Subrogation of claims: When does it happen?

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PostPosted: Thu May 08, 2008 4:30 am   Post subject: Subrogation of claims: When does it happen?  

I was involved in a rear end accident last November. I was stopped at a red light and had my blinker on to make a left hand turn. While setting there I was rear ended. My sister was in the car with me and she started complaining about her back and leg hurting (she had back problems before accident). The girl that hit me got out of her car and came up to mine and asked if we were Ok and asked if I would move my car because we were blocking traffic. I told her I wanted to call the police first, which I did and told them about the traffic and being out in the intersection. The dispatcher advised me to move my car to the nearest shoulder. Since I had my blinker on to turn left, I turned and parked in a parking area. The police came and took statements.



My sister went by ambulance to the hospital. I decided to get out of my car after my sister was in the ambulance to inspect the damages to my car, surprised damages was not that bad because I thought the impact was pretty hard. Went back to the girl that hit me to exchange insurance information and the officer taking the report asked for me to return to my vehicle that she would supply with the insurance information. The paint on my car was scratched in some areas and my license plate light was broken and there was a few small buckles on both ends under my tail lights (damage was estimated at $850). No damage was done to her vehicle because she had metal bars on the front. She was driving an SUV, I was driving a little sports car.



After the accident I went to hospital to check on my sister and they just said she was going to be sore for awhile. They took xrays and gave her prescriptions for pain pills. While I was waiting for her I got a real bad headache and my neck and right shoulder started to bother me. I went on ahead and took her home and I went home and took some advil, but the pain just got worse, so I ended up going to the hospital and was told it was from the accident. They took xrays, put a neck brace on me and told me to wear it for a week (plus prescription). What an ordeal!



I called my insurance company and than I called her insurance company to file a claim since she rear ended me. Found out the officer that took our statements gave me the wrong policy number and insurance agent for her. Anyway, I got the correct insurance info from the officer and called them to file a claim. Waited and waited to hear something back. When I would call to find out about the claim they just kept giving me the run around saying they couldn't get a hold of the other driver. Then one day at work they call and tell me that they are not going to pay the claim, becauce the accident was my fault. The girl said my car stalled and rolled back and hit hers. My car is a standard, but that is not happened. I was just setting at a stop light waiting to make a left hand turn.



BUT HERE IS THE KICKER!, the officer that took the report believed her over me and made it out to be my fault, but in the officer's report she didn't include that the vehicles had been moved, she didn't get a statement from my sister and she didn't note that where the accident happened the road was flat and sloped downward. I called the Police station and talked to the supervisor of the officer and was able to get an amended report stating the vehicles had been moved, my sister's statement (which was the same as mine) and the officer said she wasn't sure who was at fault because both vehicles had been moved after the accident. Still her insurance company refused to pay for the damages to my car.



Anyway here is where I'm at and sorry to make this so long. Her insurance company refused to pay. My insurance company believes it was not my fault, but my deductible is $1000. Damages to car $850. They talked about subrogation of claims here, but since the damages were below the deductible they couldn't do claims subrogation. So, I thought about small claims court and checked into it. Small fee and found out even if I won I would probably have to hire an attorney to have her wages garnished to get my car fixed. That would be more of an expense. So, I dropped it and just wished hurful, hateful thoughts that something bad would happen to the girl that hit me, that lied and got away with it.



NEWS! Today I receive a call from my insurance company wanting to get a statement from me about the accident because they want to go after her insurance company and get the money back on what they paid on the medical bills. Kansas is no fault state. Right!? Can my insurance company do this if they can't go for a subrogated claim ? Never heard of this before. Please advice me on this. Sorry so long, but I hope someone can help me.


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PostPosted: Thu May 08, 2008 7:29 am   Post subject: subrogated claim  

Well, it depends a lot on the degrees of your & your sister's injuries, whether or how the extent of no-fault law would act. Today, the no-fault law clearly states that you'd get medical benefits from your co. upto the limits of your PIP benefits & suing anyone is prohibited till such injuries could be considered as "serious injuries". So here lies the question!

