by Guest » Tue Jan 25, 2011 04:25 pm
I was in a car accident recently. I started feeling dizzy and nauseous even after a week and went to teh doctor and was concluded as Vertigo. The liable insurance party however would not pay for my doctors visit or medication saying that in New Jersey we will have to go through our own insurance company for medical expenses, but I have a 1000$ deductile for my insurance. I am feeling blurred vision and my neck is still stiff from the accident. I will have to go to the doctor again, but will have to pay for all my expenses. Is there no way I can make the liable party's insurance to pay for this?
Posted: Wed Jan 26, 2011 01:45 pm Post Subject:
The liable insurance party however would not pay for my doctors visit or medication saying that in New Jersey we will have to go through our own insurance company for medical expenses
This is NOT TRUE in New Jersey. Auto insurance is mandatory in NJ, and a "Standard" policy comes with a minimum of $15,000 bodily injury liability. A "basic" policy is also available, but has no liability coverage (go figure this one out).
However, if a person has only a basic policy, NJ law states:
If you do not have any liability coverage, you are responsible for paying for the pain, suffering and other personal hardships and some economic damages, such as lost wages, that you cause. The insurer will not provide or pay for a lawyer to represent you if you are sued. Your assets will be at risk, including the risk of having money deducted from your wages if a judgment is entered against you. And, if you lack coverage and someone hits you, you cannot sue.
You need to determine what coverage the at-fault party has. If no liability coverage, then you have to sue them in court to recover your loss. They DO NOT give up their liability for your damages just because they have no insurance.
Posted: Thu Jan 27, 2011 12:30 pm Post Subject:
It is unfortunate that insurance companies seem to be more adept at peddling insurance than they are in paying for claims. Insurance companies generally do not like paying claims, and they will always have excuses why they should not pay, especially if your claim is a large one. You will hear excuses like the doctor’s fees are too much, or that the medical treatment you are seeking is not necessary and reasonable.
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Posted: Thu Jan 27, 2011 05:01 pm Post Subject:
Esperanza, I can appreciate that point of view as it seems like all you ever hear is negative, the positive doesnt make headlines. But there are two sides of the fence:
Quote: "It is unfortunate that insurance companies seem to be more adept at peddling insurance than they are in paying for claims. Insurance companies generally do not like paying claims, and they will always have excuses why they should not pay, especially if your claim is a large one." - That's far from truth, although I agree there unfortunate exceptions. Im now an agent, but a former multiline adjuster that handled bodily injury and auto claims. I can tell you that the companies I represented encouraged paying claims, but only when owed. There a lot of lowcost, gapped up policies out there available for folks that just want to get the cheapest on most convenient policy the can find. Ask any agent or adjuster, you get what you pay for. If your'e curious about what you have (or dont have), swing by a local agents office and sit down and let him review your coverage. Save the .com and 800# for making after hour payments or asking basic questions.
Quote: "You will hear excuses like the doctor’s fees are too much, or that the medical treatment you are seeking is not necessary and reasonable." - I'm sure that you don't believe insurance companies should pay unreasonable fees and expenses? The insurance rates we pay are based on insurance company's loss ratio and profitabilty. Claims have the job of making sure what they pay out on behalf of a company be consistant with industry paractices, fair, and look out for fraud. As a consumer, I want to them to pay only what they owe and only that which is reasonable and neccessary.
Posted: Fri Jan 28, 2011 08:13 am Post Subject:
As a consumer, I want to them to pay only what they owe and only that which is reasonable and neccessary.
Esperanza . . .
Insurance companies are in business to make money, as are most businesses. We can all agree on that.
But what keeps insurance companies in business is PAYING CLAIMS. If an insurance company deliberately sold policies and never paid claims, it would be put out of business by the state regulators . . . or by consumers who would not do business with that company.
Insurance companies have to evaluate claims according to the contracts' language. They do not simply pay 100% of every bill presented for payment. And I'm sure you would agree that is a proper action. If you received a bill from your electric company for electricity you did not use, would you pay that bill? Of course not!
So when a bill comes in and the insurance company does not believe it is legitimate, or it is an overcharge for whatever reason, they have the right to investigate the claim and determine what they believe is the proper payment. If you disagree with what they have paid, you can always argue your point, and, ultimately, you always have recourse through arbitration or the courts.
But that does not mean you will win either. If it is determined that the insurance company's offer was reasonable and proper, that is all you will receive, and then your lawyer will take 30% to 40% of that, so you will really end up losing in such a case.
And mbyork is absolutely correct, too. Auto insurance fraud is the #1 form of insurance fraud committed in the United States. This alone accounts for insurance companies' attitudes toward claims. In California, the statistics are that nearly 50% of all auto insurance claims are fraudulent. So insurance companies need to exercise care in paying claims. If you believe you have been unfairly denied a claim, simply discussing the matter with the insurance company may result in a more favorable outcome.
And you can always contact your state's Dept of Insurance for assistance if you don't think the insurance company is acting properly.
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