by Guest » Wed Jul 11, 2012 03:05 pm
So I had my first auto accident at the end of May, I'm 33 so it's either good luck or expert driving - I think the latter ;) . I was at a stop and was rear ended by an inebriated driver going about 45. Luckily he didn't hit me square on and only caught the right half of my car, spinning me into oncoming traffic but luckily not hit a 2nd time.
The impact actually took my drivers seat off it's track, the back of the seat also reclined fully to the rear (broken) and sent me flying into the back seat with my legs still under the lap belt portion of the seat belt.
The ambulance service extracted me from the vehicle in a neck brace and back board and took me to the ER. There I received chest x-rays and two CT scans on my head and neck (I had hit the side of my head on the side panel between the front and back seats and couldn't turn my neck). The scans were clear of any fractures or brain damage thank God. After a bit of morphine drip, 6 hours in the neck brace, and a handful of prescriptions for pain, muscle relaxers and anti-inflammatory I was released.
At the end of June I made an appointment with an orthopedist because of lingering neck and back pain/stiffness - that appointment was this morning (first available date was 2 weeks after setting the appt.). So today they took some spine x-rays and determined that it is soft tissue damage only, again, thank God. They want me to start physical therapy which I don't want to do, but I also want to follow doctors orders in case something pops up later.
Overall I think I've gotten pretty lucky considering how bad it Could have been. I'm still juggling things with the auto insurance stuff - which is confusing as hell right now. Both myself and the guy that caused the accident have the same auto insurance company (hint: 4 letters, military).
The way it's been explained to me is that his coverage has already paid for my totalled vehicle ($13,500), my insurance is covering my medical costs ($8,500 so far from ambulance and ER, CT and Xray) who knows how much from today's ortho visit and physical therapy, and eventually his insurance will pay some sort of pain and suffering + lost wages (lost wages were only for 2 days for $350 luckily i sit at a desk all day and can take frequent get-up-and-stretch breaks). I'm not sure how much their pain and suffering will be but they should really calculate in having to deal with the pain in my butt from having to juggle phone calls between auto insurance, health insurance, and the hospital! lol.
Is there anything I need to be on the lookout for or be aware of when it comes time to dealing with the other policy holders adjuster? Are they going to try to tell me that pain and suffering for soft tissue damage is BS? After my medical treatment is over should I be the first to make contact with them by sending them a demand letter or should I wait for them to call me?
The impact actually took my drivers seat off it's track, the back of the seat also reclined fully to the rear (broken) and sent me flying into the back seat with my legs still under the lap belt portion of the seat belt.
The ambulance service extracted me from the vehicle in a neck brace and back board and took me to the ER. There I received chest x-rays and two CT scans on my head and neck (I had hit the side of my head on the side panel between the front and back seats and couldn't turn my neck). The scans were clear of any fractures or brain damage thank God. After a bit of morphine drip, 6 hours in the neck brace, and a handful of prescriptions for pain, muscle relaxers and anti-inflammatory I was released.
At the end of June I made an appointment with an orthopedist because of lingering neck and back pain/stiffness - that appointment was this morning (first available date was 2 weeks after setting the appt.). So today they took some spine x-rays and determined that it is soft tissue damage only, again, thank God. They want me to start physical therapy which I don't want to do, but I also want to follow doctors orders in case something pops up later.
Overall I think I've gotten pretty lucky considering how bad it Could have been. I'm still juggling things with the auto insurance stuff - which is confusing as hell right now. Both myself and the guy that caused the accident have the same auto insurance company (hint: 4 letters, military).
The way it's been explained to me is that his coverage has already paid for my totalled vehicle ($13,500), my insurance is covering my medical costs ($8,500 so far from ambulance and ER, CT and Xray) who knows how much from today's ortho visit and physical therapy, and eventually his insurance will pay some sort of pain and suffering + lost wages (lost wages were only for 2 days for $350 luckily i sit at a desk all day and can take frequent get-up-and-stretch breaks). I'm not sure how much their pain and suffering will be but they should really calculate in having to deal with the pain in my butt from having to juggle phone calls between auto insurance, health insurance, and the hospital! lol.
Is there anything I need to be on the lookout for or be aware of when it comes time to dealing with the other policy holders adjuster? Are they going to try to tell me that pain and suffering for soft tissue damage is BS? After my medical treatment is over should I be the first to make contact with them by sending them a demand letter or should I wait for them to call me?
