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.
  • Wed, Oct 19 2016 6:42 AM In reply to

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

    This example. Actual is 50 (whatever actual includes). Exactly 50. Both drivers have 25 limits.

    The max.settlement can be 50?

    If so then both drivers would have been determined to be 100% liable such that the max. limits of both their policies are being used to satisfy the settlement.

  • Wed, Oct 19 2016 7:35 AM In reply to

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

    DanWard:

    This example. Actual is 50 (whatever actual includes). Exactly 50. Both drivers have 25 limits.

    The max.settlement can be 50?

    If so then both drivers would have been determined to be 100% liable such that the max. limits of both their policies are being used to satisfy the settlement.

    No, your conclusion is wrong because you are once again misunderstanding the way the limits work. Here is how it goes step by step:

    (1) Determine the amount of the actual damages suffered by the plaintiff. Here it is $50,000.

    (2) Determine the extent of each driver’s degree of fault for the accident. Let's say Driver A is 60% at fault and Driver B is 40% at fault. That means that Driver A is responsible to pay $30,000 of the damages and Driver B is responsible to pay $20,000.

    (3) Apply the insurance policy limits to THE ACTUAL DAMAGES determine how much of each driver’s liability the insurance company will pay. Here Driver A is responsible to pay $30,000 (60% of $50,000) but his insurance limit is $25,000. So the insurance company will only pay the $25,000 (the limit) and Driver A pays $5,000 out of his own pocket. Driver B is liable to pay $20,000 (40% of $50,000), and his insurance limit is $25,000. So his insurance company will pay the full $20,000 Driver B owes as his liability did not exceed his limit.

    You seem intent on trying to apply the degree of faul to the insurance limit rather than the actual damages. I've told you before that is wrong; that is not how it works. The at fault driver's insurance pays out whatever the driver is liable to pay, up to the policy limit.

    That limit does not get reduced by the degree of fault of the driver, which is apparently what you are doing. In other words, Driver A is 60% at fault. That 60% is not applied to the policy limit for A to reduce what the insurance company will pay. That is, it is not the case that he insurance company can say that it only has to pay $15,000 (60% of $25,000) based on A's fault. Rather the insurance company has to pay out all of what the driver is liable to pay, up to the limit amount. So however much A is at fault, the insurance company will pay it up to $25,000. The degree of A's fault does not affect his limit. The degree of fault affects how much of the plaintiff's damages he must pay, i.e. how much of the $50,000 he is responsible to pay.

    Again, the 60% is applied to the actual damages ($50,000) and that determines what A owes. Then the limit ($25,000) is used to determine how much of A's liability the insurance company pays. If what A owes is more than that limit then the insurance company only pays out the limit and A has to pay the rest. The limit of $25,000 does not change regardless of what A's degree of fault is.

    So, back to the $50,000 of actual damages. If driver A and driver B were equally at fault, then the amount each must pay is $25,000 (50% of $50,000). They both have limits of $25,000. In this situation, the insurance company pays out $50,000 — the total amount of the plaintiff's damages — because neither A's nor B's limit was exceeded. This does not mean, as you said that A & B are each 100% liable. They aren't. If they were each 100% liable then each would have to pay $50,000 and then the total the plaintiff would get would be $100,000, which is more than his actual damages $50,000 and of course that isn't how it works. A and B are each 50% liable and have to pay $25,000 each. Since their limit was not exceeded, the insurance company pays out the full $25,000 for each. So the plaintiff gets paid for all his damages from the insurance, but each driver only paid (and was only responsible to pay) 50% of it, not 100%.

  • Mon, Dec 19 2016 4:08 PM In reply to

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

    Taxagent:
     start with what your ACTUAL DAMAGES are 

    Actual damages are? 

    General = pain and suffering. Special = actual medical bills, and future medical? Or does future medical estimate belong in a third category.

