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 Posted: Wed Sep 03, 2008 12:35 pm Post subject: |
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Lori mentioned that "Sure, I know, if they use their carrier, they have a claim against their policy they also have to pay the deductible and if they do not have rental they are out that money as well..using the liablity (PD) coverage they have no deductible, no claim on their policy and get a rental..." Sorry, I am a little confused and does not quite understand this part, maybe I did not ask my question right, may I ask my question again? tcope mentioned "You have insurance and your agreement with your carrier is to pay them a premium and they protect your interest when you are liable for property damage or injury to another." so, I have insurance, my insurance carrier should protect my interest, how about the other driver? the other driver has insurance as well, shouldn't the other driver's insurance company protect their interest as well? the other driver's insurance carrier did work with my insurance adjuster and my insurance already paid the other driver for their car damage, why didn't the other driver's insurance carrier continue to work with my insurance adjuster to figure out the amount we have to pay them for bodily injury? why did the other driver have to get an attorney instead of working with their own insurance adjuster? the other party does have auto insurance?
Lori also mentioned that "your own carrier will never (offically) help you with a BI claim..anyway", could you please explain why? isn't your carrier suppose to help you through the claim since you paid the premiums?
Sorry for the many questions, may I also know that is it normal that a claim is switched to different adjusters, since the accident, my insurance company has changed 3 different adjusters for my case?
Thank you for helping.
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Niki
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| Posted: Wed Sep 03, 2008 12:52 pm Post subject: |
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| Quote: | | so, I have insurance, my insurance carrier should protect my interest, how about the other driver? the other driver has insurance as well, shouldn't the other driver's insurance company protect their interest as well? |
When we say 'protect your interest' we mean from a liability/negligence stand point...meaning they are protecting your interest as it pertains to your legal obligation to compensate someone for some act that you are deemed negligent, therefore legally liable to compensate that other party...they are protecting your interest by settling (or attempting to) all claims within your limits therefore protect you from legal action. Or someone coming directly to you for their injury/property damage... | Quote: | | the other driver's insurance carrier did work with my insurance adjuster and my insurance already paid the other driver for their car damage, why didn't the other driver's insurance carrier continue to work with my insurance adjuster to figure out the amount we have to pay them for bodily injury? |
Ok, then that means they used their collision coverage (maybe) and your company reimbursed them or they subrogated your company for repayment...that doesn't happen with a BI, you don't a coverage on your policy (or anyones except Uninsured motorist or Underinsured motorist which do not pertain to this loss)....that will pay you as an insured (first party) for pain/suffering etc...maybe not even for medical bills and loss of wage, so they cannot settle it with their insured then work it out with your company.... | Quote: | | why did the other driver have to get an attorney instead of working with their own insurance adjuster? |
Honey, some people are just like that...they either, don't trust any insurance company or adjuster, or they think this is the only way to get a fair (or greater) settlement...some people are just that way...they run to an attorney before they go to the doctor...we see it all the time....
| Quote: | | Lori also mentioned that "your own carrier will never (offically) help you with a BI claim..anyway", could you please explain why? isn't your carrier suppose to help you through the claim since you paid the premiums? |
Yes, they are supposed to help you, but they will not be paying out any BI settlement so there will not be a subrogation claim for that...I also said ''offically'' help....some adjusters may offer some suggestions, but most won't...we can't give legal advise, so we have to walk a fine line, most adjusters will not say anything other than explaining the process, ie they won't settle the bi until you have finished treatment, been released from the doc, they won't pay your medical bills as you go, it's all at the end in a lump sum, the vehicle damage and bi are totally separate, etc....just basic info, cannot advise them regarding amount claimed, value of claim etc..... | Quote: | | Sorry for the many questions, may I also know that is it normal that a claim is switched to different adjusters, since the accident, my insurance company has changed 3 different adjusters for my case? |
Some company's operate that way, might be a physical damage adjuster, a subro rep, and a bi rep, that's not uncommon at all...never apologize for asking questions... 
