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Follow-Up

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Latest post Tue, Nov 10 2015 12:26 PM by ca19lawyer2. 3 replies.
  • Mon, Nov 9 2015 11:54 PM

    Follow-Up

    Jack, I was hoping for an explanation if you have one...

    I posted about an auto accident my mom had earlier this year.  The end result was the driver in the car in front of her was assigned 49% fault by the insurance company and my mom was assigned 51% fault for the car she rear-ended.  Another car hit her from behind but the insurance company said her car was already totaled from the first impact so didn't assign any fault to the car behind her.  (I don't totally understand that part.)

    Nobody was issued a ticket.

    My take:  this was basically what you call an accident.  Stuff happens when a bunch of cars are all in the same place at the same time on a public road, and this was one of those things.  There wasn't anyone doing anything horribly wrong, it just didn't work out well.

    My mom was fairly seriously injured, primarily by the airbag going off.  She is not contemplating suing the airbag manufacturer.  She was in a level 2 trauma center for 10 days following the accident, and then in a physical rehab hospital for an additional week, and then (and still) going to physical therapy to recover from her injurues.  But all's well that ends well.  It could have been a lot worse at her age.

    My remaining questions are about insurance coverage.  Her insurance company did give her a lump sum for her car.  But when she was still in the hosital there was lots of references by the medical staff to Medicare, as in, "Medicare won't pay for this, they'll only pay for that," etc., etc.

    I didn't understand why it mattered what Medicare will or won't pay for.  Isn't her primary claim to the insurance company, not Medicare?  The insurance company did pay a lot of her medical bills but now she is getting some bills (like for the ambulance) that were only partially paid. Do those go to Medicare now?  Are these because she was 51% at fault and the other driver was only 49% fault?  She has Medicare supplemental insurance too and I don't even want to think about that.  I am very confused about who is supposed to be paying for what.  She is depleting her entire savings writing checks for every bill she gets because she hates owing money, but I'm not sure that is what she should be doing.  She has so much insurance.  Shouldn't some combo of insurance and medicare be covering most or all of her bills?

  • Tue, Nov 10 2015 7:49 AM In reply to

    Re: Follow-Up

    LegalSecy:
    I didn't understand why it mattered what Medicare will or won't pay for.  Isn't her primary claim to the insurance company, not Medicare?

    I think that depends on the terms of her insurance policy, including the coverage limits.  I know that my car insurance has only a small amount ($1000 or so?) of medical payments coverage, so if I'm ever in an accident that's my fault I will only get that $1000 (or whatever it is) towards my medical costs from my car insurer.  The rest would have to come from my health insurance and/or my own pocket.

    LegalSecy:
    She has so much insurance.  Shouldn't some combo of insurance and medicare be covering most or all of her bills?

    Yes, some combo of Medicare, Medicare supplemental insurance, and her and the other driver's car insurance should be covering her medical expenses, subject of course to the applicable exclusions, deductibles, copays, AND maximum allowable charges.  Because providers are allowed to charge different amounts for the same thing depending on who is paying, some of the charges on the bills she has been receiving are likely to eventually be disallowed (especially if she lets Medicare take care of it).

    I agree with you that it's a bad idea for your mother to pay these bills just because they were sent to her.  She may need to hire a lawyer or some other professional with the expertise to supervise the whole mess and make sure each party pays what it should when it should.

     

  • Tue, Nov 10 2015 8:02 AM In reply to

    Re: Follow-Up

    You refer to "insurance company" several times in your post. You're going to have to clarify which and whose insurance company you're referring to in each reference.

    As for medicare and medicare supplement, depending which level of medicare supplement she has, between the two, they could be paying for all or most of the bills.

    Here's a website that explains all the plans.

    https://www.medicaresupplement.com/medigap/plans/

    Compare her medicare supplement to the plan descriptions. That'll give you an idea as to what coverage she has. Plan F is the most comprehensive and (as I recal) combined with medicare should result in 100% of all bills being paid. If she has a lesser plan then there will be some co-pays and co-insurance.

    At the moment I suggest that ALL of her medical (and ambulance) bills be sent to both medicare and the supplement company. For any bills that she paid out of pocket, attach the receipt so she can be reimbursed. Between both, they will figure out what gets paid or not and will provide an explanation of benefits.

    If she has Medical Payments on her auto insurance, send copies of all the bills there, too..

    The medicare and medicare supplement coverage have nothing to do with any assignment of fault by any car insurance company.

    The medicare and medicare supplement should have been the first place to go for the medical bills as those two are contractually obligated to pay without regard to who is at fault for causing the accident.

    As for who is at fault for the accident I went back and reviewed our earlier discussion:

    http://community.lawyers.com/forums/t/168849/730962.aspx#730962

    I explained that your Mom could be partially or totally at fault for hitting the car in front of her but the car in back of her is at fault for hitting her and should have some liability for her damage and injuries. And if the Swooper has any liability at all, your Mom will need a personal injury attorney to go after the Swooper and the driver of the car that hit her rather than just accept any insurance company's assignment of fault.

     

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Tue, Nov 10 2015 12:26 PM In reply to

    Re: Follow-Up

    LegalSecy:
    Another car hit her from behind but the insurance company said her car was already totaled from the first impact so didn't assign any fault to the car behind her.  (I don't totally understand that part.)

    I assume that the two impacts did not happen simultaneously.  If so, since the insurer (not sure which insurer you're talking about) determined that the car was totalled by the first impact, then the second impact caused no damage (since there's no such thing as "uber-totalled" or whatever).

     

    LegalSecy:
    this was basically what you call an accident.  Stuff happens when a bunch of cars are all in the same place at the same time on a public road, and this was one of those things.  There wasn't anyone doing anything horribly wrong, it just didn't work out well.

    Collisions result either from negligence or intentional acts.  Describing a collision as an "accident" simply means it did not result from an intentional act, which means it resulted from the negligence of one or more of the drivers involved.  Thus, I'm not really sure what point you're trying to make here.  In the case of a rear end collision, the driver in the rear is typically negligent because he/she was following too closely to stop safely.

     

    LegalSecy:
    I didn't understand why it mattered what Medicare will or won't pay for.  Isn't her primary claim to the insurance company, not Medicare?

    Obviously we have no way of knowing anything about your mother's eligibility for medicare or whether medicare would or wouldn't properly cover anything here.  As far as insurance coverage, I'm not sure whether you're talking about your mother's auto policy or her personal medical policy.  If she had medical payments coverage on her auto policy, then that will pay for medical expenses, but medpay coverage is typically very low (e.g., $1k +/-), and you described injuries that would have gone way beyond that.  If you're talking about a personal medical policy, we obviously have no idea what sort of coverage she had and how that coverage might interplay with any medicare coverage.

     

    LegalSecy:
    Are these because she was 51% at fault and the other driver was only 49% fault?

    Neither medicare nor medpay coverage on a personal auto policy nor personal medical coverage take "fault" into account.

     

    LegalSecy:
    I am very confused about who is supposed to be paying for what.

    Submit the bills to everyone and let them sort it out.  Better yet, provide all relevant insurance info to the providers and ask them to bill as appropriate.

     

    LegalSecy:
    Shouldn't some combo of insurance and medicare be covering most or all of her bills?

    Again, we have no idea what coverage she has, but insurance isn't going to apply magically if she's paying the bills out of pocket.

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