    -----------------------------------------------------------------------------------------------

    I can not find the exact post but someone said the insurance company might ask "what do you want?" That could be an interesting question:

    Legal firm: Thank you for asking that question. After putting new batteries in our calculator and arriving at a conclusion, we respectfully ask for "the moon."

    Insurance company: Thank you as well for a prompt reply. Here is how we spell "moon:"   Z E R O.

    Legal firm: Oh. 

  • Mon, Dec 19 2016 6:01 PM In reply to

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

    DanWard:

    Actual damages are? 

    General = pain and suffering. Special = actual medical bills, and future medical? Or does future medical estimate belong in a third category.

    Actual damages means the damages you actually incurred, i.e. medical bills (including any foreseen future medical needs), loss of income, damage to property, pain and suffering. In most states, medical bills would not be considered "special damages.” In short, I am referring to the provable damages you have for the injury you suffered; i.e. what you are entitled to get if you sue and win in court. The court doesn’t care about the policy limits when deciding what damages to award in the judgment. The point I was making is that you were twisting yourself into knots worrying over how to allocate fault given policy limits and that is not where your focus should be at the start. It should be on trying to get compensation for the damages you suffered.

    Once you know what your total damages are, then when discussing settlement you may need to decide what to do if the insurer offers to settle for less than that based on the maximum policy limits. For example, if the insurer offers $50,000 and that is the policy limit, and your damages are $60,000, then you have to decide if the extra expense and trouble of going to trial is worth it on the chance that the court will award you the full $60,000 or whether to just take the $50,000 offer on table now. Factors to consider when deciding that would be how strong your case is, how much in assets the defendant driver has (since you’d have to collect any judgement amount over the $50,000 from the other driver), how much going to trial may cost you and how long it will take (bearing in mind there is a time value for money).

  • Tue, Dec 20 2016 6:21 AM In reply to

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

    Taxagent:

    DanWard:

    Actual damages are? 

    General = pain and suffering. Special = actual medical bills, and future medical? Or does future medical estimate belong in a third category.

    Actual damages means the damages you actually incurred, i.e. medical bills (including any foreseen future medical needs), loss of income, damage to property, pain and suffering. In most states, medical bills would not be considered "special damages.” In short, I am referring to the provable damages you have for the injury you suffered; i.e. what you are entitled to get if you sue and win in court. The court doesn’t care about the policy limits when deciding what damages to award in the judgment. The point I was making is that you were twisting yourself into knots worrying over how to allocate fault given policy limits and that is not where your focus should be at the start. It should be on trying to get compensation for the damages you suffered.

    Once you know what your total damages are, then when discussing settlement you may need to decide what to do if the insurer offers to settle for less than that based on the maximum policy limits. For example, if the insurer offers $50,000 and that is the policy limit, and your damages are $60,000, then you have to decide if the extra expense and trouble of going to trial is worth it on the chance that the court will award you the full $60,000 or whether to just take the $50,000 offer on table now. Factors to consider when deciding that would be how strong your case is, how much in assets the defendant driver has (since you’d have to collect any judgement amount over the $50,000 from the other driver), how much going to trial may cost you and how long it will take (bearing in mind there is a time value for money).

    Good points. Thanks.

  • Sun, Dec 25 2016 2:04 PM In reply to

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

    If for example the lawyer seeks what a jury might award then the demand letter would be a good bit higher so they can negotiate down to what they really hope to achieve?

    Our actuals are property damage which was settled after about a month. Medical expenses which have been paid or not been paid, maybe future medical estimate, medications, mileage, minor loss of ability to do odd jobs like before, and that is about it. Well legal fees. They said copies of medical records that we might get ourselves are of no value other than to have copies. They still have to get them at the end = cost. 

