by fire_parmdc » Thu Jan 13, 2011 06:14 am
My family and I were involved in an auto accident this past summer. It was a simple rear-end collision and was the other party's fault. We all got chiropractic care, my husband did have to see his pcp for a headache following the wreck (he's a post-stroke patient), and my oldest son is seeing a therapist for some psychological issues it caused him. Otherwise, we are fine. The chiropractor put a lien on his portion of the claim with the other party's insurance company. In Missouri, there is no subrogation against medical payments. When I talked to the adjustor today to try and get these claims settled, she advised me that the claims to the chiropractor had been covered by our medpay, minus a very small amount...so the remainder of what medpay paid should go to us, plus the pain and suffering, and any specials, if I'm understanding correctly. She also stated that she had negotiated a price with the chiropractor and he was willing to settle for a lesser dollar amount (like $7,000 less) and that is what they would pay, and not a penny more. But total, our medpay paid out more than that. My question is, doesn't the other party's insurance have to pay us what our medpay paid out plus the pain and suffering and specials, barr none?
Thank you!
Thank you!
Posted: Thu Jan 13, 2011 03:11 pm Post Subject:
doesn't the other party's insurance have to pay us what our medpay paid out
No. To receive a payment for something already paid for by insurance is to obtain a profit, and insurance does not do that. The purpose of insurance is to INDEMNIFY -- to restore you to "whole" (financially). Since your medpay already did that, you have no additional claim for those expenses.
What it means by medpay is not subject to subrogation is this: if you were to receive a cash settlement for your "general" damages (the "pain and suffering" portion of your claims), your auto insurance company cannot make a claim against that money in subrogation of the amount it paid in medpay. You get to keep all that money.
There is no simple measure for "general" damages. I am skeptical of "psychological issues" your oldest child has as the result of the incident, but I'm not on the jury either. The therapist is just as likely to be milking this for the insurance money, too.
Depending on the nature of the actual injuries, the insurance company will offer you a certain amount of money (up to the at fault party's policy limits) -- if you want more, then you can't accept the insurance company's offer and will have to sue the at fault party in civil court. That means lawyers, additional expenses, and 30%-40% of your final award will go to the attorney, not to you and your family. If you win.
And what if the at fault party has no money or assets? You'll only get the maximum benefit payable by the insurance company -- less the 30%-40% that the attorney will take off the top.
So you'll have to consider the facts and ask for what you believe is reasonable. Is this a multimillion dollar case? No. For that, someone has to die, suffer permanent paralysis, blindness, or other severe, lasting disability. But you should be able to negotiate a fair settlement without an attorney.
Posted: Thu Jan 13, 2011 03:14 pm Post Subject:
I live in Missouri and have had to use my medpay twice in twenty years to cover my medical expenses. In both cases, the other party's insurer could not take into account what my insurer paid out in med pay and deduct that amount from their settlement. Missouri has a quirk when medpay is involved and you are allowed double dipping. You can collect from your medpay for medical expenses and collect from the at fault insurer and you do not have to repay your insurer the med pay allowance and expenses.
If you collected med pay and attempted to use your own health policy, your healt care provider would likely attach a lein to your settlement for any amount you were paid under the coverage of liability from the at fault party settlement.
Unless a recent loophole has been closed, I beleive my information to be accurate. However, I'd suggest you contact your insurer and have them put their comments and explanation in writing so there will be no misunderstanding with regard to your med pay coverage.
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