by KG » Tue Jan 29, 2013 01:34 am
On Oct. 17, 2012 my wife was involved in an auto accident in the sate of MO. The other driver was found to be 100% at fault. He was also uninsured. We had our final visit with the surgeon last week and have the all clear from him so now we are getting ready to settle the pain and suffering portion with our own insurance company, State Farm. Our uninsured motorist policy has a 250k individual/500k accident limit. The total medical bills totaled $55,800 with an allowed amount of 18,600. Our vehicle was totaled and has been replaced with a cash value of $22,600. My wife missed only a couple of days of work as she works part time and can do it from home, so loss wages were only $300 dollars. Injuries from the accident were severe facial trauma which resulted in an overnight stay in the hospital and surgery the following week to put in two plates and ten screws in her check bone and orbital rim. Other fractures were small enough that they didn't address them to limit potential scarring. There is limited scarring that is difficult to see but the eye has a different shape and is noticeably different from the other. We do not want to hire an attorney. Interesting story is that when I called our local agents office to give them an update on my wife the assistant asked after hearing of the surgery if we were going to hi an attorney. I asked why and she said it sounded like there was significant injuries and we should consider getting an attorney. When I informed her that the driver was uninsured, she quickly changed her story and said an attorney wouldn't be needed.
Any input on what sounds like a fair settlement amount would be appreciated as we are only looking for a fair amount. Thanks in advance for the replies.
Any input on what sounds like a fair settlement amount would be appreciated as we are only looking for a fair amount. Thanks in advance for the replies.
Posted: Tue Jan 29, 2013 02:59 am Post Subject:
As others will know I almost _never_ mention numbers on settlement. There is almost never enough info known to give a good number. In this case the number is big so a few thousand won't really matter. I could easily see this case being $100k - $150k. I can tell you that an attorney would start at the $250k policy limits and tell the adjuster that it's worth every penny of that. Of course, the adjuster is not going to offer that amount unless suit is filed (why would they... the only thing added to that number could be the defense cost and they can offer the $250k at any point to stop the defense costs from racking up). The adjuster would probably offer $70k. I think pretty quickly the adjusters number would reach $90k and then start to slow down. If this were the case, they could easily go to $100k to settle. Probably at this time the attorney would be around $200k. Your issue is that you (not having an attorney) would be hard pressed to get the adjuster above $100k. Do I think they would go to $120? Yes. But that would probably require someone to file suit for leverage.
Now the math....
If it went to $150k in suit, an attorney would take 40%. That is $60,000 off the top without expenses (you'd probably pay expenses). That leaves you with $110,000. This is about the same as the $100k I think you could have gotten. I really think $150,000 is possible but unlikely.
Who paid the medical bills? Are they going to seek recovery? If insurance paid, most carriers will require that you pay them back. If this is the case, an attorney would usually get that amount reduced. But you can as well. In many cases you can offer them 50%. I'd say most would reduced by at least 30%. So you can do the same thing here that an attorney can do. It's not difficult as they do it all of the time. What you want to keep in mind is that you may need to pay that money back out of your pocket. If those bills are still outstanding, you negotiate them down b y speaking to the medical providers. It's not a big deal. But your UM carrier needs to consider the whole amount... not the reduced amount.
Posted: Tue Mar 12, 2013 02:38 am Post Subject:
Thanks for the good info. We finally got the first offer and I was disappointed as it was $49,000. He separated it in the following manner, $28k in medical bills, $1k in wages and $20k in pain and suffering. I expecting something much higher than this. Should I start with a verbal response of declining it and seek a certain amount or do you go straight to the Demand Lette I read about? I want to avoid invlolving an attorney but if they don't at least double I might consider it.
Any thoughts or advise would be appreciated. Thanks in advance for your time and knowledge.
Posted: Tue Mar 12, 2013 03:24 am Post Subject:
He separated it in the following manner, $28k in medical bills, $1k in wages and $20k in pain and suffering
The total medical bills totaled $55,800 with an allowed amount of 18,600
Certainly these numbers don't add up. One reason why I seldom post/mention settlement amounts... there is never enough information posted to know what is going on.
What is the different between the $55.8k and $18.6? That is, who paid that difference? If some other insurance paid it, the adjuster needs to take $the $56.8k in actual losses, determine what amount goes on top of _that_ amount (i.e. considering _all_ of the treatment) and then subtract what some other insurance paid on the medical bills. The adjuster can't consider what was left after any other insurance paid and consider pain and suffering only on that amount.
Again, there is no way to really know what is going on.
Posted: Tue Mar 12, 2013 05:32 am Post Subject:
As tcope said, no one here can truly answer your question. But if you want to do this without an attorney, then send a demand letter for the whole $250,000 and see what happens.
And I agree with tcope also in making sure that you properly attribute medical expense. If paid by your own health insurance, they have the right to subrogate. If the $18,600 as "allowed" was a prenegotiated service cost, they cannot come back and ask for $55,800.
Is your wife's case worth $250,000? Maybe, maybe not.
Add your comment