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Lori
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| Posted: Thu Sep 04, 2008 9:49 am Post subject: |
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Hi Lori, thanks a lot for your explanations, from reading your reply, I found out that I have a totally wrong concept about how auto insurance works.
Lori explained that "Ok, then that means they used their collision coverage (maybe) and your company reimbursed them or they subrogated your company for repayment...that doesn't happen with a BI, you don't a coverage on your policy (or anyones except Uninsured motorist or Underinsured motorist which do not pertain to this loss)....that will pay you as an insured (first party) for pain/suffering etc...maybe not even for medical bills and loss of wage, so they cannot settle it with their insured then work it out with your company...."
I am still somehow confused with the above procedure in the claim process. It is ok that you could explain again, I am sorry about that.
This is the first accident I have ever had, so there are a lot of things that I don't really understand, my adjusters are really nice and friendly people, but they are too busy to explain everything to me and I am glad to find help here, sorry about my silly questions.
In my situation, my adjuster had me go to a collision center owned by my insurance company to get an car damage estimate, and after the estimate, my adjuster gave me a list of collision repair shops that are affiliated with my insurance company to choose from to get my car fixed, I picked one collision repair shop close to me and went and had my car fixed, I paid the collision repair shop my collision coverage deductible and my insurance company paid the shop the rest of the repair fees.
Is it the same with the other driver? The other driver also reported the accident to their insurance carrier and their adjuster did contact my adjuster to figure out that I am at fault, I know that my insurance had already paid for their car damage, but is it the same process as how my insurance paid for my car repair, say my adjuster also asked the other driver to bring their car for an estimate and then go for repair and then my insurance pays the repair shop that the other driver went for repair?
If so, is it the same process for bodily injury? say the other driver bring in their medical bills to their adjuster and their adjuster contacts with my adjuster and give my adjuster the medical bills and my adjuster pays the other party for their bodily injury? if this is the case, is there still a need for the other driver to get an attorney, their adjuster could help them with the same process that an attorney does?
Lori mentioned before that since I am at fault, so the other party is coming after me to get my liability insurance payment, since they are asking my insurance to pay them, not asking their own insurance for payment, why the other driver's adjuster only will help them to request car damage payment from my insurance company but not bodily injury payment? I think I understand the part that Lori mentioned regarding "that doesn't happen with a BI, you don't a coverage on your policy (or anyones except Uninsured motorist or Underinsured motorist which do not pertain to this loss)....that will pay you as an insured (first party) for pain/suffering etc...maybe not even for medical bills and loss of wage, so they cannot settle it with their insured then work it out with your company...." So, shouldn't the other driver's adjuster help them to get BI payment from my insurance company since the other driver does not have BI coverage on their policy as an insured (first party)? Just like what they did with the car damage?
Sorry about my silly questions, I am kind of confused with the whole process.
Thank you for your patience in helping.
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Niki
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| Posted: Thu Sep 04, 2008 10:19 am Post subject: |
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| Quote: | | Is it the same with the other driver? The other driver also reported the accident to their insurance carrier and their adjuster did contact my adjuster to figure out that I am at fault, I know that my insurance had already paid for their car damage, but is it the same process as how my insurance paid for my car repair, say my adjuster also asked the other driver to bring their car for an estimate and then go for repair and then my insurance pays the repair shop that the other driver went for repair |
Maybe, or their company repaired the vehicle per their way of doing business then sent your company a bill and your company reimbursed them for what they had paid...or it could have happened exactly as you did, only they didn't have to pay a deductible when it was done, or your company may have just paid them direct for the damage and they didn't even repair it, the bottom line is that your carrier has paid them in full for the repairs to their vehicle one way or the other, and that part of the claim is for all practical purposed done and closed ( the Property Damage portion, meaning the damage to their vehicle)...
