhile back, mind you), the Insurance Commissioner was the guy to go to for help if things got icky. I live in Idaho and the claims dept of this company is in Oregon. I told them I would file a complaint with the Oregon Insurance Commissioner if they didn't start doing something, but I would probably file with both states and see which one would handle it?
And yes, Jeremy, I am a tracker (hobby) and used to be a member of the ISPT and SWAT (International Society of Professional Trackers and Southwest Tracking Association). I tracked for Search and Rescue mostly and just to get closer to nature and the surrounding wildlife (I don't hunt). I still do it for fun, except here in Idaho it's mostly coyotes, bears, moose and an occasional wolf.
I will give the Insurance company until the 28th, which is 10 business days since they received my demand letter, before I start throwing bombs. Meanwhile, I might even be able to find a lawyer, I haven't given up trying....
Thanks again, so much.
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