Auto Accident settlement disabled VET

by Guest » Sat May 23, 2009 09:49 pm
Guest

Hi
I am a disabled VET who has had low back problems before this last accident. My L5-S1 region has disk thinning and calcium build up and has caused pain from time to time. It was ok before the accident. I have a disability rating at 30%. Well I was picking up my kids from high school and stopped at a red light behind a slow moving bus.
So I slowly crept up to the intersection to make a right hand turn and had to wait for school children in the cross walk. A young driver slammed into my back of my vehicle he must have been doing 30MPH. I thought I was fine right after the collision but within 30 seconds lightning pain went up my legs to my back and it seemed to have hang time were my past injury was. Then it went up to my neck.
I had sprang ankle and back pain as well as whiplash. I decided to seek my chiropractor vs MD because I did not feel the need for MRI or xray was needed I was trying to keep cost down for both sides. My car did not look that bad but bumper went into the UNI body and cost was around $9100 to fix it. I told my chiropractor to be in line with what my expenses I thought I would be reasonable. He estimated each visit to be $120. I went 30 times in close to 4 months as my pain did not decrease. I started to take Vicaden for the pain. At the 33 visit I ended treatment as not to spend too much. He said billing was ok and reasonable “I could go more” that I owed somewhere around $4300. I ended then and there. I was soon billed $5020. I still have pain but live with it. I can get free med from here on out from the VA. I got the insurance to pay the damage, and finally turned my sons whiplash bill and mine in. His bill was only $860 he was offered a total of $1500 for medical and pain and suffering. Less than 1X Pain and suffering! Then it came to my bill they said it was unreasonable for soft tissue? And they offered me $5180 total Medical and pain and suffering. Now I know it not cut and dry but I was re-injured and he hit me and screwed my life up again! I would like to get a lawyer but it could cost too much! What do you suggest?

Total Comments: 31

Posted: Sat May 23, 2009 10:58 pm Post Subject: insurance

I DO have a question for you. Are you STILL in the Military? Sometimes Disabled Vets can STILL remain in the Military, depending on what their disability is. However...I don't know if this is the case. Can you give me more of an update, please? Thanks.

Posted: Sat May 23, 2009 11:29 pm Post Subject:

I have been out of the military for almost 21 years and live in southern California. Another note I am now self employed and hard to prove my wages. The adjuster would not even consider the 38 hours I spent at the chiropractors for treatment as loss time or pay my actual car mileage! years ago I was hit by a driver and the adjusters bent over backwards to settled. I don't expect to get as much as way back then but this is ridiculous. I could have gouged them but I am an honest person. I had more then soft tissue damage. I guess I could have done a MRI and Compare prior MRIs. This accident should be worth more then $180. I had a sprang ankle for 3 weeks! plus my neck pain 3 months and back is on going. It's ok that I end up getting hooked on drugs like DR House I guess! frig! Then they offer combine figures for Med payment and for Pain and suffering award! I guess that prevents me from keeping Medpay! I could have at least argued to keep my medpay if the at fault party's insurance did not pay for my full medical treatment.

I have not and will not settle on this ( sorry for the rave I feel like a old senior citizen) Any advice all would be appreciated

Posted: Sun May 24, 2009 02:55 am Post Subject: insurance

First of all, I want to say THANK YOU for serving our country!! I'm in the Army Reserves, myself. Been in 13 years. I don't blame you for being upset......I would be, too. It DOES sound like your honest. was the other driver at fault( I'm assuming he was if the driver's Insurance bent over backwards to settle)? Ya know....you may want to find out WHY the other Insurance company is bending over backwards. SOME Insurance companies won't do that unless something was 'wrong' with the driver ( DUI, etc). THAT situation was a bit of a 'personal' experience with me, at one time. You may want to talk to a Lawyer about your case. If you do ( or even if you don't), please give me an update on what's going on. Really would like to know...........thanks.

Posted: Sun May 24, 2009 12:37 pm Post Subject:

Jerry, let me clear up a couple of questions in my head...were you disabled while in active military,

disabled VET

and then again, with the prior acccident? Was your injury that caused your disability while active military also your back? Then you were in an accident, (years ago) that also injured your back? Then you were in this accident that re-injured you again? (I'm trying to figure out if you've had two or three injurys to your back)...

I had more then soft tissue damage.

I assume you are speaking only of your ankle right? You did have your ankle x-rayed didnt' you? Someone other than the Chiro treated your ankle right? Or did the chiro treat that as well, and if so how?

I'm not sure in CA if double dipping for med pay is allowed...ask your own carrier, (not the at fault carrier)...What is your med pay limit and has your carrier paid any that to you or the Chiro?


