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Old 09-22-2015, 07:25 PM
 
10 posts, read 5,287 times
Reputation: 12

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I was in a car accident last week. While sitting at a red light, I was rear-ended. I'm not sure how fast the other driver was going, as I didn't see them coming, but the impact threw me so far forward, that my face came very close to colliding with the steering wheel (yes, I had on a seat belt).

After opening a claim with the other driver's insurance company, I went to urgent care that same day. I was having back and neck pain, along with a headache and nausea. I spoke with the adjuster the next day who indicated that he was estimating the cost of that visit and would mail me a check to cover it. At that same time, he asked whether or not I would seek additional medical attention. I told him that I didn't know and it would depend on how I progressed (the urgent care doctor told me to follow up in 3-4 days if I was still feeling unwell).

Fast forward to 2 days later. I called the adjuster with some questions, including to state that I was still feeling unwell and that I felt the need to seek additional treatment. I wanted to know how they would handle payment to the doctor. At that time, the adjuster told me that they "don't typically pay for medical expenses in a minor accident". I asked how they qualified the accident as "minor", when they hadn't even inspected the vehicle yet. The adjuster indicated that their insured stated it was a minor accident and that is all they have to go off of. Grant you, the jaws of life weren't required to extract me from my vehicle, but I've been in a minor fender bender and this was more than that. Since then, I've relayed this information to several other people who all have agreed that they should cover my medical expenses.

My question is, is there a law covering this type of situation? Or am I SOL if they refuse to cover medical expenses stemming from this accident? I've been in a few minor fender benders in my time, but none that have required a trip to a doctor.
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Old 09-22-2015, 07:32 PM
 
Location: Canada
5,805 posts, read 2,168,594 times
Reputation: 5195
Quote:
Originally Posted by Pheebs View Post
I was in a car accident last week. While sitting at a red light, I was rear-ended. I'm not sure how fast the other driver was going, as I didn't see them coming, but the impact threw me so far forward, that my face came very close to colliding with the steering wheel (yes, I had on a seat belt).

After opening a claim with the other driver's insurance company, I went to urgent care that same day. I was having back and neck pain, along with a headache and nausea. I spoke with the adjuster the next day who indicated that he was estimating the cost of that visit and would mail me a check to cover it. At that same time, he asked whether or not I would seek additional medical attention. I told him that I didn't know and it would depend on how I progressed (the urgent care doctor told me to follow up in 3-4 days if I was still feeling unwell).

Fast forward to 2 days later. I called the adjuster with some questions, including to state that I was still feeling unwell and that I felt the need to seek additional treatment. I wanted to know how they would handle payment to the doctor. At that time, the adjuster told me that they "don't typically pay for medical expenses in a minor accident". I asked how they qualified the accident as "minor", when they hadn't even inspected the vehicle yet. The adjuster indicated that their insured stated it was a minor accident and that is all they have to go off of. Grant you, the jaws of life weren't required to extract me from my vehicle, but I've been in a minor fender bender and this was more than that. Since then, I've relayed this information to several other people who all have agreed that they should cover my medical expenses.

My question is, is there a law covering this type of situation? Or am I SOL if they refuse to cover medical expenses stemming from this accident? I've been in a few minor fender benders in my time, but none that have required a trip to a doctor.
Did Police make a report? Did you report this accident to YOUR Insurance Company..because what happens is ( usually) your Insurance company goes after them..including injury settlement ( BTW~ Don't sign off on Personal Injury since it appears you got a bad "Whiplash"..which time will tell that tale!!) I know..because I stupidly signed off with similar accident/injury..and down the road had no end of neck problems and neuro symptoms for over 2 decades which ended up with symptoms so BAD required "Spinal Fusion"..So be aware!!

I sure hope you well!!
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Old 09-22-2015, 09:40 PM
 
Location: Richardson, TX
166 posts, read 174,939 times
Reputation: 296
The prior poster is incorrect. Your insurer will not pursue the other insurance carrier for medical expenses unless you have Med Pay coverage (uncommon but not unheard of in Texas). If you have PIP coverage, they are legally prohibited from attempting to recover for you unless the other driver is uninsured. They would never pursue another carrier for your settlement (ie pain and suffering) and the other carrier would likely refuse to reimburse your carrier for anything if you hadn't yet resolved your claim with them.

There are not many laws governing how the 3rd party insurer has to treat you, other than they have to act in good faith to protect their insured. If they refuse to pay your claim, you could file suit against their insured demanding they compensate you for your bills and for your pain and suffering. A 3rd party insurer will never pay for medical bills until you reach a settlement agreement with them. Since the adjuster offered to "send you a check to cover it" I think I can guess the insurance company. The check likely would have said something to the effect of "full and final settlement of all claims" and by endorsing it you may have been unwittingly settling your claim.

