What can we conclude by these insurance company decisions?

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Latest post Wed, Apr 12 2017 4:45 PM by DanWard. 110 replies.
  • Thu, Jul 9 2015 8:26 AM

    • DanWard
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    What can we conclude by these insurance company decisions?

    Auto accident involving multiple vehicles. The insurance company for the driver who caused the accident took nearly 2 weeks to decide how to share the liability between their two drivers. One of these drivers did not contribute to the accident according to the police report. During a consulation with a lawyer she said that if the insurance company shared the liability it was not in their best interest to do so. The reason being if both drivers had the 25-50-25 minimum limits, then if shared liability 50% each then that opens up both policies to liability

    They did decide to go 50% which each policy. And we were told it does not change their coverage to 12.5-25-12.5 for each driver it is still 25-50-25 for both.

    Another thing they have done which was curious to the legal firm is that the insurance company has given us two different claim numbers. One for the property damage and one for the personal injury.

    We were sent medical release forms so they could get medical records and on these forms which are clearly part of the personal injury claim, the claim number on these forms was the property damage claim number.

    So 50% sharing of liability on two policies which seems to put both on the table to be challenged by the lawyer.

    Two claim numbers which is not normal.

    What is the insurance company trying to do or not do or trying to hide?

    The property damage claim is over. The personal injury is in week number 6 and the medical bills are going to fall in a range of $7000-$8000. Most likely $7500-$8000.

  • Thu, Jul 9 2015 9:13 AM In reply to

    Re: What can we conclude by these insurance company decisions?

    DanWard:
    Auto accident involving multiple vehicles. The insurance company for the driver who caused the accident took nearly 2 weeks to decide how to share the liability between their two drivers.

    How many vehicles total?  When you say that "[t]he insurance company . . . decide[d] how to share the liability between their [sic] two drivers," what exactly do you mean?  Are you saying that The same insurance company insured two of the drivers involved in the accident?

     

    DanWard:
    One of these drivers did not contribute to the accident according to the police report.

    Did the officer who prepared the police report witness the accident?

     

    DanWard:
    During a consulation with a lawyer she said that if the insurance company shared the liability it was not in their best interest to do so.

    Huh?  Who is "she"?  Who consulted with a lawyer?  When you refer to "their best interst," are you misusing "their" to refer only to the insurance company?  If not, to whom does "their" refer?

     

    DanWard:
    And we were told it does not change their coverage to 12.5-25-12.5 for each driver it is still 25-50-25 for both.

    Who are "we"?  I assume you were one of the drivers involved in the accident.  Are you one of the two drivers to whom you referred in the first paragraph of your post?  Who told you this?

     

    DanWard:
    Two claim numbers which is not normal.

    Says who?  How do you know what is or isn't normal for X Insurance Company?  Most importantly, what difference does it make whether this is "normal" or whether this is the first time any insurer has ever done this?

     

    DanWard:
    What is the insurance company trying to do or not do or trying to hide?

    Needless to say, trying to infer some unknown person's (or persons') intent is more-or-less a crapshoot (and it's even more so when the facts aren't clear).  I assume, however, that the insurer is trying to adjust the claim in a way that complies with the applicable state's insurance regulations and which minimizes its own exposure and which protects the interests of its insured(s).  Nothing in your post suggests anyone is trying to hide anything.

     

    DanWard:
    The property damage claim is over. The personal injury is in week number 6 and the medical bills are going to fall in a range of $7000-$8000. Most likely $7500-$8000.

    Ok.  Given the policy limits you mentioned, there should be no issue with fully compensating the claimant for his/her loss.

  • Thu, Jul 9 2015 9:46 AM In reply to

    Re: What can we conclude by these insurance company decisions?

    DanWard:
    Auto accident involving multiple vehicles. The insurance company for the driver who caused the accident took nearly 2 weeks to decide how to share the liability between their two drivers. They did decide to go 50% which each policy.

    What I'm getting from all this is that you were in car #1 at the front of the line and the insurance company that insures car #2 and car #3 has concluded that car #2 (behind you) hit you first and then car #3 hit car #2 creating a second impact making both other drivers at fault.

