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What can we conclude by these insurance company decisions?

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Latest post Wed, Jun 7 2017 10:00 AM by Taxagent. 120 replies.
  • Fri, Oct 23 2015 7:00 AM In reply to

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

    DanWard:
    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

    That's ridiculous.

    You continue medical treatment as long as you need it. Pretend there was no insurance and you needed treatment for as long as it took. If you were bleeding from a bullet wound would you avoid treatment and die because you had no money?

    DanWard:
    The coverage limits create a cap do they not?

    Yes, they create a cap on how much the insurance company pays you.

    There is no cap on the amount of medical treatment you get if you need it.

    If you need $20,000 in medical treatment to fix what ails you and you only get $15,000 from the insurance company you spend the extra $5000 or you stay crippled for the rest of your life, which doesn't make any sense.

    If the insurance limits are insufficient, you look to your Underinsured Motorists Coverage if you have it and have sufficient limits.

    Bottom line: If you need the treatment, you get it. Has nothing to do with the insurance settlement. Thinking that it does can end up being very self destructive if you need surgery and don't get it.

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Fri, Oct 23 2015 8:14 AM In reply to

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

    You continue medical treatment as long as you need it. 

    ........................That could eventually run into some statute of limitations. The lawyer would likely have to decide what to do long before that, whether full recovery has been attained or not. Day time is 85-90%+ fully recovered with 3-4 hours of pain and headaches when laying down. A person could unfortunately live with 3-4 hours of sleep depriving pain but we wouild not wish that quality of life on anyone.

     

    There is no cap on the amount of medical treatment you get if you need it.

    ........................There could be as there is no under-insured (and no health insurance before, during, and after any settlement).

    If you need $20,000 in medical treatment to fix what ails you and you only get $15,000 from the insurance company you spend the extra $5000.

    .....................In that example the lawyer would get 5 of the 15, leaving the injured an amount that could easily far exceed their ability.

     

     

     

     

  • Fri, Oct 23 2015 10:35 AM In reply to

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

    DanWard:
    That could eventually run into some statute of limitations

    The statute of limitations for personal injury lawsuit is 3 year in South Carolina so you have plenty of time to determine and document any permanent partial disability.

    DanWard:
    There could be as there is no under-insured

    Why not? I think it's mandatory that insurance companies offer it. Did you elect not to have it?

    DanWard:
    In that example the lawyer would get 5 of the 15, leaving the injured an amount that could easily far exceed their ability.

    Make sure you have the lawyer negotiate a discount with the medical providers. Lawyers know how to do that. Make sure it's done and you get the discounted amounts in writing from the providers before you agree to any settlement.

    Also understand that if something can be fixed with treatment and you choose not to get treatment there is no obligation to pay you for future medical costs.

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Fri, Oct 23 2015 11:20 AM In reply to

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

    Under-insured was offered but not taken due to income levels.

    One provider asked for a lien and that was granted. So, about 20% of the medical is under a lien. The lawyer said that they can still negotiate down a lien, even though it seems to actually guarantee that the provider (third party) gets paid. We do not see how this can be negotiated lower. Maybe it can.

    We were told to not pay any medical bills. We were told they can try to get them negotiated down. We asked what type of reduction and the answers were quite vague with no guarantees. We got a 25% discount from one provider by paying same day. Another gave 25% as well. Another gave 35%. We took these and we had to go into debt to pay them same day. Our thinking was that if they are offering 25-35% on the day of service why would they offer more than 25-35% 9-12 months out? So, we were told we already got the discounts on those. But the totals before the discounts will be used to calculate legal fees. These discounted medical costs are about 20% of the total medical. The other 60% has no lien and none has been paid because the amount is so large we can not pay it.

    Treating physicians are indicating home rehabilitation and one says rehabilitation protential is fair. Indefinite treatment might not help. Fair is somewhere between good and poor. One doctor has already mentioned MMI will occur at some point and the lawyer spoke of impairment. So that hints at termination of treatment at some point (Treatment which only has a fair chance of success). The average person with poverty level income can not chase fair results with thousands of dollars over a period of years.

  • Wed, Nov 4 2015 2:48 PM In reply to

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

    Different states have different statutes of limitations. In general when should the attorney begin the process with their demand letter to avoid any time issues? Do the insurance companies ever initiate contact to see what is going on or do they just put the claim in the drawer and wait?

    Therapist says rehabilitation potential is fair. Fair is somewhere between good and poor. It might be medical bills indefinitely. Someone has to declare MMI at some point, whether all issues are resolved or not (?)

  • Thu, Nov 5 2015 8:01 AM In reply to

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

    DanWard:
    One provider asked for a lien and that was granted.

    Medical providers don't have to ask for a lien, they need only send notice of it.

    DanWard:
    The lawyer said that they can still negotiate down a lien, even though it seems to actually guarantee that the provider (third party) gets paid. We do not see how this can be negotiated lower. Maybe it can.

    True.

    Keep in mind that the same thing goes for your attorney's fee.

    When it comes time to settle you can hit him up for a reduction. Your leverage is that you walk away from the settlement offer and file bankruptcy so nobody gets anything.

    I wouldn't suggest mentioning that until the last minute when he puts the release in front of you to sign.

    DanWard:
    Different states have different statutes of limitations. In general when should the attorney begin the process with their demand letter to avoid any time issues?

    I noted earlier that the SOL is 3 years in your state. Since MMI appears likely, the demand letter ought to go out shortly after MMI is reached and documented.

    DanWard:
    Do the insurance companies ever initiate contact to see what is going on or do they just put the claim in the drawer and wait?