It is clearly stated that no-fault would apply to injuries within a certain limit ( doesn't that mean that if the injury is beyond a certain degree then the nofault thing won't act!).

Regards, PreMax


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PostPosted: Thu May 08, 2008 7:45 am   Post subject: subrogated claim  

Quote:
They talked about subrogation of claims here, but since the damages were below the deductible they couldn't do claims subrogation.
See, it shows how your co. showed interest to pursue tour case. It is a very good sign!

Hi Buddy!



Quote:
Today I receive a call from my insurance company wanting to get a statement from me about the accident because they want to go after her insurance company and get the money back on what they paid on the medical bills.


See, the best way to proceed with such cases would be through your carrier, explain the entire situation to them, let them find a way out for you!

Yes, if it is within the right of your carrier they would need to sue!

If at the end of everything, it is proved that you were not at-fault , then it would let you pull out some of the lost costs. Keep us informed of the proceedings from the insurer's point of view.

Thanks, OnlyZappy

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PostPosted: Thu May 08, 2008 7:56 am   Post subject:   

Hi onlyzappy,



Its understandable, but as you know its very difficult to be 100% not-at-fault.

Some ways or the other the adjusters would show you how you had opportunities to be on fault ( & that they can't be too sure about the ourcomes there on..)

Quote:
BUT HERE IS THE KICKER!, the officer that took the report believed her over me and made it out to be my fault, but in the officer's report she didn't include that the vehicles had been moved, she didn't get a statement from my sister and she didn't note that where the accident happened the road was flat and sloped downward.
So, over here we could see how the OP has accepted that there was indeed a downward slope ( a small piece of information subject enough to prove my doubt).

Would also like to know the reasons why the officer believed the other person more! So, I think we need some more inputs at this juncture in order to proceed any further..

Awaiting further responses..

Classyzigzagger08

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PostPosted: Thu May 08, 2008 1:24 pm   Post subject:   

Quote:
even if I won I would probably have to hire an attorney to have her wages garnished to get my car fixed
You don 't need an attorney for this, if you receive a judgement then you file the judgement against her wages for the garnishment...
Quote:
Kansas is no fault state. Right!? Can my insurance company do this? Never heard of this before.
Yes, they are a 49/51 no fault pip state but pip would meet subrogation of claims in KS if I remember correctly or they may have paid it under your medpay coverage....who cares though? Smile Good I'm glad they are going after her aren't you? If her company pays (they won't) then that would mean they are admitting liablity, if they do that then bam! you've got them and they will have to pay for your damage, and it will also open up BI settlements for you and your sister..so I would bet this will either go away or more than likely go to arbitation...make sure your adjuster keeps you updated!



Quote:
So, over here we could see how the OP has accepted that there was indeed a downward slope ( a small piece of information subject enough to prove my doubt).
NOT read it again, it sloped forward...



I would soooooooooo be raising well you know at that police station!!!! Unless there is an independent witness (not in either car) that saw you roll back into that car, this is crazy...oh man I'd have some cop in some severe trouble if it were me!!!!!


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PostPosted: Thu May 08, 2008 4:53 pm   Post subject:   

Classyzigzagger08,



From the OP's Post:



Quote:
...she didn't note that where the accident happened the road was flat and sloped downward.




Generally when one sits in an automobile they would judge a slop from that angle. Meaning that if the front of the auto is facing *UP* its an upward slope, and likewise if the front of the auto is facing down it would be a downward slope.



With the above in mind would not the auto drift forward [away from an auto behind it] if the front of the auto is lower than the back?



Just me, thinking out loud with my fingertips way to close to the keyboard.





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PostPosted: Thu May 08, 2008 5:14 pm   Post subject: Subrogation of claims  

First, if you filed in small claims court and won, the other carrier would be required to pay the amount of the judgment (their policy with their insured states that they will pay the amount their insured becomes legally liable to pay as a result of Bodily injury and Property Damage).