Try to cooperate as best as possible with the 3rd party insurance company. Allow them to inspect your car, send them your medical bills, and attempt to resolve things with them amicably. If you can't reach an agreement with them, I'd call your own insurance company and see if you can speak to an adjuster who can let you know whether your requests are reasonable. Best of luck to you and I hope you feel better.
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Old 09-22-2015, 10:35 PM
 
5 posts, read 3,176 times
Reputation: 15
Get a lawyer, most of the time they don't ask for anything up front. Go in and tell them you just want your medical expenses paid, plus or minus pain and suffering. You'll probably have to shell out the money out first for medical expenses but at least you will get it back.

Its a process and you might not receive the money until a year later.
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Old 09-23-2015, 03:50 PM
 
51 posts, read 44,731 times
Reputation: 49
Get a lawyer ASAP! They don't charge anything upfront (only get paid from the other persons insurance), you can go get medical treatment without any out of pocket and in the end you will get a little something extra in your pocket...it's really a win-win! If you want recommendations DM me and I'd be happy to suggest someone.
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Old 09-23-2015, 04:24 PM
 
Location: Richardson, TX
166 posts, read 174,939 times
Reputation: 296
I come from an insurance background so I may be a bit biased, but the only person who generally gains by an attorney's involvement is the attorney. They will send you to a medical provider they probably have a deal with and inflate your medical bills, and a year or two later you'll end up with the same amount in pocket you could have negotiated on your own if you're lucky. This is especially true of the larger firms where a lawyer will never even see your claim. Your case will be managed by someone who may not be very experienced or motivated to see you are treated fairly. They'll probably trade messages with the adjuster for months or a year or more on end before they even send a demand. That's just the game unfortunately and you can probably make the process move a lot quicker by yourself.

There are some situations where an attorney might help, such as if your claim is being unfairly denied or if you have very serious injuries and a very complex claim. In these kinds of cases, your just one of a thousand other clients on a balance sheet. The key is negotiating your claim which many people are unaware they can do. I helped a friend out recently and she ended up with double what she was initially offered just be sending a few emails. Again, good luck to you and I hope you feel better and can get everything resolved to your satisfaction.
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Old 09-23-2015, 05:07 PM
 
51 posts, read 44,731 times
Reputation: 49
Insurance companies notoriously take advantage of people, especially when they are injured. They will nit pick your entire claim and dwindle down your medical expenses so much that you may be out of pocket. At least a lawyer knows what your case is truly worth and can negotiate a fair settlement for you. Usually you get so much more when you have a lawyer that it makes their fee worth it.
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Old 09-23-2015, 05:08 PM
 
487 posts, read 523,719 times
Reputation: 828
Quote:
Originally Posted by LookingInRichardson View Post
I come from an insurance background so I may be a bit biased, but the only person who generally gains by an attorney's involvement is the attorney. They will send you to a medical provider they probably have a deal with and inflate your medical bills, and a year or two later you'll end up with the same amount in pocket you could have negotiated on your own if you're lucky. This is especially true of the larger firms where a lawyer will never even see your claim. Your case will be managed by someone who may not be very experienced or motivated to see you are treated fairly. They'll probably trade messages with the adjuster for months or a year or more on end before they even send a demand. That's just the game unfortunately and you can probably make the process move a lot quicker by yourself.

There are some situations where an attorney might help, such as if your claim is being unfairly denied or if you have very serious injuries and a very complex claim. In these kinds of cases, your just one of a thousand other clients on a balance sheet. The key is negotiating your claim which many people are unaware they can do. I helped a friend out recently and she ended up with double what she was initially offered just be sending a few emails. Again, good luck to you and I hope you feel better and can get everything resolved to your satisfaction.
Last claim I made, the adjuster gave a better offer to the attorney I hired than he gave to me (and I wasn't shy, believe me!), and I still netted more after the attorney's contingency fee. I suspect the adjuster had a higher settlement authority number once he had an attorney's representation letter in his file.
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Old 09-23-2015, 06:01 PM
 
10 posts, read 5,287 times
Reputation: 12
Thank you for the suggestions. I have had a few attorneys recommended to me by friends and family, so I will be placing initial phone calls to them this week. I'd rather handle it myself, but the adjuster is already being standoffish about the medical portion of my claim and I'm already out $$$ in medical bills (which continue to creep up). I also work full time and have a family to take care of. I don't have time to play games.

ETA: I've also missed a full day's worth of work and haven't been able to work longer than 6 hours a day on every other day. I'm hoping to be able to recover funds for missed work, as well. All told, I'm out over $1K already (not including the auto damages) and I'm not even a week post-accident.
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Old 09-24-2015, 02:14 AM
 
4,583 posts, read 6,168,276 times
Reputation: 5233
Check your work benefit package and see if you have a legal plan. Going that route may save you some money.
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