by KandSMcQueen » Mon Mar 02, 2009 04:04 am
In North Carolina, a little old lady ran a stop sign and I t-boned her going 45 mph. I had neck and back soreness, bruises and abrasions on both of my legs, arms and abdomen. At the hospital a CT scan was done and I found out that I had a umbilical hernia. I suffered from herniated discs in my neck which later ruptured while waiting for the spinal fusion surgery.
I knew the little old lady didn't have anything of value and she had a small limit. So I knew I would be lucky to get my actual out of pocket bills reimbursed so I didn't get an attorney. I purchased a book to handle everything on my own.
My 7 month old van was totalled. I settled with Farm Bureau and the GAP insurance paid the loan balance off.
I used my company's benefits of paid vacation/sick time to go to appointments and Family Medical Leave for the accident. Total time out of work was 18 weeks.
I have State Farm Insurance with:
UMBI 100,000/300000
Med Pay 25,000
I received the 25,000 med pays from State Farm (no problems).
So far, I have 70,000 in medical bills, 20,000 in loss wages and reimbursement of employer benefits along with 5,000 mileage, child care, spouse loss wages and misc. expenses. I figured 100,000 for pain and suffering.
I have yet to have my umbilical hernia surgery. So I estimated it to be 30,000 in future medical bills, medicines, loss wages and pain & suffering.
In my demand letter to Farm Bureau I asked for 230,000.
Farm Bureau offered the limits of $50,000 and I got State Farms approval.
My health insurance company (Aetna) put a lein on the proceeds of 35,000.
I negotiaged down to 20,000 and received a check for 30,000.
I am 44 years old, bookkeeper. I have always been a healthy person until this accident. I have stayed sick with ear/sinus infections, gastro problems, drug interactions, acid reflux, weight gain, thryoid problems, neck soreness, headaches, perimenopause etc.
Now I'm trying to finalize my underinsured claim.
I need help because the adjuster is stalling and I only have 60 days until the 3 year deadline it up.
He claims he doesn't owe me anything. He said that all my bills were not because of the accident and that the MRI showed I had degenerative disc disease and that he's only paying me 50% on the surgery since "I might" have had to have the surgery anyway.
My question is I'm not sure how much I have to go after since I see conflicting information.
1. If I have 100,000 UMBI less 50,000 limits Farm Bureau paid - it gets deducted. I thought I had 50,000 remaining of the claim. My adjuster said that the med pay has to be deducted from that. Is that correct?
I do have two vehicles on my policy but it does state that the UMBI applies once per poilcy to all vehicles.
2. I have med pay's on both vehicles. Can I stack Med Pay's?
Thanks for any help anyone can give me. I tried to contact a attorney last week and several wouldn't even talk to me since the deadline is so close.
I knew the little old lady didn't have anything of value and she had a small limit. So I knew I would be lucky to get my actual out of pocket bills reimbursed so I didn't get an attorney. I purchased a book to handle everything on my own.
My 7 month old van was totalled. I settled with Farm Bureau and the GAP insurance paid the loan balance off.
I used my company's benefits of paid vacation/sick time to go to appointments and Family Medical Leave for the accident. Total time out of work was 18 weeks.
I have State Farm Insurance with:
UMBI 100,000/300000
Med Pay 25,000
I received the 25,000 med pays from State Farm (no problems).
So far, I have 70,000 in medical bills, 20,000 in loss wages and reimbursement of employer benefits along with 5,000 mileage, child care, spouse loss wages and misc. expenses. I figured 100,000 for pain and suffering.
I have yet to have my umbilical hernia surgery. So I estimated it to be 30,000 in future medical bills, medicines, loss wages and pain & suffering.
In my demand letter to Farm Bureau I asked for 230,000.
Farm Bureau offered the limits of $50,000 and I got State Farms approval.
My health insurance company (Aetna) put a lein on the proceeds of 35,000.
I negotiaged down to 20,000 and received a check for 30,000.
I am 44 years old, bookkeeper. I have always been a healthy person until this accident. I have stayed sick with ear/sinus infections, gastro problems, drug interactions, acid reflux, weight gain, thryoid problems, neck soreness, headaches, perimenopause etc.