    Whether or not that actually happened isn't really relevant as long as your injury claim gets paid. The claims people are free to apportion liability among the two policyholders as they see fit.

    DanWard:
    we were told it does not change their coverage to 12.5-25-12.5 for each driver it is still 25-50-25 for both.

    True, but also not really relevant as it doesn't change the value of your claim. If your claim value is $15,000 (that's just an example) it doesn't matter if $15,000 comes from one policy or $7500 comes from each policy.

    DanWard:
    Two claim numbers which is not normal.

    Sure it's normal. You're making two different claims against two different drivers. Each claim gets its own claim number.

    DanWard:
    What is the insurance company trying to do or not do or trying to hide?

    Nothing nefarious is going on.

    DanWard:
    The personal injury is in week number 6

    Not sure why you point that out. If you and/or any other occupants of your vehicle are still under treatment and/or recovering, the claims aren't going to be settled for many months to come. You're lawyer won't submit a demand package until you are fully recovered or have reached maximum medical improvement and the claim can be quantified. Once your attorney submits a demand package the claim rep of the other drivers' insurance company is likely to counter with an offer of less money than the attorney asked for and there will be back and forth for a while longer and perhaps the need to file a lawsuit if there is no agreement. A lawsuit could mean you don't see any money for a year or two.

    DanWard:
    the medical bills are going to fall in a range of $7000-$8000. Most likely $7500-$8000.

    In your previous post of June 15 you noted that medical bills had reached $1800.

    Where are you getting another $5000 to $6000 from in less than a month?

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  • Thu, Jul 9 2015 10:45 AM In reply to

    • cbg
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    Re: What can we conclude by these insurance company decisions?

    What can we conclude by these insurance company decisions?

    That DanWard has never worked in the insurance industry and has no idea how things actually work.

  • Thu, Jul 9 2015 12:03 PM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decisions?

    How many vehicles total?  Are u saying same insurance company insured 2 of the drivers involved in the?............................................Driver 1 ran a redlight at high speed and caused the accident and was cited by police as the only driver to contribute to the accident. They got a citation for excessive speeding and agressive driving. Driver 2 was not cited as contributing to the accident, but the police report said that driver 2 was in the process of completing their turn and the light changed from yellow to red as they were completing their turn. Both drivers 1 and 2 are insured by the same company. They debated for 2+ weeks on whether to share the liability between their two insureds. They decided 50% each. Driver 3 and driver 4 were not at fault and both vehicles were stationary and hit by others.

    Did the officer who prepared the police report witness the accident?...................of course not. They were called to the scene.

    During a consulation with a lawyer she said that if the insurance company shared the liability it was not in their best interest to do so.  Huh?  Who is "she"?  Who consulted with a lawyer?  When you refer to "their best interst," are you misusing "their" to refer only to the insurance company?  If not, to whom does "their" refer?.............................Driver 3 consulted a lawyer. When the lawyer who has been in practice for 25 years heard that the insurance company might share the liability then that personal injury lawyer said the insurance company would be foolish to do it because it opens up both of their driver's to legal action. If they only accepted liability on behalf of the driver that got the two citations, only one policy would be subjected to possible legal action.

    And we were told it does not change their coverage to 12.5-25-12.5 for each driver it is still 25-50-25 for both.  Who are "we"?  I assume you were one of the drivers involved in the accident.  Are you one of the two drivers to whom you referred in the first paragraph of your post?  Who told you this?................We are the injured parties in car 3. The lawyer said that if they shared liability between their two insured, then both 25-50-25 policies would be open to legal action. 

    Two claim numbers which is not normal. Says who? ................Says us, we have two claim numbers for ONE person. The insurance company is using one claim number for property damage and one for injury damages. The second lawyer who has been in business for 35 years found this odd, two claim numbers for one person with one claim.

    I assume, however, that the insurer is trying to adjust the claim in a way that complies with the applicable state's insurance regulations and which minimizes its own exposure and which protects the interests of its insured(s). ..................BINGO...............if they wanted to minimize their exposure they would not confound the lawyers by letting two policies be subject to legal action. We are not saying that, 2 lawyers said it. 

