by birdhouselady » Mon Apr 13, 2009 10:44 pm
I was a passenger in a car that was backed in to. I received a whiplash/soft tissue type injury. It was unclear to my doctor as to the seriousness of my injuries because of the pain I was in. The accident was in September of '08. Over the course of that time, she has ordered xrays and MRI's of my head, shoulder and neck. She prescribed medical massage therapy 1-2 times a week, along with pain meds, muscle relaxers, a TENS unit.
Because the owner of the car I was in had no insurance I put in a claim with my insurance company to have my Medpay cover some of the medical costs (5k) until I was well and ready settled with the 3rd party ins. company. My medical insurance has covered the remainder of my medical expenses minus my copays and my massage therapy, these have been paid for out of my own pocket.
I am 45 years old. I had a similar injury in a previous accident 3 years prior, but I had completely healed from that accident. I live in CO. I have an insurance adjuster that has told me that it is not 'reasonable and customary' for me to still be receiving treatment, that I should be healed, and I need to settle my claim with them or they most likely will not pay for all of my medical costs, which are in excess of 12k. I have told her every time I talk to her that I will not settle until my doctor releases me. Can they refuse to pay all of my medical bills? I am out of pocket over 2k and I don't want to be stuck with all of these expenses. I have followed my doctors orders, and I have not received any treatment that she did not prescribe.
Also, can you tell me what you think would be a resonable amount for me to settle with them? It's been 7 months and I am still being treated. This has really effected my life in a negative way. I don't like being bullied, this alone has caused me a great deal of stress. I appreciate your time. Let me know if you need any additional info.
Because the owner of the car I was in had no insurance I put in a claim with my insurance company to have my Medpay cover some of the medical costs (5k) until I was well and ready settled with the 3rd party ins. company. My medical insurance has covered the remainder of my medical expenses minus my copays and my massage therapy, these have been paid for out of my own pocket.
I am 45 years old. I had a similar injury in a previous accident 3 years prior, but I had completely healed from that accident. I live in CO. I have an insurance adjuster that has told me that it is not 'reasonable and customary' for me to still be receiving treatment, that I should be healed, and I need to settle my claim with them or they most likely will not pay for all of my medical costs, which are in excess of 12k. I have told her every time I talk to her that I will not settle until my doctor releases me. Can they refuse to pay all of my medical bills? I am out of pocket over 2k and I don't want to be stuck with all of these expenses. I have followed my doctors orders, and I have not received any treatment that she did not prescribe.
Also, can you tell me what you think would be a resonable amount for me to settle with them? It's been 7 months and I am still being treated. This has really effected my life in a negative way. I don't like being bullied, this alone has caused me a great deal of stress. I appreciate your time. Let me know if you need any additional info.
Posted: Thu Apr 16, 2009 11:01 am Post Subject:
You all seem to be saying the same thing. My previous injury gives the adjuster an excuse to pay out less on my claim. No one has answered the question why? My doctor told me that this injury has nothing to do with the previous injury, and that I was healed from the other injury. So, how can the adjuster justify paying out less?
Aggravating a pre-exsisting condition is always worth less than 'causing' the initial injury..which only makes sense...now on the other hand if you can convince the adjuster that this injury was healed 100%...different story, but frankly doubt there has been enough time elapse for that...also in your demand to that settlement how long did you claim you would suffer from that injury?Posted: Thu Apr 16, 2009 11:28 am Post Subject:
Well, I guess the eggshell rule applies to medical negligence cases. I’m not sure if the same applies even to the MV accidents.
Now, the ball had rolled to your court. You are required to prove that you had healed from your initial injuries completely before the accident. Now, if you can proof that the accident has only worsen your condition, you are entitled to receive compensation for that.
Do you have a document which would suggest that you had recovered from your initial injuries before the incident?
Posted: Thu Apr 16, 2009 02:36 pm Post Subject:
Do you have a document which would suggest that you had recovered from your initial injuries before the incident?
I do not have a document, but I am sure my doctor would give me a document stating that I had recovered from my previous injury. I asked her if I was injured so easily because of my previous injury and she said "no, this injury has nothing to do with your previous injury, you were healed from that injury. This injury is from this accident". I'm sure she would put it in writing for me.
Aggravating a pre-exsisting condition is always worth less than 'causing' the initial injury..which only makes sense...now on the other hand if you can convince the adjuster that this injury was healed 100%...different story, but frankly doubt there has been enough time elapse for that...also in your demand to that settlement how long did you claim you would suffer from that injury?
Lori, what would the different story be? I beleive my doctor's diagnosis would have bearing on the out come. There was no demand for settlement with my other accident. I was at fault.
Posted: Mon Nov 01, 2010 09:52 pm Post Subject:
I just have to say that I'm an attorney, and the eggshell plaintiff rule would definitely apply to your case. PP is wrong that you would have to prove you were previously injured, it didn't cause it, etc. All you have to do, IMO, is show that you were not receiving treatment for several years, and this required you to receive treatment.
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