Why insurance claims for soft tissue injury are so critical?

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PostPosted: Fri Oct 05, 2012 7:28 am   Post subject:   

Thanks for the quick response. My apologies for not posting a new thread; to be honest forums are a tad confusing to me.



I have a few more questions. I consulted a lawyer and he said he would add up the total amounts billed to my health insurance, not how much I'm actually paying out after my health insurance. I called my health insurance, the amounts totaled billed to them is at 11,000 and what I actually owe is 2000. Your thoughts on this matter? I ask this because in your example calculations showed my health insurance would basically intercept that money. Which is understandable! I don't want anyone to go unpaid. I just want this all to be said and done. Does the example of calculations differ now because the amount billed and amount owed are 2 different amounts?



In the calculations example you said 8500 +10000. The 8500 being 85% of total medical and lost wages. Is the 10000 what you considered to be solely pain and suffering (to compensate me for pain...)? To clarify my question further, In your example, they would pay 8500 for medical and then 10,000 because I've dealt with crazy headaches & migraines every single day (the actual pain and suffering portion)?



Also, the shoes were required because of a pulled muscle that went from my foot to knee.(This was a result of hitting the brake too hard) Which I was sent to physical therapy for combined with the whiplash. The physical therapist did document that I needed the shoes for the proper healing environment.



I hope that I'm clear and concise with my questions. This is all a little overwhelming. Thanks in advance for your answers

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PostPosted: Fri Oct 05, 2012 10:47 am   Post subject:   

Quote:
I consulted a lawyer and he said he would add up the total amounts billed to my health insurance, not how much I'm actually paying out after my health insurance. I called my health insurance, the amounts totaled billed to them is at 11,000 and what I actually owe is 2000. Your thoughts on this matter?


Yes, that's the appropriate thing to do, but it is a double-edged sword . . . cutting away at your net settlement. Because the more the attorney "gets" for you in the settlement, the more he pockets, too. And, regardless of what the attorney "gets" for you as a settlement, your health insurance is still entitled to 100% of its expenses paid on your behalf, the reason being that your health insurance is not supposed to be used for third party claims (it is only intended to be used for your own medical expenses -- things that happen to you through no one else's fault).



But your attorney gets to take his 30%-40% OFF THE TOP before anyone else claims a share. So -- without a trial -- let's say your medical expenses are $11,000 and lost wages are $4000. If he gets you a settlement of $15,000 for medical expenses and lost wages, plus $7500 for pain and suffering . . . a total of $22,500 . . . and he has a 33.33% fee agreement, his cut is $7500 off the top. Your health insurance company is still entitled to recover up to $11,000.



If you cannot negotiate a reduction in their subrogation claim, you have to pay them $11,000, less your offset for any copays or deductibles (let's say $2,000). So $22,500 - $7,500 - $9,000 = $6,000 to you . . . essentially all you take from this is your lost wages plus reimbursement for your out of pocket expenses (actually a bit less, since the attorney will take some pretrial expenses, like court filing fees, off the top, too). So much for all the pain and suffering. Your attorney gets almost double what you net ($4,000). And your health insurance gets all of what it paid minus what you paid . . . and they expended no time, effort, or money to collect their share.



For those folks whose attorneys "overlook" the health insurance company's subrogation right, they do even worse. And if you go to trial, are found 15% at fault, your award is reduced by that amount. And the health insurance company still gets its full share unless you can negotiate a reduction (you could fairly argue the 15% contributory negligence offset) .



Quote:
In your example, they would pay 8500 for medical and then 10,000 because I've dealt with crazy headaches & migraines every single day (the actual pain and suffering portion)?


Yes, this was based on a trial outcome where your contribution was assessed at 15% (applies to both expenses and pain and suffering) -- but the numbers were not intended to predict the outcome of your case, they were simply round numbers for illustration purposes.



The main point of the illustrations is to show you that the attorney's take will almost always be more than yours. Especially on smaller outcomes, which is what I envision yours would be.



So, on your own, you try to negotiate the best outcome you can, knowing what your health insurance company is entitled to be paid. What's left is yours. An attorney would have to do his share better for you than that to even make hiring an attorney worth the trouble.