$850 in damages to your vehicle. Did the other adjuster directly obtain your statement prior to determining liability? Did they inspect the damages to your vehicle? If not, they did a piss poor job of investigating the claim. They should have at lease reviewed the damages to your vehicle to see if the extent of those damages agree with you simply rolling back into the vehicle stopped behind you. What was damaged on your vehicle? If the bumper absorbers were pushed in, you can find out from the manufacture what force is needed to cause them to become depressed. Most likely this is much more force then your vehicle simply rolling into another vehicle. The other carrier _should not_ simply take their insureds word for what happened... they need to obtain _all_ the information surrounding the accident.



Your carrier will not be pursuing your property damage. Also, even if they collect the money back spend on your sisters medical treatment, this does not obligate the other carrier to also pay for your property damage (it's a good indication that they should but there is no obligation to do so).



If the other _adjuster_ did not obtain your statement directly and if they did not inspect the damages to your vehicle, I'd recommend speaking to a supervisor as it's not always difficult to tell that a vehicle did not simply roll back into another based on the extent of the damages to both vehicles.



You could also always obtain the services of an attorney to pursue any excess injury amount possibly due to your sister (I've not looked up KS law on this). If the other carrier was eventually willing to settle an injury claim, you could accept the settlement as long as they also agree to pay for your property damage.



Personally, as an adjuster, I rarely believe someone who tells me that a vehicle rolled backward and hit the vehicle behind. It almost never happens, when it does there is usually no damage, and if it does happen then the person stopped behind could still be partially at fault for stopping too close to the vehicle in front (if there was enough distance, what was it... if it was more then a few feet why did they not honk their horn when they saw the vehicle rolling at them, etc). These are facts you should know before you may even think of auto claims subrogation .

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PostPosted: Fri May 09, 2008 4:00 pm   Post subject: Talk with an attorney  

I own and operate a collision repair business on a Missouri Kansas border town. It is not uncommon for me to hear claims from people who have been struck from behind and to be found partially negligent. One customer was sitting in a jeep while police were clearing a previous accident in front of him when he was impacted. The insurer of the vehicle that struck the jeep claimed only partial fault even though the accident occurred in the presence of police. I am not sure what's going on in Kansas but this seems to occur frequently and it shouldn't.



I can also sympathize with you on the injury. I too, was impacted while turning left, from behind. I would have thought my entire bumper was knocked off but only lightly marred. Having been the victim of a head on collision 15 years earlier I received some sever neck and jaw injuries. The subsequent impact has left me with permanent numbness in my left arm three years later. Now the fun begins, the insurer will likely say, pre-existing injury (No choice of a subrogated claim was there). However, attorneys refer to it as the cracked egg theory.

If you strike an egg that already has a crack , any additional impacts will only severely worsen the prior trauma to the neck.



This is why we hire attorneys to settle these matters. Insurers like to use a formula that includes the damage to the vehicle to settle your loss. The less severe damage to your vehicle, the less soft tissue impact insurers feel you suffer. With 4000 in medical bills, mri's, therapy and x-rays, the 400 dollars in damage to my vehicle would suggest I am not entitled to the accumulation of my medical expense to date, let alone some possible permanent injury. This is why I recommend one never settle on medical immediately even on the slightest of rear impacts.


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PostPosted: Fri May 09, 2008 4:57 pm   Post subject:   

I don't know of any carrier that uses a "formula" based on the damage to a vehicle to determine the extent of an injury and never heard of anything like that. Care to share where you got this information (or is it just made up)?



What carrier do use is the fact that the damages to a vehicle show the impact was to such a low extent that nothing but soft tissue injuries could have been sustained. This is usually done by looking at the bumper absorbers and that they were not compressed. Manufacturs list the force/impact needed to compress the absorbers so the speed of the impact can be determined.



If there was extremely little force from the impact does it not make sense that serious injuries were probably not a sole result of the impact? It's not like there are many people out there that think a small tap on the bumper means a pot of gold. That would never happen.