Then it came to my bill they said it was unreasonable for soft tissue?

Well Jerry most soft tissue injurys (your whiplash, not your ankle) will typcially get all the better they are going to get (with a chiro or PT) within 60 days or so...and frankly going to the chiro nearly every other day (5 day work week = 20 days per month, 33 times in 80 'work' days= every 2.4 days)..for four months...does sound excessive...especially since you weren't getting any better....

Another note I am now self employed and hard to prove my wages.


I've had many claims like this too., Here's the deal if you think it's hard to prove your wages, then how can you expect them to be paid? :? see what I mean? The adjuster HAS to prove what they are paying for..The way I always do this is have the injured party produce their last years tax return...from that I can generally figure an hourly rate...but it depends on the type of self employed business you have, whether or not going to the doc lost you any business or you had to pay someone else to 'cover' while you were at the doc, if not then maybe nothing is owed on that part...

or pay my actual car mileage!

states differ on this...I would've certainly considered this unless you were driving 100 miles each way.. :wink: but could be that CA doesn't require this..(although it would be odd)...

years ago I was hit by a driver and the adjusters bent over backwards to settled

each claim is different Jerry, and if that is the accident that 'caused' your disability then that's totally different...try not to compare one to the other..

I had more then soft tissue damage.


If you are not talking ONLY about your ankle, then what besides soft tissue did you have? and how do you know? and are you saying the chiro was treating you for something other than soft tissue injury? if so how did he/she know? and what treatment was it?

Then they offer combine figures for Med payment and for Pain and suffering award! I guess that prevents me from keeping Medpay! I could have at least argued to keep my medpay if the at fault party's insurance did not pay for my full medical treatment.

I'm confused here...your medpay should be coming from YOUR carrier...period...what do you mean 'combined' figure? In many states (mine included) if a person has med pay they can 'double dip'...meaning, they can collect the medical bill from their carrier under medpay then collect the exact same bill from the at fault carrier...(health ins, likely will subro though)....please explain that better....

Have you tried to negotiate this chiro bill with the doc? Have you turned it in to your health carrier? I can gaurantee you that the chiro does not get the entire amount he is billing from any health carrier....they are all discounted for what is prevailing in the area...

I agree your claim should be 'worth' more than 180.00 please provide the answers to the questions asked and let's see if we can help you figure it out..

His bill was only $860 he was offered a total of $1500 for medical and pain and suffering

What was this 860.00 for Jerry? How much of it was diagnostic?



( I'm assuming he was if the driver's Insurance bent over backwards to settle)?

SD, re-read it, that was a prior accident...

you may want to find out WHY the other Insurance company is bending over backwards. SOME Insurance companies won't do that unless something was 'wrong' with the driver ( DUI, etc).

NOT this claim SD... :wink:

years ago I was hit by a driver and the adjusters bent over backwards to settled

Posted: Sun May 24, 2009 04:08 pm Post Subject:

If I understand the original post, you had a prior condition that was exacerbated by this recent injury. Most likely in your state only the excaserbation part of the injury needs to be considered. That is, only the part where the injury was made worse. Another way to look at this is if you did not have a prior injury how would you have been injured in this accident... much less? If the adjuster is considering this then they are probably not going to consider all of your medical treatment.

The other things you have going against you is that you don't have good documentation of your injury. You may have been attempting to keep your bills low, but if you cannot show the adjuster the extent of your injury from _this_ accident then they may not be able to fully understand your injury. It also appears that you may have sustained a soft tissue injury... or given the facts of the accident, a person without a prior condition such as yours would have sustained a soft tissue injury. These types of injuries usually completely heal themselves with the proper treatment. As such, the offer of compensation is going to be lower as you have no lingering affects.

The offer by the adjuster is the initial offer. You can ask for more... you should ask for more. It's a negotiation in order to reach a settlement. During this negotiation you need to be making the adjuster aware of _why_ your claims is worth much more. Use facts as well as explaining how your life was changed. That is, you need to present you case just as you would be doing to a jury. That is what the adjuster is asking himself... what would a jury award this person.

Lastly, you can ask your medical provides if they will lower their bills. Most likely at $120 a visit, they will. You should be looking for them to cut the bill by 50% or as little as 20%. Explain to them that you need to pay them from your accident settlement and due to your prior condition the adjuster is paying very little. You do this toward the end of the negotiation so that they don't send a lien into the adjuster making the adjuster pay them directly (as the adjuster would need to pay 100% of their bill out of your settlement). Also, don't give the doctors office the other carriers information. So your seeking to increase your settlement amount and decrease the amount you owe on the medical bills.

