by Guest » Tue May 06, 2008 01:50 am
Hi, 3 weeks ago (April 21) I was walking down a flight of stairs at a business office complex. They were tile steps (covered by tile). Well I got about 3 steps down and one of the tiles on the step shattered and sent me flying down about 4 more steps. I immediately took a photo and called the property management. They said "oh we are sorry we knew the steps had hairline cracks and we actually have someone schedule to come out Wednesday" (April 23). There was no sign or warning or anything. The fact they knew about it sort of upsets me. It could have been a much older person and they could've been seriously injured. Anyway I went to the doctor the next day and have been diagnosed with sciatica. I feel miserable I have shooting pains down my right leg and into my feet. I am on percoset and valium and flexeril as well. I have missed 3 weeks of work (I am contracted through a place so I have no benefits) Im a 1099 employee. The inurance company (Chubb) has told me they have accepted liabilty for the claim. I also have an email from the property management with before and after photos of the steps and them saying they were sorry and that they did have it scheduled for repair prior to my falling (which shows negligence I would assume). Here is my concern:
The adjuster said they will do nothing until ALL medical is finished then they will determine a settlement amount based on lost wages, pain and suffering, medical bills, etc. However they will not do anything before my medical is done. She told me that if I could find someone who would do medical treatment on a lien then they would simply pay them directly when the settlement is done. That is fine, up to now I have been paying out of pocket but last appt my Dr. stated I may need an MRI and/or physical therapy. I am sure I can find someone to do this on a lien basis. I am really starting to feel this financially now and as much as I don't want to just hurry through this and settle but I feel I don't have much of a choice. My pain is pretty bad and I cannot work because I have to lift heavy objects. Should I find a way to make it though financially and take this until I actually feel better or would it not really effect the final pain and suffering amount? Also does the fact they knew about the steps and didn't close them off counts for anything? I have a 9 mo old daughter who I cannot even pick up right now and this is really effecting my life at this point. It really stinks and I read a lot of stories of people getting their wages, medical and like $1000 dollars. That just doesn't seem fair. I am open and appreciate any advice. Thank you in advance.
Robert
The adjuster said they will do nothing until ALL medical is finished then they will determine a settlement amount based on lost wages, pain and suffering, medical bills, etc. However they will not do anything before my medical is done. She told me that if I could find someone who would do medical treatment on a lien then they would simply pay them directly when the settlement is done. That is fine, up to now I have been paying out of pocket but last appt my Dr. stated I may need an MRI and/or physical therapy. I am sure I can find someone to do this on a lien basis. I am really starting to feel this financially now and as much as I don't want to just hurry through this and settle but I feel I don't have much of a choice. My pain is pretty bad and I cannot work because I have to lift heavy objects. Should I find a way to make it though financially and take this until I actually feel better or would it not really effect the final pain and suffering amount? Also does the fact they knew about the steps and didn't close them off counts for anything? I have a 9 mo old daughter who I cannot even pick up right now and this is really effecting my life at this point. It really stinks and I read a lot of stories of people getting their wages, medical and like $1000 dollars. That just doesn't seem fair. I am open and appreciate any advice. Thank you in advance.
Robert
Posted: Tue May 06, 2008 04:55 am Post Subject:
They are exactly correct. There are two ways I can explain this...
If/When they make payment it will be to settle the claim. That is, they are paying you in order to protect their insured. If they were to pay your medical bills as they were incurred, there is nothing to stop you from then filing suit against their insured. This would be bad faith on their part as they would not be providing the protection to their insured that is required by law.
Another way to look at it is that a judge/jury is the final word on what is owed on a claim. If you file suit, you need to show what your damages are and make a demand. The court does not tell the complex that they have to pay bills as they are incurred, nor would they leave any amount open (i.e. they would not say that the complex owes future medical bills as they are incurred)... it's one flat amount that they award. This is the same thing as the carrier offering a _settlement_ amount for your loss.
How can they know this amount until you're pretty much done treating? They can't. So they can only make an offer once they fully understand what your treatment will be (unless it's a minor claim). Almost _every_ provider will provide treatment under a lien. Look up doctors in the yellow pages... there are almost as many as lawyers. You could spit and hit 20 that would treat you under a lien.
I'm doubting that the carrier will offer you only $1k over your medical bills as it sounds like your treatment will be extensive. You mostly hear those stories for people who trip over their own two feet and have a few bruises. Keep in mind that you can obtain the services of an attorney at _any_ time. So you can wait to hear the carriers offer and then hire an attorney if you would like.