Attorneys use the same information, usually claiming that the impact was so great the vehicle was considered a total loss.



There can be a disagreement as to the extent of someone's injury. It's called a disagrement. The carrier wants to pay as little as possible for the claim and the injured party want's $200 million. Many times there can be a meeting of the minds, some times not. But the disagreement is normal and it happens in all facets of life. It's not that anyone (on either side) is trying to cheat the other side... it's just the nature of the situation (people like to think it's always the insurance company trying to cheat the person and forget about all the fraud involved in insurance claims).



Most states (if not all) allow pre-existing conditions as a mitigating factor on an injury claim. The at fault party would owe for the injury but only for the exacerbation of the prior injury... not the entire injury itself.



I know where you are coming from when you mention how hard an impact feels. I was rear ended by a vehicle and it felt like a train slammed into my truck. There was very little damage to my metal bumper and I was not hurt at all but it still felt much worse.

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PostPosted: Fri May 09, 2008 10:41 pm   Post subject: Oh Really?  

Quote:
There can be a disagreement as to the extent of someone's injury. It's called a disagrement. The carrier wants to pay as little as possible for the claim and the injured party want's $200 million. Many times there can be a meeting of the minds, some times not. But the disagreement is normal and it happens in all facets of life. It's not that anyone (on either side) is trying to cheat the other side... it's just the nature of the situation (people like to think it's always the insurance company trying to cheat the person and forget about all the fraud involved in insurance claims).




Your reply is typical insurance logic.



Are all attorneys money grubbers and all injured claimants seeking more than what they may be owed? You certainly implied that in your quote.



Insurance proceeds should be available to those that are entitled to be compensated for their personal injuries and losses. A person purchases insurance in hopes that they will never have to use it, but are counting that indemnification is there when you have an actual loss. One shouldn't have to hire an attorney to get what may be owed, it is required, because the insurer's idea of what is fair is far from the average injured party believes is owed. Insurers having hold of the purse strings have forced people to hire attorneys to collect what could reasonably be determined is owed them. Allstate made that an artform with the boxing gloves treatment in the nineties and too many insurers seemed to have copied their successful strategy.


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PostPosted: Sat May 10, 2008 5:43 am   Post subject:   

Quote:
Are all attorneys money grubbers and all injured claimants seeking more than what they may be owed? You certainly implied that in your quote.
Not sure what you were reading. I thought what you actually placed in bold was pretty fair. You think I implied that attorneys are money grubbers and injured claimants are seeking more then owed? Did you not read this part of what you quoted and placed in bold, "The carrier wants to pay as little as possible for the claim"? I gave both sides of the coin.



But to go a bit further... I'll give you a extreemly common occurance; an attorney sends a demand to a carrier offering to settle for $500,000. The carrier offers $5,000. The claim eventually settles for about $10,000. If I look at 100 injury demands, this reflects 99 of them. I'm not exedurating one bit. But do I think the attoney's are just doing their job? Yup. Everyone hears about the insurance that offered peanuts on an injury claim... you never hear about the stupid demands of attorneys. It's the nature of the business.



Quote:
One shouldn't have to hire an attorney to get what may be owed, it is required, because the insurer's idea of what is fair is far from the average injured party believes is owed.
Sorry Mike, but truth is... you know very little about the insurance industry, the way an injury claim is settled, the laws coverning liability, injuries, the legal aspects of a claim or the reality of negotiating a settlement. Your statement pretty much shows that to be correct. You make it sound like someone is injured and there is a magic number that should be paid on the claim. This could not be further from the truth. Tell you what, you tell me what a fractured clavical to a 45 year old man who works as a day labor is worth in KS and I'll be sure to make a note of it. Then add in the fact that he stepped in a 6" depression on someone's lawn while leaving a flyer on the person's door. What is it worth now?



It would be a little like an insurance company telling you how to repair a vehicle, huh.