  • Mon, Dec 26 2016 11:00 AM In reply to

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

    DanWard:
    If for example the lawyer seeks what a jury might award then the demand letter would be a good bit higher so they can negotiate down to what they really hope to achieve

    An insurance company isn’t going to be fooled by a demand for more than you can possibly prove in damages. All that does is discredit the lawyer asking for the absurd amount of money. In any negotiation, whether in a lawsuit, in business, or whatever, a person asking for something unreasonable isn’t taken very seriously. The lawyer ought to start out asking for the high end of damages that he/she thinks might be possible to get at a jury trial. How much he or she ought to come down from that in negotiation depends on a variety of factors, including the strength of the case, what kinds of damages make up the total being sought, whether the damages sought exceeds the insurance limit and, if so, what assets the negligent party has to collect the rest, etc.

    DanWard:
    Our actuals are property damage which was settled after about a month. Medical expenses which have been paid or not been paid, maybe future medical estimate, medications, mileage, minor loss of ability to do odd jobs like before, and that is about it. Well legal fees. They said copies of medical records that we might get ourselves are of no value other than to have copies. They still have to get them at the end = cost. 

    The negligent party is not responsible for paying your legal fees or other costs of litigation other than the few costs that by statute are “taxed” to the losing party — which typically amounts to the fee for filing the complaint and having it served and few other things like that. But not your legal fees, and not your costs to get your medical records. Your property damage, medical expenses including any future medical expenses that can be proven with reasonable certainty, any lost wages due to the accident, compensation for any permanent disabilty caused by the accident, and some amount of pain and suffering are the main damages you may be compensated for in this kind of lawsuit. Your lawyer will know what he/she can seek and what things don’t count, and you do have a lawyer, right?

  • Wed, Feb 1 2017 12:05 PM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decision...

    When a doctor says "after reaching MMI a letter from lawyer would be needed."

    What kind of letter content?  (since the doctor would already have some legal document to complete upon release or would receive some sort of document from the lawyer after release)

     

     

     

  • Wed, Feb 1 2017 12:17 PM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decision...

    We tried to add a phrase and system failed.

    A lawyer can feel that an opinion letter might help but that does not sound like a "letter" asked for or expected by the doctor.

  • Wed, Feb 1 2017 1:03 PM In reply to

    Re: What can we conclude by these insurance company decision...

    DanWard:
    When a doctor says "after reaching MMI a letter from lawyer would be needed."

    Without any context for why the doctor wants a letter from the lawyer I cannot say what the content of the letter would address. Why is the doctor asking for a letter? Really you need to ask the doctor what he/she is looking for since it is the doctor asking for it.

  • Wed, Feb 1 2017 2:33 PM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decision...

    Word for word is all I can do:

    Dr. Jones also stated that once MMI is achieved, she would need a letter from your attorney. Please let us know if you would like for us to make this appointment.

     

  • Wed, Feb 1 2017 4:03 PM In reply to

    • DOCAR
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    Re: What can we conclude by these insurance company decision...

    I would suggest that you call the doctor's office and ask what they need in the letter. We are not mindreaders.

  • Wed, Feb 1 2017 6:06 PM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decision...

    We thought a lawyer who had handled many cases might know the possible reasons why a doctor would require some letter with certain content at MMI.

  • Wed, Feb 1 2017 8:54 PM In reply to

    • DOCAR
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    Re: What can we conclude by these insurance company decision...

    There could be many reasons, so unless the lawyer has previously worked with that lawyer, he would just be guessing. I practiced over 30 years and I have no idea from the vague language. btw, it could be much cheaper for you to call and ask the doctor than for the lawyer to do it.

  • Sun, Feb 5 2017 12:55 PM In reply to

    • DanWard
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    Re: What can we conclude by these insurance company decision...

    Early on we asked what medical records will the insurance company have access to. The reply was "only what you give them access to." Somewhat puzzling answer. 

    I can not locate the message right now but the same person told us in recent weeks that they will have access to all records going back to the date of birth.

    They may or may not have said "if it goes to court."

    I'll have to switch computers and see if the message is there where they said "all records" if......

     

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