I need to back up here a minute for the sake of argument...the list of repair facilitys your company gave you were shops that they (your company) would gaurantee the work or repair to your vehicle, you did not have to go to any of those shops and I'm sure they explained that...it was a list of shops that they back the work right? | Quote: | | If so, is it the same process for bodily injury? |
no, no, no a thousand times no, it's nothing like the vehicle damage... | Quote: | | say the other driver bring in their medical bills to their adjuster and their adjuster contacts with my adjuster and give my adjuster the medical bills and my adjuster pays the other party for their bodily injury |
no, not at all if and only ''if'' the other party has some first party coverage like medpay could 'their' carrier pay any medical bills at all...let's assume they did (although it doesn't matter anyway)...they give their carrier the medical bills their carrier pays the bills....that's it with their carrier, they can pay the medical bills up to the medpay limit (remember only if they have that coverage)...med pay is generally not subrogatible.. | Quote: | | if this is the case, is there still a need for the other driver to get an attorney, their adjuster could help them with the same process that an attorney does? |
It's not the case...if they had med pay their adjuster pays the med bills only...that's it...they still have a claim for any non-covered...(and some states you can get paid twice for the same med bills it's called ''double dipping")...their loss of wage, and pain and suffering that they get from your company...only, they cannot get that from their company there is no coverage that allows that..(for the sake of argument, we won't go into um uim pip etc because it does not pertain to this loss)....ok...so your company will not pay them one penny until they have finished all their treatment and are ready to settle once they settle they will pay it all at once in one lump sum...their adjuster cannot EVER represent them in a bi settlement...because (for one reason) they have not paid out any money to recoup or subrogate your company for....
| Quote: | | Just like what they did with the car damage? |
No, they are totally different coverage...BI coverage is a liability coverage, for injurys caused to another person by you...no one can collect under their own liability coverage, you cannot be liable to yourself...in other words bi coverage is ONLY for other people...never ever for the insured....so their company cannot pay them ANYTHING under their own bi coverage, that is why they must come to your policy for it....look at it like this if it were in reverse the other party at fault rather than you...then you might allow your carrier to fix your car, but they could not pay you an injury settlement you must go to the other/at fault party for that...again re: the attorney...it just happens (alot) people think they need one to get moremoney or to protect themselves fromt he mean old adjusters...  | Quote: | Sorry about my silly questions, I am kind of confused with the whole process.
Thank you for your patience in helping. |
Ins and claims in particular can be very confusing just keep asking until you understand...
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Lori
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| Posted: Fri Sep 05, 2008 7:39 am Post subject: |
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| Quote: | | Hi Lori, thanks a lot for your explanations, from reading your reply, I found out that I have a totally wrong concept about how auto insurance works. |
Well, Niki it is somewhat a common problem with many of us. We often don't understand what the policy papers explain and don't even bother to find it out unless got hit in the head.
Collision coverage follows the vehicle and covers the losses caused to it. Liability is designed to cover the losses caused to the others and doesn't cover the losses of the policy holder.
When your car has suffered damages in an accident, you can either file the claim with your insurer or can file it under the other party's policy when the other driver was at fault.
The bodily injury claim works differently. The other driver is required to file the claim with your insurer for the medical expenses, wage loss and other financial losses. However, if only the other driver has the Medpay, he can get reimbursement for his medical expenses from his insurer. The insurer then will subrogate your insurance company for the money paid to his customer.
Hope it clarifies a bit 
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Juanita |
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Juanita
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| Posted: Fri Sep 05, 2008 12:17 pm Post subject: |
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| Quote: | | I need to back up here a minute for the sake of argument...the list of repair facilitys your company gave you were shops that they (your company) would gaurantee the work or repair to your vehicle, you did not have to go to any of those shops and I'm sure they explained that...it was a list of shops that they back the work right? |
Sorry if I am not clear enough, because it was a while ago, I remember my adjuster said that I could go to any repair shop, but if I go to the ones on the list, if anything happens later with the repaired damaged parts on my car, my insurance will take care of it, I hope I am right here?
Lori mentioned | Quote: | ...their adjuster cannot EVER represent them in a bi settlement...because (for one reason) they have not paid out any money to recoup or subrogate your company for....