    The property damage claim is over. The personal injury is in week number 6 and the medical bills are going to fall in a range of $7000-$8000. Most likely $7500-$8000. Ok.  Given the policy limits you mentioned, there should be no issue with fully compensating the claimant for his/her loss..............................If the limit is 25,000 and medical is 8,000 that only leaves room for a multiplier of 2.125.   2.125 x 8000 medical = 25,000 and the policy limits are exhausted. Lawyer can not ask for 3 multiplier. Not that they would get it but 25,000 limits the multiplier.

    Two claim numbers which is not normal. Sure it's normal. You're making two different claims against two different drivers. Each claim gets its own claim number.......................................One person, has one claim against the insurance company. That one claim was divided and there is a property damage claim number and personal injury claim number for one injured person. 

    the medical bills are going to fall in a range of $7000-$8000. Most likely $7500-$8000.  In your previous post of June 15 you noted that medical bills had reached $1800. Where are you getting another $5000 to $6000 from in less than a month?...................$1800 was an example only on June 15. The actual numbers were posted the 16th. As of today, medical is 4300 not yet paid by anyone, 460 paid out of pocket by the injured, 150 in medications, and a lien on up to 12 physical therapy sessions. Those will vary from $200-$300 each. 4300 + 460  + 150 = 4910 + (2400 to 3600) = 7300 to 8500 so mid way is roughly 8000.

    As far as the next one everyone knows the insurance company would settle for $123.50 if they could. So no we have not worked in the insurance industry. They are paid to pay out as little as they can, no matter the injuries. That is why personal injury lawyers are required.

     


  • Thu, Jul 9 2015 12:56 PM In reply to

    Re: What can we conclude by these insurance company decisions?

    DanWard:
    Did the officer who prepared the police report witness the accident?...................of course not. They were called to the scene.

    Then the officer's conclusion regarding fault is no better than that of any other person who didn't witness the accident.

     

    DanWard:
    Driver 3 consulted a lawyer. When the lawyer who has been in practice for 25 years heard that the insurance company might share the liability then that personal injury lawyer said the insurance company would be foolish to do it because it opens up both of their driver's to legal action. If they only accepted liability on behalf of the driver that got the two citations, only one policy would be subjected to possible legal action.

    That's silly.  All drivers involved are "subject[] to possible legal action" regardless of anything their insurers do.

     

    DanWard:
    Two claim numbers which is not normal. Says who? ................Says us

    Your post makes it clear you have no basis whatsoever for claiming to know what is or isn't "normal" for this particular insurer (or any insurer).

     

    DanWard:
    If the limit is 25,000 and medical is 8,000 that only leaves room for a multiplier of 2.125.   2.125 x 8000 medical = 25,000 and the policy limits are exhausted. Lawyer can not ask for 3 multiplier. Not that they would get it but 25,000 limits the multiplier.

    I think you're dreaming if you think you're getting more than $25k if your only damages are $8k in medical bills.

     

     

  • Thu, Jul 9 2015 1:54 PM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decisions?

    The officer gave out citations to driver 1 and indicated "not contributing" to the accident (for drivers 2-3-4) based on 2 sets of witnesses. Sure they can try to sue us but they have already admitted fault and assigned the "one" claim to two claim numbers. One claim number for property damage handled by one adjuster and the other claim number personal injury part of the same claim. We are just telling you what the lawyers said. They both agreed it would have been in the best interest of the insurance to not give 50% liability to driver #2 since he was not said by police or witnessses as having contributed. We never said the settlement would be more than 25,000, it might be medical bills only. We only pointed out that if there was only one policy with minimum limits of 25-50-25 then the max. settlement (short of court) would be 2.125 multiplier of the medical bills which looks like they will be in the $7500 to $8000 range. However, since they are placing 50% liability on each of their insureds, there are two policies with $25,000 personal injury to be challenged which has nothing to do with the final settlement amount. And we assume they had the minimum limits. They may not.

  • Thu, Jul 9 2015 3:43 PM In reply to

    Re: What can we conclude by these insurance company decisions?

    You're spending an awful lot of time on stuff that's of no importance with regard to your claim.

    It doesn't matter that there are two claim numbers. It doesn't matter that the insurance company is apportioning the claim to two policyholders. It doesn't matter what the police officer said. It doesn't even matter what your lawyer says about what the insurance company is doing.

