What settlement can I expect from herniated discs?

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PostPosted: Sun Oct 04, 2009 4:09 pm   Post subject:   

Just an update, it's been 3 weeks since I turned in my settlement packet. I finally received an email from the adjuster telling me that she was having trouble getting some of my medical records. I gave her what info I had so she can get copies of the records. It's funny, she's twice sent me a medical records release telling me she wanted to have everything together, one over a year ago and one about 3 months ago, but she didn't start gathering everything until I sent her the settlement packet.

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PostPosted: Sun Oct 04, 2009 4:30 pm   Post subject:   

Some of those med auth's are only good for a short period of time. And some docs/hospitals (even if not dated) will require a new one every thirty days or so. This might be the case.



Thanks for the update, keep 'em coming, and good luck!



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PostPosted: Sat Oct 17, 2009 6:47 pm   Post subject:   

I received a reply from my adjuster. She is requesting additional medical records and clarification on some issues.



She wants to request my medical records for the previous 3 years because the MRI showed “mild degenerative changes”. I have no problem with this because I have had no previous back or neck problems. Fortunately, 4 months before the accident I had a complete physical and everything was completely normal. The “mild degenerative changes” are from the impact that spun my car 180 degrees and launched my bumper over 30 feet. What else could help prove this?



She also says she doesn’t see a work release in the records. I have a statement the doctor completed for my PIP that gives the dates of my disability for days missed the 1st week of my accident and 3 days afterward. The doctors instructions to me on my first visit were to work and resume activities “as tolerated”. Should this be sufficient or do I need to get the doctor to sign off on every day I missed?



One thing I failed to mention in my settlement demand is that I was demoted for missing too much work. The owner felt he could no longer count on me to be at work when he needed me. After this I stopped my therapy and was reinstated to my previous position. Shouldn’t this be considered in the settlement?

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PostPosted: Mon Oct 19, 2009 11:02 am   Post subject:   

Quote:
Shouldn’t this be considered in the settlement?
Certainly the difference in pay for the duration you were in the demoted postion.


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PostPosted: Tue Oct 20, 2009 12:13 pm   Post subject:   

Do you think the adjuster could be delaying settlement? She said one of the doctor's told her they didn't have any records for me, but when I called they found them right away. She also says she is having trouble with records from my neurosurgeon because she doesnt know if he's with the hospital or clinic, but the medical records come from one department for both. I called them yesterday and there is no problem with getting the records.



Why would she be doing this?

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PostPosted: Tue Oct 20, 2009 12:21 pm   Post subject:   

I forgot to mention that she sent me claim documents that I couldn't open. I emailed her and called her and it took me almost 2 weeks to get the information. She said she mailed it but I didn't get that either. I had to go to the office and pester the staff (she wasn't there). Finally she copied to a regular email. That why I get the feeling that she might be delaying the claim.



Any reasoning behind this?

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PostPosted: Fri Oct 23, 2009 11:26 am   Post subject:   

If she's delaying..it sounds more like laziness to me rather than an unwillingness to settle the claim



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PostPosted: Sun Nov 01, 2009 5:07 pm   Post subject:   

I gave the adjuster my demand packet on Sept 18th. My packet was about 50 pages and I included parts of my daily diary, my missed work and a statement of lost wages signed by my employer, and a summary in the form of a list that listed in order and severity my pain and suffering and losses I've experienced due to this wreck. I also included large color pictures of my totaled car and the scene of the wreck. I tried to make the packet complete and at the same time organized to save her time and make it easier for her to understand. I also sent her a statement from my physician that states this accident is the cause of my injuries.



I realize that she had to request additional records (I really thought she would have requested previous records earlier), but it seems that she's taking longer that usual to do her job.



I've never been thorough this before, is it normal for her to take so long?



Is there anything I can do to hurry her up that wouldn't affect me negatively in the settlement?

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PostPosted: Mon Nov 02, 2009 10:56 am   Post subject:   

Jo,



Did you put a date on your demand? ie "this offer of settlement will be withdrawn on blank date?"





Did you send it certified with return receipt?



