What can we conclude by these insurance company decisions?

Previous | Next
 rated by 0 users
Latest post Wed, Apr 12 2017 4:45 PM by DanWard. 110 replies.
  • Sun, Feb 5 2017 4:10 PM In reply to

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

    DanWard:
    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. 

    Not puzzling if the answer came from your doctor. Very generally, under federal law, your doctor cannot disclose your medical records to others unless you give consent for that or the doctor is legally compelled to provide them (e.g. search warrant, subpoena, summons or other legal process). So, the doctor is not going to release it just because the defense lawyers ask for it. Until you sue the defendant (and its not clear to me yet whether you have filed the civil complaint in court yet) he or she has no way to compel release of any of your medical records. What the insurance company will get prior to the lawsuit being filed is whatever you make available to it.

    It changes though, once the lawsuit is filed. What your lawyer should have told you if you asked that question is that if the matter ends up in a lawsuit, the defendant will be entitled to get pretty much ALL of your medical records. 

  • Mon, Feb 6 2017 8:09 AM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    It was the legal team case manager that said it. Part (10% of their statement was surely meant to mean if the insurance company sends you any forns to list service providers, give them nothing)

    I think they said once a lawsuit is filed then all records are open.

     

  • Fri, Feb 10 2017 5:17 PM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    Taxagent:

    DanWard:
    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. 

    Not puzzling if the answer came from your doctor. Very generally, under federal law, your doctor cannot disclose your medical records to others unless you give consent for that or the doctor is legally compelled to provide them (e.g. search warrant, subpoena, summons or other legal process). So, the doctor is not going to release it just because the defense lawyers ask for it. Until you sue the defendant (and its not clear to me yet whether you have filed the civil complaint in court yet) he or she has no way to compel release of any of your medical records. What the insurance company will get prior to the lawsuit being filed is whatever you make available to it.

    It changes though, once the lawsuit is filed. What your lawyer should have told you if you asked that question is that if the matter ends up in a lawsuit, the defendant will be entitled to get pretty much ALL of your medical records. 

    direct quote

    "If the claim goes to court then the other side will be able to get previous medical records from all sources during the discovery phase of the claim. They will likely ask for either 3, 5 or 10 years prior medical records from any and all medical providers. They could also do this after they receive the demand even if it does not go to court."

     

  • Fri, Feb 10 2017 7:53 PM In reply to

    • DOCAR
      Lawyer
    • Top 25 Contributor
    • Joined on Sat, Dec 9 2000
    • NV
    • Posts 5,448

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

    They could also do this after they receive the demand even if it does not go to court

    Understand, they can ask for whatever they want to.  How you respond, is up to you and your attorney.  They just cannot get them from your doctor without your consent without going to court.

  • Mon, Mar 6 2017 5:26 AM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    Well the doctor that is the one to release thinks MMI has been reached. Another doctor, the treating physcian, said they would send the head doctor "a letter." Clearly to us this letter would be the doctor's opinion and proposed treatment plan for the person to pursue after release. At least two times we asked the attorney to get the records and read this "letter." It could very well be as good as an opinion letter. We were ignored it seems as they have send a request to the doctor for an opinion letter. Wrong doctor to be asking for that. They refused to give another appointment unless the $318 they were owed was paid in full. If they refuse to see a cash paying patient over $318 you can imagine what they charge for an opinion letter. This may turn out to be one of the opinion letters that cost hundreds of dollars. We think they (lawyer) should have waited until they had "the letter" and evaluate the content. Not good at all.

  • Fri, Mar 17 2017 6:17 PM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    from an article.........

    "If your specials are $3,000 and the adjuster offers you a total of $6,000, you'll know he assigned a multiple of 2 for your pain and suffering".

    Why is that a multiple of 2?

    If specials are 3K and the total is 6K why isn't the general 3k or 1 times?

    3 + (1x3) = 6 = multiple of 1

  • Sat, Mar 18 2017 12:22 AM In reply to

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

    DanWard:

    from an article.........

    "If your specials are $3,000 and the adjuster offers you a total of $6,000, you'll know he assigned a multiple of 2 for your pain and suffering".

    Why is that a multiple of 2?

    If specials are 3K and the total is 6K why isn't the general 3k or 1 times?

    3 + (1x3) = 6 = multiple of 1

    The total amount received is twice what the special damages were, hence a multiple of two (2 x special damages = total amount) was used. In other words, the pain and suffering amount was not determined by multiplying the special damages by two, but rather the total amount offered was determined by multiplying the special damages by two, with the difference between the two being the pain and suffering. 