If you don't feel the insurance company is being fair to you, then you hire the attorney, but that's no guarantee of a better outcome. Any attorney who promises you more is not to be trusted. When you look closely at the fee agreement, all he is promising is to get you a settlement offer, not a positive outcome at trial. If you turn down the settlement offer, not only will you pay him his 30%-40%, but he'll also charge you for all the expenses of trial, too -- if you win. And if he forgets to add those charges into the original complaint, you can't collect them from the other party if you win the matter at trial.



If you lose, you'll pay your attorney some exorbitant hourly fee (like $300-$500) plus the expenses of trial. His fee agreement doesn't exactly say what you thought his television commercials did, "If you don't win, you don't owe us anything." Listen more carefully, and you're likely to hear, "If we don't get you a settlement, you don't owe us a thing." The fee agreement will talk about a pretrial or prejudgment settlement "offer".



So, figure out in your mind how much you want in your pocket after all your direct medical expenses and lost wages were. Add those amounts to your "pocket" and that's what you ask the insurance company for. Assume they will offer you half of that, so you might want to increase what you are asking for (after medical expenses and lost wages) by 100%. If you want $10,000 plus, you ask for $20,000 plus.



You should also prenegotiate a subrogation amount with your health insurance company. If they are entitled to $11,000 - $12,000, ask them to reduce their take by 50% and see what they offer in return. To them, anything is better than nothing if they don't have to hire an attorney, since it could cost them 30%-40% to collect their 100%. So, getting a reduction to 60%-70% of $11,000 would be pretty good on your own. You still get your $2,000 offset against that (but that's negotiable, too, and they might want you to give up some of that -- but you don't have to, since you actually paid it).



And, don't forget, their $11,000 could be a "phantom" number. They may have received "billings" from physicians and others totaling $11,000, but only paid those folks $5,000. That's what you really need to know -- how much they actually paid. It could be less than half of what was "billed" because they have negotiated rates with their network hospitals and physicians and other providers.



It's a wonderful game that gets played from several angles. Fail to play by the rules, and you are the one who gets hurt (maybe even worse) the second time.



Hope this helps.


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Last edited by MaxHerr on Tue Oct 30, 2012 2:31 am
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PostPosted: Mon Oct 29, 2012 5:00 pm   Post subject: claim  

I am wondering what a fair settlement amount is for my case. The other party is assuming 100% fault, the damages to my vehicle were around 4,000$which I received. The doctor bills for me and my two children total around 11,000$ I have been on prescription pain meds since may 7th when the accident occurred. I was last week released by the chiropractor and today released from physical therapy from the personal injury claim. I was treated for whip lash and a sprain to my lower back-hip area My children were both treated for whip lash as well but where released from the claim a few months ago. The other parties insurance company is State Farm. I am just wondering what is a fair amount to expect from this claim


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PostPosted: Mon Feb 04, 2013 3:59 pm   Post subject: car accident  

have a back spain and neck sprain and really bad panic attacks now medical bills are about 3000 now how much should i ask for.


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PostPosted: Mon Feb 04, 2013 6:34 pm   Post subject:   

No one here can tell you the answer to that question. You are entitled to 100% of your medical expenses. What are "panic attacks" and why do they have anything to do with a collision?



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PostPosted: Mon Mar 11, 2013 8:07 pm   Post subject: Rear ended 2 weeks ago  

Long story short ; got rear ended 2 weeks ago while I was at a stoplight waiting for light to change , my car was totaled by at fault driver's insurance . X-rays were taken and according to my chiropractor I have a soft tissue injury . I've been seeing my chiro everyday , missed 10 days of work at her recommendation . Headaches still after 12 days but decreasing in intensity . Adjuster met with me after the incident and gave me the claim number to bill everything under their name. I know it might be a little premature to talk about a settlement but what $$ should I be aiming for ? I don't want to get a lawyer involved but I don't want to get a lowball offer from insurance ? Would like a fair amount for all my troubles . Any suggestions ? Thanks in advance !!


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PostPosted: Tue Mar 12, 2013 12:12 am   Post subject:   

Quote:
Any suggestions ?


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PostPosted: Fri Mar 29, 2013 6:32 pm   Post subject: curious  

My wife and I were involved in a rear end collision. It totalled our vehicle ($21000) and we had $54000 worth of medical bills. We were in physical therapy for approx. 3 months. We had no breaks or scars, just neck sprain(both), back strain(both) and limited range of motion (wife's arm). My wife kinda freaks out when traffic gets somewhat conjested now also, whether she's driving or not. Does anybody know a ball park figure that should be reasonable for pain and suffering?