Them not closing off the area seems like a moot point as you mentioned that the carrier has accepted liability. There may be mitigating factors involved but to me it seems like there are none.
One thing you want to ask about is if the insurance policy had Medical Payment coverage. If so, the policy can pay ongoing medical bills up to the limit of that coverage (pays _medical bills_ as they are incurred). I typically see this coverage up to either $5k or $10k. Again, I see almost _every_ commercial General Liability policy with Medical Payment coverage.
Posted: Tue May 06, 2008 07:29 am Post Subject:
The adjuster said they will do nothing until ALL medical is finished then they will determine a settlement amount based on lost wages, pain and suffering, medical bills, etc.
That is a thing usually done when we get treated under a healthcare unit which is not enlisted with the carrier. But generally these carriers have some listed health service providers wherein if you get treated, then they would need to get informed about your hospitalization 24 hours prior to your getting admitted (except if it is a certified emergency). I don't know if such a condition exists with your policy or not.
Regards,
Paltrywire
Posted: Tue May 06, 2008 09:27 am Post Subject:
Hi Robert,
She told me that if I could find someone who would do medical treatment on a lien then they would simply pay them directly when the settlement is done.
I have all the reasons to believe that it is all about TPAs or third party administrators that they are talking. The third party administrators are people who have people to go ahead & negotiate the medical expenses pertaining to any such case as yours & then settle it on behalf of the carrier. Later one, they would send in the actual details pertaining such expenses to the carrier & the carrier would pay them back! Pale-blue-face
Posted: Tue May 06, 2008 10:28 am Post Subject:
Tcope has fully answered your questions, just to let you know another adjuster agrees..
However they will not do anything before my medical is done.
Robert this is standard procedure...I've never paid a penney until the injured party was finished with treatment and ready to settle...He also went were I was going to go...find out about the med pay...
One thing I don't understand however...why valuim? That's not a pain reliever...it's more of a sedative right? they may question that one...
Posted: Tue May 06, 2008 09:57 pm Post Subject: insurance limits
The doctor I seen after the ER visit also was questioning the valium. Also, no MedPay. Do properties have to have a minimum amount of coverage? Like auto insurance. I just don;t want them to come back and say well this property has $2500 total coverage or something wild like that and that is all I can get and then I am forced to sue the property for the rest.
Posted: Tue May 06, 2008 10:09 pm Post Subject:
No minimum is required but I've not seen a carrier that would write a policy with less then $100,000 of liability coverage and most commercial policies are $1,000,000.
If your state allows it, I'd ask for a copy of the insureds Declarations Page (Dec sheet). it will list all the coverages.
Posted: Wed May 07, 2008 10:33 am Post Subject:
again i agree with my est.collegue...100k is the least i've seen, and i have never seen a property policy with liability that did not have medpay...don't mean they don't exsist...i've just not seen it my friend....call your states Dept. of Ins...or check their site to see if this is an automatic written on all property policys....they too (the doi) should be able to tell you if your state compells carriers when ask to disclose limits...(most don't).
Posted: Thu May 08, 2008 01:47 am Post Subject:
Ok Thank you all very much. I received the hospital bill today. It is $1800 so I will probably have about $3000 total in Dr. bills, $7000 in lost wages and then whatever pain and suff is determined to be. Is there a formula or anything they use to figure it out or is it just whatever they feel like offering?
Thanks again
Posted: Thu May 08, 2008 12:25 pm Post Subject:
Is there a formula or anything they use to figure it out
noor is it just whatever they feel like offering?
yes, kind of they will review all the info including what the doc's reports and notes say, and then will determine what the ''range'' of settlement should be for your injury type and area. (PS they will be offering the lower portion of their range first)
Posted: Fri May 09, 2008 07:26 pm Post Subject:
Ok I have one more question. My visit to the doctor today is done. He said he is pretty sure I have either a bulging disc or herniated disc. He gave me a lab order for an MRI. Here is the problem, should I find a way to get it done. Or is his diagnosis enough. I am just wondering what is going to be better for the adjuster to figure out amounts. Also, IF I have the MRI and it is not not a herniated or bulging disc and just nerve damage is that going to be a lower grade of injury. Or would it be better to just leave the doctor notes for that and not have the MRI?
Also, do meds matter, he prescribed me a steroid, another muscle relaxer and something else. 4 in total.
Thanks
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