    Depends. Claim reps have diary systems where the claim pops up periodically for follow up. They can choose the frequency but don't necessarily need to make contact if there is no activity and nothing is expected. I would diary a file like yours for six months at a time and send a status request to the lawyer and diary it for another six months.

    DanWard:
    Therapist says rehabilitation potential is fair. Fair is somewhere between good and poor. It might be medical bills indefinitely. Someone has to declare MMI at some point, whether all issues are resolved or not (?)

    MMI is determined by you and your doctor, then documented to the attorney. When that actually happens is anybody's guess.

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Mon, Dec 28 2015 9:10 AM In reply to

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

    Things are getting worse. Gross medical yesterday was $7800. Now 24 hours later with no medical services the amount is up to $10,000. The policy limits may be $25,000. There is an excellent chance it is $25,000.

    Medical is getting to be too large a % of the potential. As medical goes up the potential P&S goes down. 

    Lawyer said possible multiple might be 2.0. That is now impossible. They can not pay $30,000 on a $25,000 policy. 

  • Mon, Dec 28 2015 12:02 PM In reply to

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

    If the policy limit is $25,000 then that is the maximum you'll get from the insurance company no matter what the mix of actual medical bills and pain and suffering you come up. You can sue the negligent party for more than the policy limit, however, and if the judgment exceeds the policy limit you may try to collect out of whatever assets and income the negligent person has. Note that pain and suffering damages are impossible to predict with accuracy; juries are all over the place with what they figure pain and suffering is worth and there’s no telling what those unknown jurors are likely to do in your case.

  • Mon, Dec 28 2015 12:17 PM In reply to

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

    The insurance company shared the liability between two drivers. Whether that makes both policies able to be challenged, we assume so, but escalating medical bills that have not solved the medical issues is not good at the moment. 

    We have been shown a map of jury tendencies which had 4 colors, blue, purple, red, green, where the red and green were the counties where juries were more liberal in their decisions.

    An article said both attorney and adjustor, neither wants to go to court if it can be avoided due to the fact that jurors can make hasty decisions. We saw one case where medical bills were near $28,000 and the jury came back with around $7,500. Horrendous outcome. I guess that person had to declare bankruptcy. And the lawyer got their $9,300 or 1/3. Leaving nothing to go toward the medical bills and of course zero for P&S.

  • Mon, Dec 28 2015 4:06 PM In reply to

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

    DanWard:
    The insurance company shared the liability between two drivers. Whether that makes both policies able to be challenged, we assume so,

    Could be.

    My policy's Bodily Injury Liability coverage has the following provision:

    "OTHER INSURANCE If there is other applicable liability insurance we will pay only our share of the loss. Our share is the proportion that our limit of liability bears to the total of all applicable limits."

    Check your own policy. If it reads exactly like that, chances are that the other drivers' policies read the same way.

    Find the provision and quote it word for word.

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Mon, Dec 28 2015 4:53 PM In reply to

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

    "OTHER INSURANCE If there is other applicable liability insurance we will pay only our share of the loss. Our share is the proportion that our limit of liability bears to the total of all applicable limits."

    We are not clear on what that means exactly. Both drivers have $25,000 limits as far as I know. So they should be equal in proportion unless you mean that if the personal injury is $32,000 that $16,000 would come from each policy (?)

    If they had different limits of coverage then......

  • Mon, Dec 28 2015 6:29 PM In reply to

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

    DanWard:
    "OTHER INSURANCE If there is other applicable liability insurance we will pay only our share of the loss. Our share is the proportion that our limit of liability bears to the total of all applicable limits."

    Is that from your policy or just what I quoted from mine.

    DanWard:

    We are not clear on what that means exactly. Both drivers have $25,000 limits as far as I know. So they should be equal in proportion unless you mean that if the personal injury is $32,000 that $16,000 would come from each policy (?)

    If they had different limits of coverage then......

    I can't answer that without a quote from your own policy so I can see of South Carolina auto insurance is written.

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Tue, Dec 29 2015 7:52 AM In reply to

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

    That quote was what you posted. Boy oh boy my agent is balking at getting me a copy of my policy. They want to answer the question by e-mail instead of giving me a chance to read the language.

    They did make a comment that things can vary from state to state and company to company. 

    So suppose you have Nationwide there in your state. And Nationwide has policy owners in all 50 states. Does Nationwide have 50 different policies one geared to each state?

    The other drivers are with State Farm and the S.C. language for State Fam may be diffferent than my policy language.

     

  • Tue, Dec 29 2015 8:09 AM In reply to

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

    DanWard:
    Does Nationwide have 50 different policies one geared to each state?

    Yes, since insurance laws vary from state to state it isn't unusual that policies will be amended even slightlty to comply with the laws of the state they are issuing in. Now some states are probably identical to other states and there is no need to re-invent the wheel but each policy is still going to have language for the state it is in.

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • Tue, Dec 29 2015 10:50 AM In reply to

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

    DanWard:
    my agent is balking at getting me a copy of my policy

    Jeeze.

    Where the heck is YOUR copy of the policy that YOU got in the MAIL when you first BOUGHT it??????

    Try getting the policy form from Nationwide's website. You'll have to set up an account to get to your policy information. Might be able to download a duplicate policy booklet that way.

    https://www.nationwide.com/access/web/login.htm

    DanWard:
    So suppose you have Nationwide there in your state. And Nationwide has policy owners in all 50 states. Does Nationwide have 50 different policies one geared to each state?

    Yes, that's entirely possible.

    DanWard:
    The other drivers are with State Farm and the S.C. language for State Fam may be diffferent than my policy language.

    There might be minor differences but they will mostly conform to South Carolina insurance laws and insurance department requirements.

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
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