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Sorry I am still confused here, regarding the car damage part, I think the other driver went for an damage estimate, and my adjuster paid them the repair amount on the estimate, probably including rentals, etc., I don't think the other driver's insurance carrier paid them anything on their car damage, they ask my insurance for all of the damage payments, so in this case, the other driver's insurance carrier has nothing to subrogate my insurance for, am I right? If so, why is it not the same with bodily injury payments? The other driver's insurance did not pay out any money for their car damage, but their adjuster still represented them to work with my adjuster for their car damage payment, why can't their adjuster represent them for bodily injury payments as well, isn't it just like the car damage part, the recoup or subrogate process is not involved for both car damage and bodily injury, because their insurance did not pay out anything, they are getting it directly from my insurance liability?
| Quote: | | No, they are totally different coverage...BI coverage is a liability coverage, for injurys caused to another person by you...no one can collect under their own liability coverage, you cannot be liable to yourself...in other words bi coverage is ONLY for other people...never ever for the insured....so their company cannot pay them ANYTHING under their own bi coverage, that is why they must come to your policy for it.... |
Thank you Lori for the above statement, I understand that BI coverage is a liability coverage for other people not for myself, but isn't property damage (car damage) coverage a liability coverage as well? but why is BI liability coverage and property liability coverage processed differently even when subrogation process is not involved? the other driver's adjuster will only help them with the car damage, but not the BI part, thus, the attorney gets involved?
  sorry about all the questions...............
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| Posted: Fri Sep 05, 2008 12:53 pm Post subject: |
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| Quote: | | I hope I am right here? |
That is correct...I just didn't want this thread to turn into a 'steering' argument...thanks for clarifying...
| Quote: | | so in this case, the other driver's insurance carrier has nothing to subrogate my insurance for, am I right? |
Yes, you are correct...this party had the choice, either let your carrier handle their vehicle damage OR use their own policy/collision coverage, have their carrier pay it then subro yours for their collision payment...most people (understandably) would prefer the at fault carrier pay it...
| Quote: | | If so, why is it not the same with bodily injury payments? The other driver's insurance did not pay out any money for their car damage, but their adjuster still represented them to work with my adjuster for their car damage payment, why can't their adjuster represent them for bodily injury payments as well, isn't it just like the car damage part, the recoup or subrogate process is not involved for both car damage and bodily injury, because their insurance did not pay out anything, they are getting it directly from my insurance liability? |
What they would've been working out, was the liability decision, and if your carrier had accepted full liability for the accident...once that was agreed upon, then your carrier (with the owners consent) paid their damage...all the other party's adjuster was doing was making sure that their vehicle damage was being addressed and if not then they would've done so under the collision coverage....what you aren't understanding is there was coverage under their policy to repair their vehicle if need be (collision) there is no coverage under their policy to address their bi claim...only your policy....so there is no (financial) ''interest'' in the bi claim for their carrier..so no negotiation, or discussion between the adjusters regarding the bi claim other than maybe advising that there is one, and maybe providing some information, but i doubt it because they are attorney rep'd...once a person is atty rep'd NO adjuster can talk to that party about their claim, you HAVE to talk to the atty only unless the atty gives you permission to talk to them....so they must come to your carrier for this bi claim, there is no other pocket... | Quote: | | I understand that BI coverage is a liability coverage for other people not for myself, but isn't property damage (car damage) coverage a liability coverage as well? but why is BI liability coverage and property liability coverage processed differently even when subrogation process is not involved? |
It is confusing isn't it? Because as I said there is coverage under their own policy to fix their car...so they (their adjuster) needed to make sure your carrier was handling it, if not then they would've....however, if your company had denied the claim, their company would've fixed their car using their coll. coverage, however, they would not have been able to do anything for them injury wise...an insurance company technically cannot represent an insured unless they have (or could have) a finacially interest...otherwise they would be practicing law... | Quote: | | the other driver's adjuster will only help them with the car damage, but not the BI part, thus, the attorney gets involved? |
yes, basically, the other person didn't have to get an attorney they could've handled it themself, but they chose to....
keep asking questions until you're comfortable... have you talked to your adjuster yet?