Note: You don't tell the adjuster your lowering the medical bills... they need to consider the charges as they were submitted. Attorneys do this all of the time.

Posted: Sun May 24, 2009 11:26 pm Post Subject:

Well to answer all yes I have pre existing injury. First event was while in the Navy and I sub stained a low back injury on the flight line and with further exacerbation by PTs while in special fitness training. Second was a drunk driver who hit my car 10 years ago that led to further exacerbation to my existing condition. But it healed somewhat to a point I was comfortable. I go through life occasionally with sciatic pain and treat only when I absolutely need it. This accident did not just cause a bruising or a tear in muscles etc as they argue with soft tissue damages. The pain is pulsating through my spine as if my bone is hitting the nerve sac. If you were to look at my spine you would see my disk is very thin as with degeneration a heavy calcium buildup on lower vertebrae and bone spurs. I believe when I get these pain periods in my life it is due to bone and nerve bundle contact as last MRI showed they are very close in proximity. I am not arguing I was 100% before the accident, but the longer the time it took to heal vs some human model through colossal was warranted. Because I was hurt more from any prior condition should not take away from medical expense it took to heal me to the same degeneration I had before. So it it took me longer to alleviate pain. I could have taken MD path but choose a DC I had already had history with, this alleviated spending moneys for x-ray or MRI. I feel either path could have charged the same amount in my circumstance. I was trying to get my back to the condition before the accident. But that is not the case as my prior pain was sciatic and that I still have with this occasional spine throbbing thing that the VA will now be treating at no cost other then US tax dollars!
Sorry he hit a crippled and I take longer to heal. But I am not going after long term care or for any new impairment. Just pain and suffering for the time of treatment which yes took that long. I quit when I felt good enough. I am also asking for my commute time and time spent at chiropractics office and mileage. There low ball of $180 is not worth what the driver took away from me.
To clarify Med pay was only a thousand. And I am not sure on double dipping law in California. My question on payment would be if the other driver’s insurance adjuster denies’s full medical payment then I would not have to pay back my medpay and use that to help payback the DC as he refuses to lower his bill and has tried to affirm his position on his treatment coarse he performed on me. If the adjuster combines medical payment with the pain and suffering without separating the value of either I have no argument to bring back to my insurance company to say they did not cover my entire medical bill. Amazing how you these games are played. I should have gone to the ER when the flash of pain happened and be billed about $20,000!

Posted: Mon May 25, 2009 12:39 am Post Subject:

Because I was hurt more from any prior condition should not take away from medical expense it took to heal me to the same degeneration I had before.

I'm sorry, but in many states it does. If you had an existing injury and this accident made it worse, then the other party only owes you for the past that was made worse.

I was trying to get my back to the condition before the accident. But that is not the case as my prior pain was sciatic and that I still have with this occasional spine throbbing thing that the VA will now be treating at no cost other then US tax dollars!

You need to be able to show the adjuster exactly this. I'm guessing with the limited diagnostic work that it's difficult to see on paper. Perhaps you should have a current MRI done in order to show the difference. If your going to need additional medical treatment you need to make this case as well when you settle.

There low ball of $180 is not worth what the driver took away from me.

If you don't include all the treatment, as some of it was done due to the prior condition, it's more then $180.

If the adjuster combines medical payment with the pain and suffering without separating the value of either I have no argument to bring back to my insurance company to say they did not cover my entire medical bill.

I'm not sure what the Med Pay laws are in CA... can a carrier recovery on money they pay under Med Pay? But yes you can always argue that some of the treatment was due to a prior injury. Of course I don't know if this will help with Med Pay as they should only be paying for treatment related to this injury and if you argue that some of the treatment was due to a prior injury, they may still have a right to recover what they paid as it's not related. You argue where ever you can (where it helps you) that your settlement with the at fault carrier did not address all of your treatment. If if it lowers what you owe, you make that argument.

I should have gone to the ER when the flash of pain happened and be billed about $20,000!

If it would have helped document the extent of your injury, perhaps. But perhaps even an MRI now would help your case. If a person comes to me and with 10 visits to a chiro and $1000 in medical bills but tells me that they will never be the same, I have to consider the medical evidence in front of me that says otherwise. After all, a jury of independent people are going to do the same. Of course, your treatment was more extensive and there should be medical notes to support a larger claim but my point is the same. Limiting medical treatment, while always a good thing, can hurt the support of your own claim.

Again, the initial offer was just that. Nothing says you have to settle for that amount. You can also wait (and I'd almost advise that you do) until you can be sure you know the full extent of this injury. Time is on your side.