  • Sat, Mar 18 2017 6:24 AM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    Taxagent:
    The total amount received is twice what the special damages were, hence a multiple of two (2 x special damages = total amount) was used. In other words, the pain and suffering amount was not determined by multiplying the special damages by two, but rather the total amount offered was determined by multiplying the special damages by two, with the difference between the two being the pain and suffering. 

    Well that is not good since it means if there is a settlement we lose 1 of the possible multipliers (1,1.5, 2, 2.5, etc.)

    1.0 would mean no pain and suffering and only medicals bills whereas we thought P&S would be 1 x medical expenses.

    We thought medical expenses were X and pain and suffering would be a number under say 5 that was multiplied by the amount of the medical bills. Oh well if the lawyer ask for 4 times, it's really only 3 for P&S.

     

  • Sat, Mar 18 2017 7:04 AM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    I waited too late to edit the one above.

    So a multiple of 1 would be medical expenses only.

  • Sat, Mar 18 2017 8:35 AM In reply to

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

    DanWard:
    We thought medical expenses were X and pain and suffering would be a number under say 5 that was multiplied by the amount of the medical bills.

    It can be that. It’s just a matter of how it is phrased. As I said earlier when discussing another part of this, focus on what the total amount will be. So ask the lawyer what the total amount he/she is seeking and how that breaks down by dollar amount, e.g. $X for medical bills, $Y for lost wages, and $Z for pain and suffering. That way there is no confusion about what kind of offers are on the table.

  • Sat, Mar 18 2017 9:34 AM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    We'll see what happens in coming weeks. Various articles on how P&S is calculated seem to give a number multiplied by the medical bills. None seem to say medical bills are part of that ending calculation.

  • Sat, Mar 18 2017 4:14 PM In reply to

    • DOCAR
      Lawyer
    • Top 25 Contributor
    • Joined on Sat, Dec 9 2000
    • NV
    • Posts 5,448

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

    They are always part of the ending calculation, because that is what you are trying to get to.  You keep making this more complicated than it has to be.  Concentrate of the final number when you get it, and not how they got there.

  • Sun, Mar 19 2017 1:24 PM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    Well that was not known by us. We understood it to mean that the part of the settlement that included lost wages, P&S would be a multiple of the medical bills. We did not know that a multiple of 1 = all medical bills and 0 for all the rest. As an example if medical was 4 and the lawyer said well we got them to agree to offer a mutiplier of 2 then that is not 4+ 2 x 4 = 12,000. It's only 8.

    So one of the multiples if it is more than 1.0 goes down the drain.

    Multiple of 1 means they pay the medical bills and not a penny more.

    That is not the way we thoughtit was but oh well.

  • Sun, Mar 19 2017 4:34 PM In reply to

    • DOCAR
      Lawyer
    • Top 25 Contributor
    • Joined on Sat, Dec 9 2000
    • NV
    • Posts 5,448

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

    There are many ways different companies is different states work out the final number.  Sometimes it is all money damages times a multiplier to include pain and suffering, sometimes it is just meds X the multiplier plus all other out of pocket costs.  Some give you your out of pocket plus some for pain and suffering that they feel compensates you based on the nature of the injuries and duration of discomfort.  Of course limited by the policy limits. It all depends upon the insurance adjuster, the insurance company and the state where the accident occured. Again, concentrate on the final number, not how they got there.  If you are satisfied with it, accept it, if not reject it.

  • Mon, Mar 20 2017 9:45 AM In reply to

    • DanWard
      Consumer
    • Top 500 Contributor
    • Joined on Mon, Apr 13 2015
    • SC
    • Posts 102

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

    Then this statement must not be correct:

    Insurance companies typically multiply the amount of medical bills by a number between one and five to calculate “pain and suffering.”

    I won't post the webpage where that was seen. Since I copied I can not adjust the size of the fonts, sorry.

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

    It was my understanding that pain and suffering was calculated by some method and would be a separate calculation as implied above.

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

    If it is not per the other comments then a mutiplier does not begin to calculate general damages until the adjustor gets to and begins with a multiple of 1.1 or higher.

    Lawyer celebtrating 1.0 means the insurance company gave zero for generals.

    2.0 means medical is X in the settlement and generals is 1 times X in the settlement.

    1.0 and there is no alottment for pain and suffering. 1.1 and above there is "if" the statement at the top is false.

Page 7 of 8 (111 items) « First ... < Previous 4 5 6 7 8 Next > | RSS

My Community

Community Membership New Users: Search Community