Posted: Thu Jul 12, 2012 12:31 am Post Subject:
Yes, definitely. Depending on where you reside, certain medical treatment providers or insurers might look to reclaim some of their payments from your bodily injury settlement. When negotiating with the responsible party, keep this in mind and seek an appropriate figure that will not only compensate you for non-economic damages (i.e. pain & suffering, lost wages, etc.) but will also compensate you for the amount of liens you need to satisfy. Keep in mind, you can often negotiate these medical liens down. Another thing to consider is your spouse. He or she might also be able to bring an independent claim against the responsible party for loss of consortium (i.e. loss of family benefits such as marital relations, household chores, etc). If you have any permanent injuries or scarring, you will likely want to seek a higher settlement value. Note also that each state sets a time limit (i.e. a statute of limitations) to bring a claim against the at fault party, it varies from state to state but is normally two years from the date of loss
Posted: Thu Jul 12, 2012 04:28 am Post Subject:
I'd also pay close attention to what medical information the other person's adjuster has. That adjuster should not have access to _any_ medical information unless you sign a medical authorization. Most likely the other person's adjuster will need to review your medical bills so unless you sign documents allowing this, that adjuster should not give you any indication that he/she has seen any bills/notes.
Posted: Thu Jul 12, 2012 03:18 pm Post Subject:
my insurance is covering my medical costs ($8,500 so far from ambulance and ER, CT and Xray) who knows how much from today's ortho visit and physical therapy
Although this tends to be the norm rather than the exception, THIS IS ENTIRELY IMPROPER!
Your health insurance is only intended to cover FIRST PARTY claims (sicknesses and injuries acquired without the input of a known third-party [the driver who caused your injuries]).
The person who caused your injuries is liable for the full cost of your medically necessary health care expenses, rehabilitation, lost wages, and other damages.
As Counselor Crawford has said, the cost of your health care related directly to the collision is creating a lien against any eventual settlement you may obtain. It would be better if all those bills were now being paid by that party's liability insurance instead of your own health insurance. That way you don't have to get involved in negotiating a reduction of the lien at the same time you are trying to negotiate a settlement with the insurance company.
Your health insurance company is also obtaining the benefit of your own efforts to settle your claim. All they need to do is file a primary lien, and let you do all the legal work for them. They don't have to expend one ounce of effort in order to collect.
Your legal fees come off the top, then the primary lien claims come next, and you get what little remains. If you take the medical bills out of the equation, you'll end up with far more in your pocket when everything else is said and done.
Most people are reluctant to do this. Or they just plain don't understand what's happening. It amazes me that so many attorneys simply permit their clients to continue accruing medical expenses under their own health insurance. Perhaps if attorney's fees were the last to be paid instead of the first, it would help.
Posted: Thu Jul 12, 2012 03:41 pm Post Subject:
Although this tends to be the norm rather than the exception, THIS IS ENTIRELY IMPROPER!
I think ther OP's bills are being paid under his/her own PIP... which is correct (PIP is primary over just about everything).
[quotw]The person who caused your injuries is liable for the full cost of your medically necessary health care expenses, rehabilitation, lost wages, and other damages.[/quote]
Except that in many state you cannot subro on PIP, so the BI carrier also gets an off-set for that amount.
It would be better if all those bills were now being paid by that party's liability insurance instead of your own health insurance. That way you don't have to get involved in negotiating a reduction of the lien at the same time you are trying to negotiate a settlement with the insurance company.
As mentioned above, I think it's the OP's PIP carrier that is paying those bills but I'd say the best thing would be to have them unpaid. If the OP's health carrier were to pay them then the health carrier has a lien for the full amount they paid (granted the OP could still attempt to negotiate that). If the bills were unpaid then the OP could _easily_ negotiate the bills down as this happens all the time with medical providers. That is, the OP submits the full amount of the medical bills for consideration to the liability carrier and gets paid based on the full amount. The OP then negotiates the medical bills down and pockets the difference.
Posted: Thu Jul 12, 2012 03:42 pm Post Subject:
Although this tends to be the norm rather than the exception, THIS IS ENTIRELY IMPROPER!
I think ther OP's bills are being paid under his/her own PIP... which is correct (PIP is primary over just about everything).
The person who caused your injuries is liable for the full cost of your medically necessary health care expenses, rehabilitation, lost wages, and other damages.
Except that in many state you cannot subro on PIP, so the BI carrier also gets an off-set for that amount.
It would be better if all those bills were now being paid by that party's liability insurance instead of your own health insurance. That way you don't have to get involved in negotiating a reduction of the lien at the same time you are trying to negotiate a settlement with the insurance company.