Note: I think part of the problem is that perhaps you should have sought PT or DC care from the VA with the thought that the prior injury was also coming into play. If the VA felt that some of the treatment was unrelated to your prior condition then they could seek recovery from the other carrier. But this way you would not be looking at a bill for your treatment.

Posted: Mon May 25, 2009 03:02 am Post Subject:

More spin!
I only expected treatment to bring me back to the point prior to the accident. Due to my prior injury's I can not take as much abuse as if I was whole person. They did not magically put my spine and disk back to the way it was when I was 19 and some how I gained on this medical treatment. It just took longer to relieve and heal as with my condition. I do not expect any extra treatment beyond what the accident caused.

The argument is the time and money it took to get me to heal to that prior point. I should be afforded to be recovered to the second before the accident and I am only owed to be brought back in like same. Any lawyer can argue this point.
Regardless of my prior I should be brought back to my prior at least in my view! I live in a very expensive part of the country (OC) and regardless of my great driving record I pay high dollars into insurance as well as the other millions here. Auto repair and medical is not cheap as leases and cost of business is more. Who am I to argue the DC bill or how much it should cost. But when I have someone tell me my pain should have been gone in 60 days and never look me in the eyes well B1te ME comes to mine!

Posted: Mon May 25, 2009 04:21 am Post Subject:

I'm just trying to point out the adjusters point of view (as I see it). What you will need to do is to argue your case. You have valid points and these need to be brought up during your negotiations. The adjuster is just going by what he/she sees at this time. They do want to spend as little money as possible... that is the job of any company. They also have their point of view on your injury. I was pointing that out. You need to argue your side and show them what you have stated here. You could very well see that offer go way up, very quickly.

Who am I to argue the DC bill or how much it should cost.

Because your the one paying the bill. How long were you treated for $120 and by who? I'm guessing 45 minutes? Perhaps an hour? Some times they won't lower their bill.... often they will.

Posted: Mon May 25, 2009 11:05 am Post Subject:

Jerry, I'm going to post what you left in my quick message into this thread...it's relavent and could help another (and since you're not 'registered' I cannot respond personally to you)

Accident on flight line. hit by drunk driver 10 years ago. New accident January! Soft tissue damage only determined by the adjuster. My ankle was sprang 3 weeks no big deal. Xrays for a sprang I guess I could of if I wanted to really rack up medical bills. Chiro Adjusted it a few times I soaked and Bandaged it. Most of bill was related to my back injury and with some portion directed towards whiplash. Whiplash was gone about 8 to 9 weeks into treatment.My back has prior and was just treating by chiro to alleviate pain. I do not want to get addicted to pain medice as I can get them like candy from the VA for my injuries. If I am in pain I do seek Chiropractors as well as MD help. But new the MD Medical path would rack up even more monies. I at one time paid 12000 for Pain shots series. worthless treatment gave me two weeks relief is all. I argue soft tissue as I know my back. MRI and Xrays reveal that there is a close proximity to vertebrae and nerve bundle. Did the driver cause this no. but he did cause for the need for this treatment to get my back to realign to the point of were it was before hand. It was not just a UBOO to get money from insurance. Math 17 weeks 33 visits roughly 2 visits a week. Sorry I do not live down south anymore but unfortunately in one of the most exspensive areas in California. As technology dictates Every one charges what they can get here and is usually allot more then what I had spent in Raleigh NC.Work thing.I am in research and design and currently funding my own project and will sell my finished product for some good change when I finish the build. The accident took away time from my project. Unfortunately I have very little income to show for entire last year. but I do have statements of payment of hourly rates I receive last quarter that shows my billed hourly rate. I am only asking for commute time and treatment time. 33 times an hour. that includes 30 min to an hour treatment time and time in commute.Car Millage simple and small 9.2 miles round trip times 33 visits at government prevailing mileage rate. Chiro was treating me for all pain. adjustments and other stuff that helped to a point. Now seeking VA help and not even considering asking for any consideration on the money they spent on my care!Chiro is adamant on sticking to his bill and tried to make a case to the adjuster. I will not be seeking his care again as I thought it was going to come under $4000.I would work with the adjusters on this but they it seems like they are not considering everything. If they chose to pay med to only $4000 pain and suffering at a fair rate then I would be good to go. The med pay I could argue wopuld not need to be paid back as they did not cover all my medical.But when the adjuster combines the two figures pain and suffering with medical payments with out delineating the two values I have no argument to keep the medpay to help pay down what they deem high chiropractic rates. I am not sure on sons charges it is not well defined on his bill.Now it's almost to the point that I if ever hit again will not try to go the cheap route. Get in the ambulance and let the medical industry have at it. With this attitude it will eventually cost us all more moneys!Thanks LoriHave a good holidayAny further help would be appreciated

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