by jo » Wed Sep 02, 2009 03:38 am
I was involved in an accident that totaled my car. It was s 2000 Monte Carlo and they paid me $6K for it. They said the frame was too badly damaged to buy it back.
I had physical therapy for 4 months with very little improvement. Finally I had an MRI 6 months after the wreck. It showed herniated discs at C3-C4 and C5-C6 both mildly flattening the spinal cord. I had physical therapy for 4 more months with much more relief. I am still in daily pain and I have limited motion in my neck and my right shoulder.
I had no previous injuries, this was my first car accident. I hardly ever go to the doctor, about once a year usually with the flu. I had no pain before the accident and now it's my constant companion. I also have ringing in my ears that's much worse when the neck pain gets worse.
I was supposed to have a stricture in my esophagus stretched the day of the accident. The accident pushed back this procedure 4 months, causing me to suffer from nausea, indigestion and severe difficulty swallowing.
I was active before the accident but now I am very limited in what I can do. Thankfully I have an office job, so I can still work.
My medical bills are $10K and my lost wages $3K.
What would I be looking at for a fair settlement?
I had physical therapy for 4 months with very little improvement. Finally I had an MRI 6 months after the wreck. It showed herniated discs at C3-C4 and C5-C6 both mildly flattening the spinal cord. I had physical therapy for 4 more months with much more relief. I am still in daily pain and I have limited motion in my neck and my right shoulder.
I had no previous injuries, this was my first car accident. I hardly ever go to the doctor, about once a year usually with the flu. I had no pain before the accident and now it's my constant companion. I also have ringing in my ears that's much worse when the neck pain gets worse.
I was supposed to have a stricture in my esophagus stretched the day of the accident. The accident pushed back this procedure 4 months, causing me to suffer from nausea, indigestion and severe difficulty swallowing.
I was active before the accident but now I am very limited in what I can do. Thankfully I have an office job, so I can still work.
My medical bills are $10K and my lost wages $3K.
What would I be looking at for a fair settlement?
Posted: Fri Oct 23, 2009 11:26 am Post Subject:
If she's delaying..it sounds more like laziness to me rather than an unwillingness to settle the claim
Posted: Sun Nov 01, 2009 05:07 pm Post Subject:
I gave the adjuster my demand packet on Sept 18th. My packet was about 50 pages and I included parts of my daily diary, my missed work and a statement of lost wages signed by my employer, and a summary in the form of a list that listed in order and severity my pain and suffering and losses I've experienced due to this wreck. I also included large color pictures of my totaled car and the scene of the wreck. I tried to make the packet complete and at the same time organized to save her time and make it easier for her to understand. I also sent her a statement from my physician that states this accident is the cause of my injuries.
I realize that she had to request additional records (I really thought she would have requested previous records earlier), but it seems that she's taking longer that usual to do her job.
I've never been thorough this before, is it normal for her to take so long?
Is there anything I can do to hurry her up that wouldn't affect me negatively in the settlement?
Posted: Mon Nov 02, 2009 10:56 am Post Subject:
Jo,
Did you put a date on your demand? ie "this offer of settlement will be withdrawn on blank date?"
Did you send it certified with return receipt?
If not it's been over thirty days, I'd call or send a letter requesting confirmation it was received and request a response within 'x' amount of days.
Posted: Mon Feb 01, 2010 11:32 am Post Subject:
Jo posted this in my box
Hi Lori,Farmers changed my adjuster and that delayed everything. He finally called me to talk about the claim this week. He said the neurosurgeon records show what I told him, that he suggested surgery along with other options I could consider. But the adjuster said unless I give him a letter from the doctor saying the surgery is necessary and an estimate on how much is costs, he will consider my injury only a neck strain. He also said if he sent me an offer without the letter, I would find it insulting. Is it necessary to have the letter even though everything is in the records just as I said?
I totally get where this adjuster is coming from Jo, and agree with him. Unless I had something from a doc, saying that surgery is absolutely 100% the only way to fix you, I wouldn't be able to consider it either. And frankly if that's the case you shouldn't settle until after the surgery because you don't know you'll have complications or not. So if your set on settling prior to that you need to get this letter from the doc. He can find out the charges from his staff and the hospital he is affliated with.Posted: Sat Feb 06, 2010 03:13 pm Post Subject:
OK, I can understand the need for the letter. But how does the absence of the letter change my condition from herniated discs compressing the spinal cord to neck strain? I realize that an adjuster can do what they want to, but honestly, this is what makes people want to get a lawyer. Until that point, I thought I could work with this adjuster to come to a mutual agreement, but that statement put a different light on this.
Posted: Sat Feb 06, 2010 04:22 pm Post Subject:
But how does the absence of the letter change my condition from herniated discs compressing the spinal cord to neck strain?
It doesn't, I think what he meant by that was that, without a letter stating the absolute need for the surgery and estimated cost of it, he can't include it, (ins claims are ALL about documentation--an old saying is, 'if it's not IN the claim it didn't happen)...so just get the letter from the doc along with the estimated cost of the surgery, recovery time etc..I realize that an adjuster can do what they want to,
No they really can't...but honestly, this is what makes people want to get a lawyer. Until that point, I thought I could work with this adjuster to come to a mutual agreement, but that statement put a different light on this.
I think you still can...you're taking the statement differently that he meant it, (and I can see how you would)..He's not saying that the neck strain is ALL that's wrong with you...what he's saying is he needs additional documentation to PROVE it to the claim (and his superiors/doi, etc)...and without that, although you have a herniated disc, they only documentation he as at this point is the treatment for the subsiquental neck strain that follows with a herniated disc (I personal have several of these along with fractures)...Get what he needs Jo, and send it to him and let's see what they say after that.Posted: Sat Mar 13, 2010 08:34 pm Post Subject:
My medical bills total almost $10K but when the health insurance sent the bills to the adjuster, they discounted them 30%. I have an HMO and although MY bills show full price, they don't reimburse full price. How does this work on my end? The adjuster is trying to use this lower amount to minimize my injuries, saying, you ONLY have $7K in medical expenses.
Posted: Sat Mar 13, 2010 08:47 pm Post Subject:
I dont see how he only has documentation of a cervical strain when he has my MRI report that say I have "small to moderate disc herniations at c3-c4 and c4-c5 which result in mild flattening of the cervical cord at these levels".
I just went back for another MRI which shows an increase in size of the disc protrusion with further cord indentation and moderate stenosis.
How is that not enough to prove the injury? Even when I have surgery he can come to the conclusion that is wasn't necessary surgery and refuse to pay for it.
That's what I mean by the adjusters can do whatever they want. They can refuse to pay without justification but they must have justification to pay. Seems like a win-win for the adjuster, and I have to go to a lawyer to get justice.
Posted: Sun Mar 14, 2010 03:24 am Post Subject:
That's what I mean by the adjusters can do whatever they want. They can refuse to pay without justification but they must have justification to pay. Seems like a win-win for the adjuster, and I have to go to a lawyer to get justice.
Hard to say. But, there must be evidence to the contray that led to his/her decision. And, no we can't do what we want. We follow the evidence.
Posted: Sun Mar 14, 2010 01:11 pm Post Subject:
I
dont see how he only has documentation of a cervical strain when he has my MRI report that say I have "small to moderate disc herniations at c3-c4 and c4-c5 which result in mild flattening of the cervical cord at these levels".
I don't know either Jo, but apparently he doesn't have that..Have you ask the adjuster that very question? Have you said, are you looking at the same radiology report I'm reading? Do that and see what he says. Maybe he doesn't have the report you have...Add your comment