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Lori
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| Posted: Fri Sep 05, 2008 1:39 pm Post subject: |
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good morning Lori and all  Thanks a lot for your patience in answering my concerns, I think my confusions are cleared will have to call my adjuster next week.
| Quote: | | What they would've been working out, was the liability decision, and if your carrier had accepted full liability for the accident...once that was agreed upon, then your carrier (with the owners consent) paid their damage... |
When you mentioned "(with the owners consent)", does it mean that I have to sign anything for my carrier to pay the other party for their vehicle damage? I was never asked for any consent from my adjuster regarding this matter and when my premium went up at policy renew, I called my adjuster and my adjuster then told me that they had already paid the other driver for their vehicle damage?
| Quote: | | ....what you aren't understanding is there was coverage under their policy to repair their vehicle if need be (collision) there is no coverage under their policy to address their bi claim...only your policy....so there is no (financial) ''interest'' in the bi claim for their carrier..so no negotiation, or discussion between the adjusters regarding the bi claim other than maybe advising that there is one, and maybe providing some information, |
What happens if the other party does not have collison coverage with their own carrier? in this case, does it mean that since there is no coverage under their own policy to address their vehicle damage, so there is no (financial) "interest" in the vehicle claim for their carrier as well, so in this situation, their adjuster will not negotiation, or discussion between the adjusters regarding their vehicle damage, just like their carrier has no (financial) ''interest'' in the bi claim as well? then the other party has to also get an attorney for their vehicle damage claim if they chose not to handle by themselves?
Thank you
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Niki
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| Posted: Fri Sep 05, 2008 9:47 pm Post subject: |
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| Quote: | | When you mentioned "(with the owners consent)", does it mean that I have to sign anything for my carrier to pay the other party for their vehicle damage? |
nope you won't have to sign anything...what i meant was with the owner of the others vehicle consent it was up to their discretion whether they used their collision coverage or your pd coverage...
| Quote: | | I called my adjuster and my adjuster then told me that they had already paid the other driver for their vehicle damage? |
right they do not need your consent to pay a claim you are legally liable for...and yes, this loss could certainly increase your rates..
| Quote: | | What happens if the other party does not have collison coverage with their own carrier? in this case, does it mean that since there is no coverage under their own policy to address their vehicle damage, so there is no (financial) "interest" in the vehicle claim for their carrier as well, so in this situation, their adjuster will not negotiation, or discussion between the adjusters regarding their vehicle damage, just like their carrier has no (financial) ''interest'' in the bi claim as well? |
That is correct, if they had not had any collision coverage, then their adjuster still would've talked to your adjuster to make sure they agreed on the liability, and their adjuster would've told your adjuster there is no collision coverage so they will be coming to you for their vehicle repair... | Quote: | | then the other party has to also get an attorney for their vehicle damage claim if they chose not to handle by themselves? |
yes, the ''could'' have, however most attorney's won't handle the vehicle repairs (there's no money in it for the atty... )....
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Lori
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| Posted: Sat Sep 06, 2008 7:27 am Post subject: |
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Thanks a lot for your detailed explanation.
| Quote: | | yes, the ''could'' have, however most attorney's won't handle the vehicle repairs (there's no money in it for the atty... |
Does this mean the attorney could get a lot of money from my insurance carrier on the BI claim? How can an attorney make money out of the other driver's medical treatment bills? if my carrier is paying the other driver the amount on their treatment bills, what money are there for the attorney? Does the attorney or the other driver make up or provide false medical information? otherwise I really don't get how the attorny could get money in the BI claim?
Thank you.