As mentioned above, I think it's the OP's PIP carrier that is paying those bills but I'd say the best thing would be to have them unpaid. If the OP's health carrier were to pay them then the health carrier has a lien for the full amount they paid (granted the OP could still attempt to negotiate that). If the bills were unpaid then the OP could _easily_ negotiate the bills down as this happens all the time with medical providers. That is, the OP submits the full amount of the medical bills for consideration to the liability carrier and gets paid based on the full amount. The OP then negotiates the medical bills down and pockets the difference.
Posted: Thu Jul 12, 2012 04:41 pm Post Subject:
I think ther OP's bills are being paid under his/her own PIP... which is correct (PIP is primary over just about everything).
That is correct...or soon will be.
Initially since I had to provide insurance at the time of the injury my wife gave them our health insurance card and we paid our ER deductible. Since then, and this was only a few weeks ago, our health insurance has paid the entire bill. I called them and gave them my auto insurance claim number (as well as calling my auto insurance to give them my healthcare providers #) so as to get the bill to the right place. I also called the hospitals finance department and they are sending the payment back to my health insurance and collecting from auto.
Long story short, my PIP is going to pay for the bills...eventually.
It's funny, at first my adjuster questioned my need to visit the orthopedist saying "I thought the ER told you that no follow up was required" and then questioned my gap between the ER visit and the orthopedist visit (a whole 6 weeks). For the first 2 weeks after the accident I was on pain meds, then I had to schedule my ortho appointment 2 weeks out because they were overbooked - so there's that.
Posted: Thu Jul 12, 2012 05:42 pm Post Subject:
at the time of the injury my wife gave them our health insurance card and we paid our ER deductible. Since then, and this was only a few weeks ago, our health insurance has paid the entire bill.
This is what is precisely the wrong thing to do. Since 1986, it has been unlawful for any "Medicare-participating" hospital emergency room in America to deny service to any person whether they have health insurance or the ability to pay for health care expenses or not (I don't know of any hospitals which are not Medicare-participating providers).
The federal law is known as "EMTALA" (Emergency Medical Treatment and Labor Act, sometime referred to as the "Anti-Patient Dumping Act"). You cannot be sent to another hospital because you don't have insurance, don't have a credit card or bank account, and you cannot be moved down the triage list (i.e., waiting room hell) simply because you don't have the ability to pay. For more information on EMTALA, see: http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/ or simply "google" emtala.
If you are injured in an auto collision which is not your fault, and you are transported to a hospital emergency room, when asked, simply deny that you have any health insurance to cover the charges.
As tcope has said, it might even be best to allow the bills to go unpaid. The hazard in that, however, is that after as little as 30 or 60 days without payment, the hospital is very likely to turn their billings over to collections, which can make your life miserable and adversely impact your credit standing around town.
So get the medical treatment you need immediately, then get the claim going with the at fault party's insurance company, and, if you are in one of the states with PIP (California is not one of them, so my personal experience with it is nil), you get your insurance company working to pay the hospital and doctor bills, too.
JUST DON'T INVOLVE YOUR PERSONAL MEDICAL INSURANCE in a third-party event! No matter the state in which the collision occurs.
Posted: Sun Jul 15, 2012 03:37 pm Post Subject:
Be on the look out for everything. The other insurance provider job is to pay as less or no money. Make sure you have everything you need.
Posted: Sun Jul 15, 2012 06:25 pm Post Subject:
Since 1986, it has been unlawful for any "Medicare-participating" hospital emergency room in America to deny service to any person whether they have health insurance or the ability to pay for health care expenses or not (I don't know of any hospitals which are not Medicare-participating providers).
There was no mention if anyone denying service... only that they asked for insurance information.
If you are injured in an auto collision which is not your fault, and you are transported to a hospital emergency room, when asked, simply deny that you have any health insurance to cover the charges.
A person can certainly do this but then the hospital will send the patient the bill and if not paid or told about payment will probably turn it over to collections. At that point it's just a huge pain in the butt... and can even result in credit issues and/or a lien. All of this when the person is paying for insurance to address the bills.
If the bills are paid under PIP then its no big deal as in _most_ cases there is no recovery on PIP (all states should be this way but they are not).
If the OP has PIP then those bill _have_ to be paid under PIP first. The liability carrier does not need to pay or even consider them directly.
If a state has PIP then filing a PIP claim won't affect rates.
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