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PostPosted: Fri Mar 29, 2013 6:39 pm   Post subject:   

Each case is based on its own merits. Some folks suggest 2x or 3x the medical expenses, but this is not always a reasonable amount. You pretty much have to decide what you think your damages are worth.



Your wife's anxiety in traffic is understandable and not uncommon, but it should dissipate with time. How much time? Could be a few months to a few years. But it will fade, unless she's succumbed to PTSD. To be compensated for that will require a fairly extensive psych evaluation by your side and the at-fault party's as well.



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PostPosted: Fri May 23, 2014 12:58 am   Post subject: lumbar sprain/strain  

I work with. Disabled. Adults. While. Assisting. A client. In a wheelchair. Up on to a van. That was did not have. Wheelchair. Access. The client. Fell on me and i had to lift. The client. Up off me. After. That i had to lift. Her wheelchair. Up on to the van.. .and. normally. The company. I work. For. Suppose. To supply. A wheel chair. Access. Van. But they. Rented. One. Cause. The bus.They. Have. Was in the shop. . Can i sue them for. That. When. It was there Fault? ?? Twisted Evil


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PostPosted: Fri May 23, 2014 4:56 am   Post subject:   

April . . .



Your injuries are covered under Workers' Compensation laws which normally prevent you from suing your employer. Where folks end up in litigation over WC injuries is the determination of the degree of disability.



You are free to contact any WC attorney of your choosing and obtain a free consultation about your situation.



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PostPosted: Fri Jun 20, 2014 1:15 pm   Post subject: BI settlements for soft tissue injuries  

I think everyone needs to look at the whole aspect of the claims. Each person is diffrent and each claim is handled diffrently.



Vehicle now days are designed to absorbe the impact so it doesn't get transferred to the occupants of the vehicle so when you have vey little damage based upon a bio-mechanical standpoint you should have no injury or a very minor injury that will resolve on it's own.



With that being said there is nothing wrong with going to the emergency room or your primary doctor to be evaluated and if they feel a referral for additional treatment is needed they will give you one.



Also the provider you choose has a great deal to do with how the insurance companies evaluate your claim. Insurance companies now days track the relationships between attorneys and providers. They alos look at the reputation of the providers as well. If you go to an attorney who sends you to a chiropractor without the recommendation of a medical doctor it will be viewed diffrently. On the same note if you go to a doctor who has a history of over treating or being excessive in their treatment then that is looked at as well.





So to summarize if you are involved in and accident by all means go to be evaluation in the emergency room or your primary doctor. If they feel that additional care is needed they will send you. Most insurance companies don't change their evaluation based upon attorney involvement. The only diffrence is some people accept the first offer the insurance compaies puts out when all they really need to do is say they are looking for more and negotiate with the insurance company. Attorneys like to say they will get you a third more in your settlement but they take 33% of your settlement and then deduct any fees involved which in most cases will cause you to receive less than you would have received on your own. There is some additional work you have to do the present the claim on your own such as submittting your medical records and bills for review.


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PostPosted: Thu Jul 17, 2014 8:18 pm   Post subject: car accident  

My daughter was in a wreck, not her fault totaled her car, gave her $12000.00 do get another car. They want to pay med bills which total $4400.00, $660.00 lost wages and

$3500 general damages. Do you think the $3500 in general damages is fair?


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PostPosted: Fri Jul 18, 2014 6:05 am   Post subject:   

Quote:
Do you think the $3500 in general damages is fair?
It's not what I think, it's what your daughter thinks. If she believes that amount is fair "compensation" for her injuries, fine. If not, then she needs to ask for more -- ideally with a specific number in mind. If she asks for more and they refuse, then she can do one of two things: (1) accept the offer or (2) hire legal counsel to sue the person who caused her injuries, knowing that the attorney will take 30%-40% of any settlement or jury award.


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PostPosted: Wed Aug 06, 2014 3:42 pm   Post subject: 3 year old toe.  

My son who is 3 opened a door to a establishment. In doing so the weather stripping at the bottom of the door was not attached properly, and the metal sliced the tip of his toe. I know from a previous incident with myself, they really don't stitch that area. We bought bandages, ointments, etc. And took care of it on our own. We sent pictures of when it happened and pictures throughout the healing process. That company wants to know what kind of monetary compensation I would like. I have no idea what to say. Any suggestions would be great.


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