    You have an injury. You have a lawyer. The lawyer is dealing with the claim rep. Once the claim is quantifiable your lawyer will get you money.

    Your entire discussions of the last few weeks can be boiled down to those 4 sentences and that's all you need to be concerned with.

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Fri, Jul 10 2015 10:31 AM In reply to

    Re: What can we conclude by these insurance company decisions?

    DanWard:
    Sure they can try to sue us but they have already admitted fault and assigned the "one" claim to two claim numbers.

    An insurer's agreement to pay a claim is not an admission of liability that could be used against the insured if the insurer were to change its mind.  And the assignment of multiple claim numbers is irrelevant to anything.

     

    DanWard:
    We are just telling you what the lawyers said. They both agreed it would have been in the best interest of the insurance to not give 50% liability to driver #2 since he was not said by police or witnessses as having contributed.

    That's fine, but that's very different from saying that the insurance company's action somehow exposed someone to being sued who was not already at risk.

     

    DanWard:
    We only pointed out that if there was only one policy with minimum limits of 25-50-25 then the max. settlement (short of court) would be 2.125 multiplier of the medical bills which looks like they will be in the $7500 to $8000 range. However, since they are placing 50% liability on each of their insureds, there are two policies with $25,000 personal injury to be challenged which has nothing to do with the final settlement amount.

    Again, nothing the insurance company has done has any impact on your potential for recovery.  In other words, if we assume you have a valid claim against Driver 1 but aren't sure you have a valid claim against Driver 2, the insurer's actions aren't increasing the potential exposure under Driver 2's policy.  Of course, the insurer may decide that both policies are in play and offer a number in settlement that is in excess of either policy's maximum limit, but that would only be a volutary decision by the insurer.

  • Mon, Jul 13 2015 10:26 AM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decisions?

    Yes we are aware of the deciding factors and we are not sure how things are done where you all live or work. The question was asked due to the two claim numbers and the 50-50 liability. People asked other questions and we needed to post some details from the other thread which was not our intent. When the 50-50 puzzles two lawyers and the two claims numbers for 1 of the injured causes the case manager to call and ask "why do you have two claim numbers?" then it must not be the way most of them do it.

    The 50-50 seems puzzling since one policy with 25-50-25 would easily cover the 3 property damages and easily cover the 1 BI. Unless they are putting PD on one of their insured and BI on the other. We doubt they are going 50-50 to benefit us.

    Medical appears to be winding down in the next 5-6 weeks and nothing after that maybe but leftover pain if any. Time will tell what the settlement is and all settlements have numbers with which to calculate a multiplier whether it is used or not or is even a term used by the parties doing the negotiations.

  • Mon, Jul 13 2015 11:07 AM In reply to

    Re: What can we conclude by these insurance company decisions?

    DanWard:
    Yes we are aware of the deciding factors and we are not sure how things are done where you all live or work. The question was asked due to the two claim numbers and the 50-50 liability. People asked other questions and we needed to post some details from the other thread which was not our intent.

    When you originally posted about two claim numbers I mistakenly thought that separate claim numbers were assigned to each policyholder, which would make sense to allocate a share of the claim for each policy.

    You've clarified that there is a claim number for the BI and another one for the PD. This also makes sense because the Bodily Injury Liability and Property Damage Liability are two distinctly different lines of coverage. Some companies have one claim rep doing both types of claims, usually small companies. But many of the larger companies have their claim reps trained separately for injury claims and property damage claims.

    If you took a close look at the two claim numbers you might find that the differ by only a couple of numbers or letter to distinguish between the two lines of coverage.

    DanWard:
    When the 50-50 puzzles two lawyers and the two claims numbers for 1 of the injured causes the case manager to call and ask "why do you have two claim numbers?"

    That's because lawyers and their employees might know how to file insurance claims but they have no clue as to the inner workings of an insurance company.

    DanWard:
    Unless they are putting PD on one of their insured and BI on the other

    Unlikely.

    DanWard:
    We doubt they are going 50-50 to benefit us.

    And they aren't doing it to your detriment either. In fact, they aren't doing it with you in mind at all. The allocation of the claim payment between two policyholders has nothing to do with you and I am amazed that you are still picking at it. I though we've already made that clear.