There is a figure I like to rememeber from my time in Florida... only 3% of the suits filed ever see the inside of a court. So take the percentage of claims that are _not_ settled prior to suit (almost all are) and then take just 3% of those. That is the number of claims where the attorney felt the insurance company was not offering enough money. My guess is this probably equates to less then much less then 1% of all attorney represented claims. Even less if you consider all the settlements accepted where the person was not represented. Those attorney commercials don't seem to indicate this. Wonder why.



If I thought all injured people were lying about their injuries I'd not last very long in this business.
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PostPosted: Sat May 10, 2008 6:05 am   Post subject:   

Thank you all for your comments and concerns. After reading my first post over again I realized I did leave something out (meant to put it in). The officer that took our statements said in the report that my car rolled back when I left the scene. I remember my car rolling back, but I was parked on a slope. Where the accident took place the road is flat and slopes slightly downward, not backwards. My mistake was I didn't get a copy of the police report right away. I should of, I know, but I thought to myself it was a rear end accident, it was her fault. I'll let the insurance companies take care of it. I never dreamed that the girl would say my car rolled back and hit hers. Also I thought the police officer would of done a better investigation. Both vehicles were moved as stated in the amended report, so she couldn't determine who was at fault. That statement should of been in the first report, but the officer sided with the other driver. Her supervisor told me that the officer was only suppose to take statements, not take sides.



I did talk to 2 attorneys about what I could do and since the damage to my vehicle was only $850 and medical wasn't that much and was paid by my insurance company, they suggested small claims court. Even told me it would cost $50 to file a petition, but then I was told that even if I won it wouldn't guarantee that I would get the money to fix my car. It would be my job to pursue the driver and that I would probably have to hire an attorney to garnish her wages if she refused to pay. That is what I was told. So that is the reason I backed down from filing.



All I can say is I know it was not my fault! I was just setting at a stop light and was rear ended. Wish I would of NOT of moved my car. Just hope I will never have to go through this kind of ordeal again. Hopefully next time I will be better prepared on what to do. I know now to get a copy of the police report, ASAP and not trust anyone, even the police, I hate to say. I do now keep a camera in my car, just in case I need it.



Thank you all again! Will keep you informed.


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PostPosted: Sat May 10, 2008 9:57 am   Post subject: accident  

OMG!! I'm sorry all of this has to happen to you, BUDDY. I'm not an Insurance 'expert', by any means. I just want to 'show my support' for you, in this situation. I live in the state of PA. ( I think?) If you rear-end someone, it's AUTOMATICALLY 'your' fault ( the person who did the rear-ending..) Are you injuries 'any better'? Are you recovering ok? Sometimes we are so worried about our transportation ( not saying it's NOT a concern..) that we put our 'well-being' second. What about your passenger......etc.?

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PostPosted: Sat May 10, 2008 7:06 pm   Post subject:   

Quote:
It would be a little like an insurance company telling you how to repair a vehicle, huh.




And you believe this doesn't happen? I will give you this; they try. If I was a DRP shop, they would definately tell the shop how to repair the car even though they are not experts.



What I am about to say isn't a slam against you personally T, unless the shoe fits. Just like I don't claim to be an insurance expert as you are quick to point out, I am a policy holder, a claimant who has gone through the personal injury process and I am familiar with attorneys both, good and not so good who use my services and expert opinion to make determinations on factors involving the personal injury settlement process.



I have had property damage appraisers in my customer waiting room attempting to settle personal injury claims along with the property damage who had been adjusters for less than six months for one of the top five insurers in the country. That's just wrong, waiving a small check in front of someone who they sense that will grab a quick settlement to avoid paying for possible agravating injuries that may surface later.



