by billarmoush » Wed Aug 25, 2010 04:00 am
I was at a light and rear ended and my vehicle was totaled..My attorney sent her a demand letter and they have to respond by the 27th..She is telling my attorney my injuries are not related.. Will she come with an offer?
Posted: Wed Aug 25, 2010 04:02 am Post Subject:
I had surgery and my medical bills were 73 k and the adjuster approved the surgery on my shoulder.. Then she offered 0 saying the injury was not related..
Posted: Wed Aug 25, 2010 06:11 am Post Subject:
Sounds like this is a liability case... as such, the other person's insurance company would not "approve" any medical treatment. This is what health insurance companies do.
There is simply no way for anyone to know what some unknown 3rd party is going to do or not going to do.
Here is the thing... you are going to be paying your attorney 33% of any settlement amount (probably around $20,000)... so why not ask your attorney? This is why they get paid. I never understand why some people pay attorneys thousands and thousands of dollars and then never communicate or ask questions. Personally, if I was paying someone 3-4 months of wages for a few hours work... I'd be asking any question I could think of.
Posted: Wed Aug 25, 2010 06:14 am Post Subject:
the adjuster did approve medical treatment, but then when it came to make an offer she didn't think my injuries were related...
Posted: Wed Aug 25, 2010 09:57 am Post Subject:
Didn't you question on what basis she's responded that way? She must have some reason for failing to relate your injuries to this accident. IMO you do have the right to know how and to what extent they're assuming the cause to be something else..
Posted: Wed Aug 25, 2010 10:16 am Post Subject:
As tcope has pondered, why are the questions being posed here and not with your attorney? Why even bother with an attorney if you're going to second-guess them with advice from folks like us who understand insurance (often times better than some attorneys do), but are not lawyers, and cannot truly give you legal advice.
If you didn't think you could handle the claim on your own, and you sought an attorney to handle the matter for you, you should trust their expertise to get the job done.
Here in California, if a health insurance company approves a medical procedure, it is generally going to be in hot water if the procedure is performed and then the insurance company decides not to pay (happens in policy recissions/postclaims underwriting circumstances). The Insurance Code doesn't specifically address the same occurrence by an auto insurance company.
I can't tell from your post if the adjuster approved payment for the surgery before or after the surgery was performed, or if you are waiting to have another surgery performed. If all of this is "postoperative", then it could come back to bite the insurance company as a matter of "bad faith" in the claims settlement process.
But again, that's a matter for your attorney, not us.
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