    DanWard:
    Time will tell what the settlement is and all settlements have numbers with which to calculate a multiplier whether it is used or not or is even a term used by the parties doing the negotiations.

    Lawyers might talk in terms of "multipliers" but the claims will be paid based on each claim's merit. For example, if you have $6000 in medical bills and your lawyer adds $18,000 to that (3 x multiplier) for pain and suffering it's not likely to happen.

     

    • The right of the people 
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  • Mon, Jul 27 2015 11:03 AM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decisions?

    Medical bills have taken a turn lower than previously possible. $7,500 to $8,000 is no longer expected unless there is some very unexpected event. The estimated total now looks like $6,000 to $6,500 excluding misc. legal expenses such as gathering of medical records. $7,000 looks like a maximum. Time will tell on the rest.

  • Wed, Sep 23 2015 10:11 AM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decisions?

    adjuster jack:
    Lawyers might talk in terms of "multipliers" but the claims will be paid based on each claim's merit. For example, if you have $6000 in medical bills and your lawyer adds $18,000 to that (3 x multiplier) for pain and suffering it's not likely to happen.

    Every settlement has a multiplier. Even though it may not be called that.

    Total settlement - total medical bills / by medical bills yields a number between 0.0 and X.

    This case is winding down and we would like to know how the lawyer knows when medical treatment is over.   

    A. The doctors assume the patient won't be back and forwards records to lawyer. We've heard that this is very unlikely since asking for and getting the records may be a challenge so don't expect them to start anything.                                                                                                                                              B. The lawyer periodically contacts the treating physicians.                                                                      C. The lawyer periodically ask the patient how things are going to get an idea when they do not expect to revisit a physician. This is not happening. The legal firm has case managers to handle medical records and frankly they do not like communication.                                                                                                  D. The patient tells the lawyer that they do not expect to revisit a doctor for xyz reasons.

    Never in our entire life has a doctor officially released us either verbally or in writing. They do not know whether the patient will be back for another followup related to the vehicle accident. We have three treating physicians and our opinion based on their comments at the most recent appointment imply that two of them are no longer able to help us medically. So, how does the lawyer find out medical is over? Is it A or B or C or D above or some other method?

     

  • Wed, Sep 23 2015 10:56 AM In reply to

    Re: What can we conclude by these insurance company decisions?

    DanWard:
    So, how does the lawyer find out medical is over? Is it A or B or C or D above or some other method?

    None of the above.

    At some point you will find that you no longer have pain, soreness, or discomfort and you can engage in normal physical activities. Do that for a month or two to make sure nothing residual comes up. Then make a final appointment with all your doctors and tell them that you are fully recovered. They'll check you out and write up the results of your visit for your file.

    Then advise your attorney of your recovery and completion of treatment and your attorney will order the records from your doctors so he can prepare the demand package.

    Getting medical records from several doctors and/or hospitals could take up to a month or two, maybe more. Sending medical records to attorneys is not a priority for medical providers. Some attorneys use records copying services where they pay somebody to go from provider to provider with a portable copying machine and they copy the records on the spot. This sometimes works a little faster.

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Thu, Oct 22 2015 7:11 PM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decisions?

    adjuster jack:

    At some point you will find that you no longer have pain, soreness, or discomfort and you can engage in normal physical activities. Do that for a month or two to make sure nothing residual comes up. Then make a final appointment with all your doctors and tell them that you are fully recovered. They'll check you out and write up the results of your visit for your file.

    Then advise your attorney of your recovery and completion of treatment and your attorney will order the records from your doctors so he can prepare the demand package.

    The above is not playing out as hoped. We have a lingering issue and the therapy has failed to resolve it. They expected 6-8 weeks and we are now in week 15. The doctors are close to a plateau in abilities short of surgery. 

    Another issue that is developing is that the total medical bills are becoming a large % of the possible settlement. Isn't there a point in time where medical has to be stopped because the total is so large that the rest of the settlement can not be a reasonable amount (total - medical = R (rest) and R / medical = a number such as 0.75 or 1.0 or some other number) because the medical is so high?

    The coverage limits create a cap do they not?

     

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