I do not claim to be an expert on personal injury, but I do understand the process of settling a personal injury settlement having been the victim of a head on collision where both vehicles were traveling 55mph at the moment of impact. I understand the force of two masses impacting at opposing speeds and directions where the car stops but the internal organs of your body do not . What it feels like to have the floorboard press against every joint in your body, what your temporal mandible feels like when it been misaligned due to hitting steering wheel and what your hands feel like when you can no longer hang on to the steering wheel after you have folded it over in half and then rammed your hand through the windshield. What price do you pay for seeing an infant come out of a side window of the vehicle that struck you and hit your windshield and die in front of you? You can't place a price on what it is worth to not be able to give your grandchildren piggy back rides or wake up ever morning for 15 consecutive years of having to run hot water on your neck and back to loosen it up so you can stand erect. Just how do you place a value on that? That value is a different figure to every individual that experiences it.



I provide those pictures and documentation to attorneys that want to see the crush zones, collapsed bumper shocks, the damage at the opposite end of the car where the energy traversed. I prepare estimates for actual costs to repair for the attorneys of the actual damage of the vehicle and not what the insurer pays for the property loss based on their visual inspection. I am aware of M.I.S.T and it's implications in injury settlements.



Quote:
The carrier wants to pay as little as possible for the claim and the injured party want's $200 million.




I think you may have made your point better by stating that, you as an insurer, want to pay what is fair and reasonable dictated by the individual circumstances of the claim rather than as little as possible. But I understand, insurers must make money. Fifty Five billion just last year.



And the claimant wants 200 million? That's not an insult to claimants everywhere? I personally believe the need for attorneys could be partially eleminated if insurers would intially offer to pay what was fair and reasonable rather than "as little as possible" and to not delay paying for what is owed or denying it entirely.



I received 23 percent of what potentially could have been the maximum amount of stacked uninsured motorist policies I possessed. I asked for about 40 percent. Today looking back 100,000 percent of the amount would not have paid for the pain and suffering I have dealt with to this point. If I had not had an attorney, the insurer would have never explained that I could have stacked certain UM policies. We won't even discuss my own company's putrid initial offer.



I work with a young attorney that use to be an insurance defense attorney for one of the county's largest insurers. He told me in confidence that he could no longer work as a bodily injury insurance defense attorney. He didn't have the stomach to look into the eyes of parents of children they owed settlements to, and offer what he felt was severely and woefully inadequate. He left a lucrative job to become a stay at home dad while his wife left the insurance industry as an attorney as well to work in the private sector.



I guess if you stick with it long enough you can develope a desensitivity to what you are required to do in order to settle for "as little as possible" for gigantic wealthy corporations. I don't envy you, I do comprehend the stress you are likely going through in your work. It can't be a fun job if you are determing what the death or dismemberment of and individual is. I can also understand where a personal injury adjuster could develope a condescending attitude towards claimants all demanding 200 million dollars and for anyone that is not an injury settlement expert.


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PostPosted: Sun May 11, 2008 2:37 am   Post subject:   

Quote:
And the claimant wants 200 million? That's not an insult to claimants everywhere? I personally believe the need for attorneys could be partially eliminated if insurers would initially offer to pay what was fair and reasonable rather than "as little as possible" and to not delay paying for what is owed or denying it entirely.
My entire point was that there is a difference in opinion as to what an injury claim is worth. One side wants as much as they can get, the other side wants to pay as little as possible. Many times these amounts _are_ "fair" but what is "fair". You keep stating that the settlement should be this "fair" amount. Again, I'll ask... what is a fair amount?



You give the impression that attorneys are some caped crusaders, doing right by the little and defenseless mother/father/child. I'm sure there are one or two of those types of attorneys. Truth is, the other 99.99999% just want a pay check at the end of the day. Anyone who knows anything about personal injury attorneys will agree with this. Don't buy into those afternoon commercials attorneys put on TV. I find most of them funny. I especially like the ones where they claim I have a pocket full of attorneys handling the claim, against the little injured person. Truth is, there is 1/2 a phone book of personal injury attorneys will to take 33% of someones settlement money and then there is just me.



How do I sleep? Most of the time fairly well. I think of myself as a good shepherd of the companies money. I treat people like I would want to be treated and I settle claims for what I feel is fair to both parties. But then we get right back to the _real_ question... you tell me what is a "fair" settlement amount.
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