by TexasFireman » Tue Aug 10, 2010 05:09 am
It has been a bit over a year since my family and I were rearended. My wife went through 1 series of physical therapy sessions and I had to go through 2 series of sessions.
We both had MRI's that we paid out of pocket (after the wreck) which showed some problems in our necks...like c4 c5 kinda problems. The MRI results showed only "degenerative" issues. No herneations or bulges. We have never had neck problems and have never had any need for REHAB or any therapies.
Our pain started right after we were rearended.The adjuster offered my wife a small settlement that wouldnt even cover her medical costs. We rejected it and waited till I finished all of my remaining therapy.
I submitted all bills and documentation to the adjuster. the adjuster sent it to a medical review team. (took over a month and a half) He sent me a copy of the teams results which stated since our MRI's showed "degenerative"...and that the previous offer to my wife was retracted and no other offer will be made or considered. Thank you have a nice day. I guess they are making it seem as a previous condition.
We are out alot of money. But thank God the therapy worked.
What should I do. I doesnt seem fair at all.
What has been your experiences with insurances playing this "degenerative card" on people with zero medical history and retracting and refusing to cover medical costs???
I have not wanting or have even mentioned pain n suffering. I do not want to make money off this wreck.
I might mention that the first adjuster that helped us the first 3-5 months got firedor no longer with the company...the second adjuster helped us for about 4-5 months...and this 3rd one is the one that has been playing hardball with us for the last 4-5 months.
Please help my family out with any suggestions as to what we can mention in our first"confirmation signature reciept letter" to the insurance company that can maybe resolve this matter,
Thanks in advance for all your time and consideration.
We both had MRI's that we paid out of pocket (after the wreck) which showed some problems in our necks...like c4 c5 kinda problems. The MRI results showed only "degenerative" issues. No herneations or bulges. We have never had neck problems and have never had any need for REHAB or any therapies.
Our pain started right after we were rearended.The adjuster offered my wife a small settlement that wouldnt even cover her medical costs. We rejected it and waited till I finished all of my remaining therapy.
I submitted all bills and documentation to the adjuster. the adjuster sent it to a medical review team. (took over a month and a half) He sent me a copy of the teams results which stated since our MRI's showed "degenerative"...and that the previous offer to my wife was retracted and no other offer will be made or considered. Thank you have a nice day. I guess they are making it seem as a previous condition.
We are out alot of money. But thank God the therapy worked.
What should I do. I doesnt seem fair at all.
What has been your experiences with insurances playing this "degenerative card" on people with zero medical history and retracting and refusing to cover medical costs???
I have not wanting or have even mentioned pain n suffering. I do not want to make money off this wreck.
I might mention that the first adjuster that helped us the first 3-5 months got firedor no longer with the company...the second adjuster helped us for about 4-5 months...and this 3rd one is the one that has been playing hardball with us for the last 4-5 months.
Please help my family out with any suggestions as to what we can mention in our first"confirmation signature reciept letter" to the insurance company that can maybe resolve this matter,
Thanks in advance for all your time and consideration.
Posted: Tue Aug 10, 2010 06:15 am Post Subject:
My first red flag is that the adjuster did not review his/her own claim. In my experience when they ship it off to a bunch of nurse want-to-be's it turns into trouble.
I think you understand that degenerative changes mean that they existed before. However, this _certainly_ does not mean that your condition was not made worse from the accident or that you did not feel any pain. Here is the thing... did you feel _any_ pain after the accident? Then they need to make a payment.
If they are offering nothing then I think they have their heads up their butts. That is _really_ bad business on their end. I'll explain why. You now have medical bills which you can't pay or should not have to pay. If they offer nothing they have left you no choice but to get an attorney. I can _guarantee_ that this will increase _their_ expense. It does not mean you will get more (in the end)... only that it will cost the insurance company more.
IMHO any offer less then your medical bills is really just stupid in this case. A few thousand for the med and perhaps a few hundred more is nothing when it comes to an injury claim.
In that the adjuster is not the one reviewing the medical bills and settling the claim themselves tells me that it's an insurance company that watches every nickel and dime that goes out the door. These companies usually end up paying much more... it just looks better on paper.
What you need to point out the them is that you were not in pain before the accident and you were not under the care of a doctor for any injury. Point out that regardless of your prior condition, all of the medical records indicate that you received some type of injury in the accident, be it new or an exacerbation. Point out that regardless, an amount is still owed. Let them know unless they want to seriously discuss settlement you will have no choice but to secure the services of an attorney. Give them 14 days to respond.
Posted: Tue Aug 10, 2010 03:39 pm Post Subject:
Thanks tcope...I will be setting aside a few hours today to draw up this letter. You gave me some good advice.
I could not sleep AT ALL last night. I just really want to get this over with.
The only KINDA good thing that came out of this wreck is that it made me more aware of needing to know your rights, and made me more aware that there are some really coldhearted poeple out there...to the extent...that I went out to one of these adjuster schools and became a licensed adjuster last month. I honestly didnt learn as much as i wanted to, but any knowledge is power...and at the time...I was feeling a bit POWERless.
Thanks again and please keep the advice coming...and keep us in your thoughts.
Posted: Sat Sep 11, 2010 11:48 am Post Subject:
Knowing your rights doesn't get counted for insurance only. But when it comes to insurance we need to make sure that we've read through our policy papers and clarified all our doubts. We should also go through the state dept. website and make a note of the guidelines.
Add your comment