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Niki
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| Posted: Sat Sep 06, 2008 9:54 am Post subject: |
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| Quote: | | Does this mean the attorney could get a lot of money from my insurance carrier on the BI claim? |
yep atleast a third of what the injured party settles for is customary. | Quote: | | How can an attorney make money out of the other driver's medical treatment bills? if my carrier is paying the other driver the amount on their treatment bills, what money are there for the attorney? |
remember there is also a pain and suffering settlement on top of the actual medical bills...also the attorney will likely negotiate the bills down...after receiveing payment in full for them of course.. | Quote: | | Does the attorney or the other driver make up or provide false medical information? otherwise I really don't get how the attorny could get money in the BI claim? |
I won't say they make up any bills...stretch the amount of suffering and pain surely...believe it or not some attorney recommend docs, and visa versa...
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Lori
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| Posted: Sat Sep 06, 2008 11:30 am Post subject: |
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Dear Lori,
| Quote: | | ...also the attorney will likely negotiate the bills down...after receiveing payment in full for them of course.. |
Sorry, I don't really understand this part, could you please explain?
| Quote: | | ...believe it or not some attorney recommend docs, and visa versa... |
Do you mean that doctors recommend the other party to get an attorney as well? Does the doctor get money too?
Thank you Lori.
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Niki
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| Posted: Sat Sep 06, 2008 12:02 pm Post subject: |
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| Quote: | | Do you mean that doctors recommend the other party to get an attorney as well? Does the doctor get money too? |
yeah, there are some unethical atty's and docs...if a patient comes to the doc with a geniune issue, the doc send him to his atty buddy, and if a person goes to an atty, then the atty send him to his buddy the doc to run up the bills...of course this is the minority and gives all good docs (generally chiropractors) and atty's a bad name, but it does happen... | Quote: | | Sorry, I don't really understand this part, could you please explain? |
An atty, some times an adjuster and certainly the patient can many time negotiate down med bills, treatment stuff mostly like chiro's or pt...say the bill is 7k and hasn't been paid, an atty could contact the doc and say, 'listen i can get this entire thing paid in a lump sum if you'll accept 5k for the full amount'....more times than not they will accept it.
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Lori
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| Posted: Mon Sep 08, 2008 10:31 am Post subject: |
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How are you?
| Quote: | | An atty, some times an adjuster and certainly the patient can many time negotiate down med bills, treatment stuff mostly like chiro's or pt...say the bill is 7k and hasn't been paid, an atty could contact the doc and say, 'listen i can get this entire thing paid in a lump sum if you'll accept 5k for the full amount'....more times than not they will accept it. |
Sorry, I do not really understand how this process works, if those unethical attorneys or doctors are in the business of running up bills, why will they negotiate down the bills?
Regarding the pain and suffering part on top of the actual medical bills, do you know usually how much the other driver could get? I understand that everyone's claim will be different, but is there a formula to follow, say the pain and suffering settlement will be 3 times the medical bills, etc.?
Could you please give me some examples of the pain and suffering claims that people usually make?
Thank you.
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Niki
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| Posted: Mon Sep 08, 2008 11:20 am Post subject: |
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| Quote: | | Sorry, I do not really understand how this process works, if those unethical attorneys or doctors are in the business of running up bills, why will they negotiate down the bills? |
ok, the bills are lets say 10k...the insurance company pays the 10k (and additionally pain/suffering whatever)...usually health providers attach a lein to any settlement so they HAVE to be paid...they have usually been outstanding for some time...so you call them up and say, look if this was going thru a health provider this would be about half this much....what can we discount and get this paid in full for TODAY....usually you can get any provider to reduce the total by atleast 20-25% maybe even larger, i got a hospital to take 50 cents on the dollar on a bill my daughter had....so that's how that works...
There is nor has there ever been a formula for pain and suffering lots of people think that three times is it, and back in the good old days that worked some times...it really depends on too many things past health, present health prior injuries etc....someone with a 'whiplash' could get anywhere from 200-2k in pain an suffering so many things go into it...facial scaring especially on a young woman or child can go pretty high, of course bad injuries or permanent disabilitys can go real high it just depends on so many factors..
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