by Guest » Fri Apr 20, 2012 09:29 pm
Ok, here goes. I was in a pedestrian accident last April, where I was hit in a crosswalk by an elderly driver. I had the walk sign, and she had a green, but it was a yield turn for pedestrians. She plowed right into me, and continued to drive with me on the hood of her car an additional 3 ft until she hit the brake and I fell off. Other cars stopped, called 911, I was checked on the scene, but did not go to the hospital. She was cited and a police report was filed. I immediately went to my chiropractor, and went to a spine/sports MD a few days later. Nothing broken, but $5690 was charged to her insurance via PIP, and another $900 for massage. I don't have the numbers for the sports MD and X-ray he performed.
We are now here a year later, my chiropractor has closed my case, and the insurance company has offered a settlement of $6000 ($1200 of which is to cover upcoming chiro. treatments needed to maintain my neck position).
I went to a therapist a few times, as the accident combined with a separate case of road rage caused severe anxiety right before I had to fly overseas. I had insomnia for three days, and finally saw a therapist. I did not charge them for those visits, as I don't feel it was completely due to the accident, though it did play a role.
I want to be fair, and am not out to get rich off of this. However, I also feel that I need to be compensated for how badly this disrupted my life the past year. I am a musician, and it severely impacted the length of time I am able to perform comfortably, in addition to making it difficult to juggle multiple chiro/massage appointments each week in addition to taking care of my daughter. I am preparing to mail a counter offer letter requesting $14,380, as I took the $6590 in medical specials X 2 and added the $1,200 for future chiropractic treatments. Is this being fair?
We are now here a year later, my chiropractor has closed my case, and the insurance company has offered a settlement of $6000 ($1200 of which is to cover upcoming chiro. treatments needed to maintain my neck position).
I went to a therapist a few times, as the accident combined with a separate case of road rage caused severe anxiety right before I had to fly overseas. I had insomnia for three days, and finally saw a therapist. I did not charge them for those visits, as I don't feel it was completely due to the accident, though it did play a role.
I want to be fair, and am not out to get rich off of this. However, I also feel that I need to be compensated for how badly this disrupted my life the past year. I am a musician, and it severely impacted the length of time I am able to perform comfortably, in addition to making it difficult to juggle multiple chiro/massage appointments each week in addition to taking care of my daughter. I am preparing to mail a counter offer letter requesting $14,380, as I took the $6590 in medical specials X 2 and added the $1,200 for future chiropractic treatments. Is this being fair?
Posted: Fri Apr 20, 2012 10:40 pm Post Subject: Is this fair?
I think thats fair considering a insurance adjuster deals with these claims daily as a career and anything to close this case with the least anount of money will benefit the insurance company. Not you. If this is what you feel is due to you than dont look back and without remorse. Remember the sooner the insurance adjuster can close this case with the least amount of money makes there boss happy.
Posted: Fri Apr 20, 2012 11:45 pm Post Subject:
I think you need to be on the same page. I suspect that the adjuster's offer is above the medicals bills that have already been paid and your demand is not (as typically people take a multiple amount of the medical bills to include the bills as well).
To me honest, with the very limited information I know of, I'd say $6000 above the medicals is pretty good. With an initial offer of $6000 I'd say the adjuster target should be $7500 with a top of $8500. Personally, I think $6000 (above the medical bills) is a little high but I know next to nothing about the claim. Certainly juries don't like people who hit pedestrians.
What is the PIP minimum in your state? Unless it was exhausted (some how at an odd number) it should pay for your medical bills, present and future (up to the statute allowed time wise). So your future medical _bills_ should be paid by PIP but your pain/suffering for that treatment should be consider under your settlement offer. A release does not waive your right to collect under PIP. Something is not right here.
Posted: Fri Apr 20, 2012 11:55 pm Post Subject:
Yes, you are right about the PIP. It is separate and is $35,000 for 3 years. The adjuster initially offered $4,800 before my chiro released me, then upped it to $6,000 after the release (2 months later). At first, I was going to counter $8,500 and hope for $8,000, but the more I read, the more this seemed low for what happened. Like I said, I want to be fair, so I appreciate any help you have. I don't want to throw out the $14,380 and look as though I'm a greedy "you know what". :-)
Posted: Sat Apr 21, 2012 02:35 am Post Subject:
First, there is really no way for me (or really anyone here) to say what your claim is worth. It depends on many factors that are unknown to us. What I'm going on is what you posted. You have a soft tissue injury and it appears there is no reason you should not have a full recovery (maybe you won't).
Personally, I think $14,000 would be a target or on the high end side of the settlement an adjuster might offer to include the already paid medical bills.. But at $6500 in medical bills and a $6000 offer, the adjuster is _starting_ at $12,500.
I'm just adding things together above to show my point. But really no one should be talking about what your actual medical bills are when discussing a payment... as those medical bills were already paid and future bills will be paid as well. An adjuster does not want to make an offer of lets say $10,000 have the person accept (thinking they are going to get $10,000) and then the adjuster says, okay... less the $5000 already paid on the medical bills leaves $5000. Now that person's $10,000 just turn into $5,000. I'd be PISSED OFF if an adjuster made an offer like that. If PIP is paying the bills, better to just discuss how much the check is going to be for as PIP is going to continue to pay regardless of the settlement.
If I were you I'd ask for $14,380 (the odd number make it sound like you really gave it some deep thought). To me, this tells the adjuster that at least you are in the same ball park and you should be able to get this settled. Make a list of arguments in your favor, as you mentioned in your initial post (trauma, not being able to work, etc.). Slowly through these things out there in order to get the adjuster to go higher. Once you feel the adjuster has topped out, let them know you simply cannot go any lower, you've asks around and you feel the claim is worth more. End the conversation nicely (for example, "I need to weight my options at this time, thank you"). If you can wait (PIP is paying your bills) then give it several weeks or even a month. The adjuster wants to close the claim and you've left the adjuster wondering what is going on. You will either get a call or you can call the adjuster and and if you are willing to accept the last offer, let the adjuster know you'd accept for another $xxx (something like $750 or $500 more). Let them know this would settle the case but you're already taking a hit by accepting that little (something like that). It's icing on the cake for you.
You also need to be _sure_ you will only have $1200 more in medical bills. No point in rushing the settlement. What if it turns out to be $3000 more? Then you left money on the settlement table.
Also, does PIP address loss wages in your state? Some don't but others usually pay around 80%. I handle claims in a lot of states but don't recognize a $35,0000 PIP limit.
Posted: Mon Apr 23, 2012 05:52 pm Post Subject:
Thank you so much for your reply.
Just to make sure I clearly understand, the insurance has already been billed at least $6500 for medical expenses via PIP. They have stated the the pain and suffering offer is above the $35,000/3 yr medical payment portion of the owner's policy. Their current offer for pain & suffering/liability is at $6000.
Am I out of line for requesting the $14,380 for the pain and suffering portion above what they have paid for medical? I used the "medical specials" formula to calculate that number, and want to know if that is accurate.
If it helps, I'm in WA state.
Thanks!
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