If not it's been over thirty days, I'd call or send a letter requesting confirmation it was received and request a response within 'x' amount of days.



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PostPosted: Mon Feb 01, 2010 11:32 am   Post subject:   

Jo posted this in my box

Quote:
Hi Lori,Farmers changed my adjuster and that delayed everything. He finally called me to talk about the claim this week. He said the neurosurgeon records show what I told him, that he suggested surgery along with other options I could consider. But the adjuster said unless I give him a letter from the doctor saying the surgery is necessary and an estimate on how much is costs, he will consider my injury only a neck strain. He also said if he sent me an offer without the letter, I would find it insulting. Is it necessary to have the letter even though everything is in the records just as I said?
I totally get where this adjuster is coming from Jo, and agree with him. Unless I had something from a doc, saying that surgery is absolutely 100% the only way to fix you, I wouldn't be able to consider it either. And frankly if that's the case you shouldn't settle until after the surgery because you don't know you'll have complications or not. So if your set on settling prior to that you need to get this letter from the doc. He can find out the charges from his staff and the hospital he is affliated with.


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PostPosted: Sat Feb 06, 2010 3:13 pm   Post subject:   

OK, I can understand the need for the letter. But how does the absence of the letter change my condition from herniated discs compressing the spinal cord to neck strain? I realize that an adjuster can do what they want to, but honestly, this is what makes people want to get a lawyer. Until that point, I thought I could work with this adjuster to come to a mutual agreement, but that statement put a different light on this.

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PostPosted: Sat Feb 06, 2010 4:22 pm   Post subject:   

Quote:
But how does the absence of the letter change my condition from herniated discs compressing the spinal cord to neck strain?
It doesn't, I think what he meant by that was that, without a letter stating the absolute need for the surgery and estimated cost of it, he can't include it, (ins claims are ALL about documentation--an old saying is, 'if it's not IN the claim it didn't happen)...so just get the letter from the doc along with the estimated cost of the surgery, recovery time etc..
Quote:
I realize that an adjuster can do what they want to,
No they really can't...
Quote:
but honestly, this is what makes people want to get a lawyer. Until that point, I thought I could work with this adjuster to come to a mutual agreement, but that statement put a different light on this.
I think you still can...you're taking the statement differently that he meant it, (and I can see how you would)..He's not saying that the neck strain is ALL that's wrong with you...what he's saying is he needs additional documentation to PROVE it to the claim (and his superiors/doi, etc)...and without that, although you have a herniated disc, they only documentation he as at this point is the treatment for the subsiquental neck strain that follows with a herniated disc (I personal have several of these along with fractures)...Get what he needs Jo, and send it to him and let's see what they say after that.


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PostPosted: Sat Mar 13, 2010 8:34 pm   Post subject:   

My medical bills total almost $10K but when the health insurance sent the bills to the adjuster, they discounted them 30%. I have an HMO and although MY bills show full price, they don't reimburse full price. How does this work on my end? The adjuster is trying to use this lower amount to minimize my injuries, saying, you ONLY have $7K in medical expenses.

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PostPosted: Sat Mar 13, 2010 8:47 pm   Post subject:   

I dont see how he only has documentation of a cervical strain when he has my MRI report that say I have "small to moderate disc herniations at c3-c4 and c4-c5 which result in mild flattening of the cervical cord at these levels".



I just went back for another MRI which shows an increase in size of the disc protrusion with further cord indentation and moderate stenosis.



How is that not enough to prove the injury? Even when I have surgery he can come to the conclusion that is wasn't necessary surgery and refuse to pay for it.



That's what I mean by the adjusters can do whatever they want. They can refuse to pay without justification but they must have justification to pay. Seems like a win-win for the adjuster, and I have to go to a lawyer to get justice.

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PostPosted: Sun Mar 14, 2010 3:24 am   Post subject:   

Quote:
That's what I mean by the adjusters can do whatever they want. They can refuse to pay without justification but they must have justification to pay. Seems like a win-win for the adjuster, and I have to go to a lawyer to get justice.




Hard to say. But, there must be evidence to the contray that led to his/her decision. And, no we can't do what we want. We follow the evidence.
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