Now I'm trying to finalize my underinsured claim.
I need help because the adjuster is stalling and I only have 60 days until the 3 year deadline it up.
He claims he doesn't owe me anything. He said that all my bills were not because of the accident and that the MRI showed I had degenerative disc disease and that he's only paying me 50% on the surgery since "I might" have had to have the surgery anyway.
My question is I'm not sure how much I have to go after since I see conflicting information.
1. If I have 100,000 UMBI less 50,000 limits Farm Bureau paid - it gets deducted. I thought I had 50,000 remaining of the claim. My adjuster said that the med pay has to be deducted from that. Is that correct?
I do have two vehicles on my policy but it does state that the UMBI applies once per poilcy to all vehicles.
2. I have med pay's on both vehicles. Can I stack Med Pay's?
Thanks for any help anyone can give me. I tried to contact a attorney last week and several wouldn't even talk to me since the deadline is so close.
Posted: Mon Mar 02, 2009 06:23 am Post Subject:
I can't tell you if the UIMBI stacks, but your carrier can. And this leads me to the second part...
This SF adjuster is deducting the $25MP from what? It does not get deducted from any limit. Example of how it _should_ be applied:
$100k in meds
less $25k paid by MP
less $25k paid by clmt carrier
-------------
Leave $50k in meds that need to be paid. Offer for "pain and suffering" is made on medical treatment, injury etc and lets say it's an additional $100. So we add $100k to the $50k of outstanding medical treatment and we get $150k UIMBI settlement amount. Well, you have a $100k limit so the $100 limit is paid. If I understand you post, your adjuster is deducting the $25k MP from your $100k limit. Perhaps I'm reading that incorrectly.
I seldom comment on what amount should be paid on an injury claim as there is never enough info posted to make a good determination but in this case you have $40k left in meds that need to paid and another surgery scheduled. The SF adjuster is trying to say all of this was an aggravation of degenerative disc disease?
Here is my recommendation... request the $100k UIMBI policy limits and accept nothing less then $70k. If they don't make a $70 offer, obtain the service of an attorney in order to file suit and protect the statute.
Unfortunately an attorney is going to take 40% of that 100k (your UIMBI limit) so the most you can hope for is $60k if you use an attorney. As such, if the carrier will offer you more then that, you might as well take it.
You may want to do two things in the meantime... send in an official UIMBI demand asking for the $100k and also your might want to see if you can speak to a supervisor and have the supervisor review the claim to see what they would offer. Let them know of they offer less then the $100k UIMBI limit you will have no choice but to secure the service of an attorney in order to protect the statute by filing a Complaint against your carrier.
Posted: Mon Mar 02, 2009 11:27 am Post Subject:
I think its a well comprehended and exhaustive response by tcope. I certainly feel that you are entitled to receive the limit of the UMBI coverage since the expenses are so high. I dunno about medpay reduction but the amount paid by the at-fault driver’s insurer would get deducted from the UMBI. Hence, if you have $70, 000 worth of medical bills & receiving $50, 000 from the at-fault driver’s policy, then you would receive the remaining from the UMBI.
2. I have med pay's on both vehicles. Can I stack Med Pay's?
It’d depend upon the state laws. In some state, e.g. Virginia, it is allowed. Hence, you let us know your state of residence, we can provide state specific laws.
Posted: Tue Mar 17, 2009 12:16 pm Post Subject: How does Optional Med Pay affect UMBI limits?
I would advise you to get a lawyer. I am in SC and attorney's get 1/3 of what you settle for. What you got from the other insurance company has nothing to do with your policy if you medical bills are high enough. You should get a lawyer because you need to toll the statute and you can have a bad faith claim against State Farm. State Farm is the worse ins. company when it comes to paying claims. Get a lawyer fast before your time runs!!!!
Posted: Fri Jan 20, 2012 04:13 am Post Subject: med pay
who receives the check me or the doctor
Posted: Fri Jan 20, 2012 04:50 pm Post Subject:
In this case and in case of most medical claim settlements, the doctor or the hospital gets the check.
Add your comment