Ok I am in ca and my and I were in a accident the police rep

by wanglanlan421 » Thu Aug 19, 2010 03:12 am

Ok I am in ca and my and I were in a accident the police report shows my wife made a unsafe lane chage and the other driver was following to close so the determined it was 50/50 I have full coverage .

anyway my insurance company (gieco) says our car is coverd under collision no biggie but I was injured hurt my back I spoke with the other drivers ins and they said after i was released from dr care they would discuss a cash settlement.Well my insurance called today saying now the other guy might not have been covered by his ins at the time of the crash. So my insur. agent tells my my injury will be covered under my bodily injury coverage my question is will they settle with me a cash settlement or just pay my dr. bills? Thanks Dom

Total Comments: 11

Posted: Thu Aug 19, 2010 05:59 am Post Subject:

agent tells my my injury will be covered under my bodily injury coverage my question is will they settle with me a cash settlement or just pay my dr. bills?

If the other person is not insured then your injuries would be considered under Uninsured Motorist Bodily Injury.

A quick looks tells me that CA has comparative negligence.. meaning that the amount you can collect from another party is equal to their negligence. If the other person is 50% liable, then your UMBI coverage will only pay for 50% of your loss (medical bills and pain and suffering).

Its _possible_ that a wife might be able to be liable to her husband in CA but I just don't know. If so, your policy _might_ consider the other 50% under your (your wife's) BI coverage. But I doubt this will be the case.

If your doctors don't file a lien with your carrier for your outstanding bills then the money should go to you.

If this happens, you then can see if your doctors are willing to discount their bills so that you can pay them. In many cases doctors will reduce their bills 50%. This is what an attorney would try. Once you hear a good number from your carrier (this will be a negotiation) you can hold off on accepting it and contact your providers to see if they will accept a discounted rate. You can then go back to your carrier and either accept or reject their offer based on this info.

Posted: Thu Aug 19, 2010 11:26 pm Post Subject: Thanks

Ok I have Kieser medical coverage the wife and I have double coverage we pay about 14000.00 a year for this coverage yea its high! But I am getting my care for my co pay so this should not even matter but does this mean my ins co will only be liable for my co pay which is only 20.00 buck a visit and 20 bucks for my mri on my back etc... If so i dont think thats very fair I feel the ins co. should be liable for the exact cost no matter how I got it done. So should I just contact my ins and tell them to settle with me becuase i have my own ins coverage? Will this even work? or are they gonna try to get me to give them my bills which will not add up to much becuase its under my ins. coverage. Thanks for the info its very helpful and appreiceated.

Thanks Dom

Posted: Fri Aug 20, 2010 05:04 am Post Subject:

but does this mean my ins co will only be liable for my co pay which is only 20.00 buck a visit and 20 bucks for my mri on my back etc

No because most likely (unless CA allows double dipping) you "should" need to pay back your health carrier. I said "should" as you may have this obligation or they may seek recovery but I've found may times they just don't pay attention and don't seek recovery. None the less, your entire medical bill would be considered even if paid by your health carrier.

Posted: Sat Aug 21, 2010 01:20 am Post Subject:

Your claim for medical expenses would not be paid by your auto insurance company unless you carry medical payments. Regardless, if any auto policy would compensate you for the cost of your medical care, that money is actually payable to Kaiser Permanente, not you.

Your HMO coverage is not intended to pay for expenses you incur as a result of a third party's negligence, or for a workers' compensation injury. If you are not making a claim against the other party in the collision, and you are not claiming reimbursement under your own auto policy med pay coverage, then Kaiser has fulfilled its responsibility to you as a subscriber who paid his required copay.

As previously mentioned, money paid by any other insurance is payable to Kaiser. The provision is called SUBROGATION, and is described in your contract with Kaiser.

Posted: Sat Aug 21, 2010 04:38 am Post Subject:

Your claim for medical expenses would not be paid by your auto insurance company unless you carry medical payments

Odd, as UMBI would address the OP's injury if the other person was not insured.

our HMO coverage is not intended to pay for expenses you incur as a result of a third party's negligence, or for a workers' compensation injury.

I don't know of any health policy that excludes coverage for injuries caused by another party. Many times have I received subro letters from health carriers against my insured's BI and UMBI coverage. Usually they _do_ exclude anything paid by WC.

As previously mentioned, money paid by any other insurance is payable to Kaiser

While the insurance company could pay the provider, there is no obligation to do so without knowledge of a lien. I never did as 1) I did not want to get in the middle of it and 2) It made my UMBI settlement offer look better if I paid 100% to the claimant, with the warning that he/she may need to pay their health carrier (I was not responsible to know if the state allowed double dipping).

The provision is called SUBROGATION, and is described in your contract with Kaiser.

The insurance company (auto) is not a party to that contract.

Posted: Sat Aug 21, 2010 03:40 pm Post Subject: In Lamen Terms

After I heal becuase I am thinking its just a pulled muscle or pinched nerve I WANT TO KNOW WILL I GET A LUMP SUM SETTLEMENT from my Bodily Injury coverage ? I am not liable to my Kieser bill any more then my primium and co-pay so do I call my ins company and say OK I AM FINE I PAID FOR ALL MY MEDICAL NOW CUT ME A CHECK FOR THIS AMOUNT I am thinking 20 G's Thanks yall for the info

Posted: Sat Aug 21, 2010 04:52 pm Post Subject:

Your BI won't address your loss... it's UMBI.

Yes, the short answer is that it's issued as a one time payment as a signed release is also required before being paid.

I am not liable to my Kieser bill any more then my primium and co-pay

I would not be so sure about that... you probably _are_ responsible for paying them back if they ask.

Posted: Sat Aug 21, 2010 05:56 pm Post Subject: I called them

I pay for insurance I was told if I broke my leg or hurt my back it does not matter how i got injured thier job is to treat my injuries per my agreement which is my CO-pay and premium . she said if my premium is paid and I have paid my premium and paid my co pay then my responsibility is taken care of if I sue a guy for say breaking my arm I am insured to go to kieser to get my arm fixed but they would not get involved with my law suit. So yes i have UMBI so they will want me to sign a release and get the check. This is correct I just got off the phone with my UMBI adjuster and she said once I am healed and get the release from my dr. to sedn here the release and we will talk settlement. Thanks everyone for the help.

Posted: Tue Aug 31, 2010 11:00 pm Post Subject: Pay em back

How is that that I have to pay them back? Thats what I pay for to take care ofme if injured, Why in the world or better yet how in the world can a med insurance company demand more money for services rendered?

anyway thats not the case I talked to my med insurance and they want nothing just settled for $18,000.00!!!!! Thanks :-)

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