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 Posted: Fri Nov 20, 2009 12:51 am Post subject: |
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The at fault drivers insurance has authorized the release of the policy limits. I am waiting for my insurance to allow me to accept the offer. My question is why would my insurance's med pay of $5000 place a lien on the claim. Shouldn't they go after the driver instead of my PI settlement. I have asked to have this waived and they said they will consider.
1.) How would someone negotiate with the uim carrier for additional benefits if I choose not to have surgery? I still have the injury and it has its limitations. I would like to "live with it" and avoid the 6-9 months of recovery.
2.) Are the policy limits all the moneys available or is my wife able to file because she is my wife for additional benefits? |
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donti32
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| Posted: Fri Nov 20, 2009 11:50 am Post subject: |
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| Quote: | | My question is why would my insurance's med pay of $5000 place a lien on the claim. Shouldn't they go after the driver instead of my PI settlement. |
Well they can't go after the driver if they allow you to accept his/her policy limits..you'll have to sign a release...so the settlement from that drivers BI limits is their only hope in subrogating their medpay payment. They should however, (IMO) waive their subro rights IF your med bills are high and your injury claim in excess of that drivers limits... | Quote: | | I have asked to have this waived and they said they will consider. |
They probably will..what about your health carrier? Have they filed a lein? | Quote: | | 1.) How would someone negotiate with the uim carrier for additional benefits if I choose not to have surgery? |
First off you do understand the UIM carrier is your insurance company right? I don't think you'd have much of a chance here, unless your doc reports state that the possibility of surgery in the future is well over 50% | Quote: | | I still have the injury and it has its limitations. I would like to "live with it" and avoid the 6-9 months of recovery. |
I don't blame you, I'm right there with ya..(refusing spinal surgery, that has been recommended for years..I'll have to have it some day, but it will be when I can no longer function at all  )...don't think I'd tell them that though, I'd take the stance, (for negotiating reasons) that I am going to (eventually) have this surgery, it's not a question of IF, but WHEN..
| Quote: | | 2.) Are the policy limits all the moneys available or is my wife able to file because she is my wife for additional benefits? |
Most states allow for 'loss of consortium' claims, but typcially they are not a 'separate' claim. However, state vary on this, so I'd ask..If it is considered a separate claim.. then the same limits would apply to her..auto policys have split limits ie 100/300, meaning 100k (max) per person 300k per accident.
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Lori
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| Posted: Fri Nov 20, 2009 7:40 pm Post subject: |
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thanks for the help!!!
My insurance has filed a lein on the insurance claim. I asked to have this reduced or waive and they told me they are trying to get that waived and it looked pretty good to have it waived.
1.) I have several other bills. My medical has not payed anything. I am using them for the PPO fee reduction. For example each session of physical therapy is around $400. With the PPO reduction it is around $100. I have a $2000 deductable and haven't reached it yet. Should I tell them to file a lein with my insurance or should I pay them out of pocket?
2.) The surgeon told me the MRI is so bad that I will need surgery but the "when" will be up to me and how strong physical therapy can make it. In his eyes delaying will not worsen the prognosis. It will be very difficult to find a replacement for work and my office may not be able to survive the 8 month healing. When and how would I demand the limits of my UIM? I am delaying legal rep. to avoid a long and painful arbitration.
Advice?? |
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donti32
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| Posted: Fri Nov 20, 2009 9:31 pm Post subject: |
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| Quote: | | I am delaying legal rep. to avoid a long and painful arbitration. |
AND giving up a third of your settlement! when you've done all the work...
Remind me what your UIM limits are...have they (your UIM adjuster/carrier) got all the info they need? ie doc reports etc..? If not where are you in the negotiation process? It may be that they won't move forward with that until you have been paid the policy limits of the at fault driver.
If you can afford to pay the med bills out of pocket, I think that would be the way to go...and keep it simplier. More over, you are submitting the full cost right (ie 400 per session?)...
If the surgeons report will reflect what you've said. Once your carrier has all the information they need I would simply request policy limits, and tell them that I'm sure after they have time to absorb all of the data, including what eight months of loss wages would be not to mention the cost of the surgery, that you're sure they will agree it is a limits case.
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Lori
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| Posted: Sat Nov 21, 2009 12:16 am Post subject: |
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I have 250/500 UIM. They will only allow 150k with the 5k med pay credited back. So in reality 100k from the at fault driver and 150k from the UIM if they waive the 5k med pay. The physical therapist is submitting the $400 per session to the insurance. The price reduction is because they are in network. That reduction occurs after the claim has been processed. I just sent a new release to my insurance for med records. They tried to get me to sign a blank copy. I instead filled out the form for what they needed. I also gave them 30 days to allow me to accept the 100k form the at fault driver or allow them to pay me to allow them to sue the driver for the excess.
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| Posted: Sat Nov 21, 2009 12:15 pm Post subject: |
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| Quote: | | They tried to get me to sign a blank copy. |
 That's nuts! | Quote: | | I instead filled out the form for what they needed. I also gave them 30 days to allow me to accept the 100k form the at fault driver or allow them to pay me to allow them to sue the driver for the excess. |
Great job! "you don't need no stinkin' attorney" (before I get hate mail I love attorneys, that's from a movie, I just can't remember the title  )
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"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
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Lori
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| Posted: Sat Nov 21, 2009 3:47 pm Post subject: |
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| Quote: | | "you don't need no stinkin' attorney" |
Badges?!? We don't need no stinking badges. - Blazing Saddles (1974)
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Dasfuk
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| Posted: Sun Nov 22, 2009 1:39 pm Post subject: |
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Loved it! "Mongo like cigars"
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Lori
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| Posted: Mon Nov 23, 2009 3:36 am Post subject: |
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I will see my surgeon for a follow up this week. He will give me another work release for 50% work schedule. Currently we have surgery on the books for 3/2010. I will have him write this up and make sure he state surgery will be needed. I will also get a letter from physical therapy explaining the limitations I am having. This along with the radiology report, past notes, ER notes, and a wage letter from my practice should be enough to push the limits now. I know they will say we will settle after the surgery. I will push for the need to get compensated for lost wages, past pain, past lost wages, etc... to get settled now.
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| Posted: Mon Nov 23, 2009 11:58 am Post subject: |
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You've got a good plan, and I doubt you will have any problems at all...do let us know if you need any assistance, and when you get this resovled.
I would mention that your wife has a loss of consortium claim (along with having to care for you, do things, that you normally did etc.) and see how it flys. I'd ask for policy limits on that claim as well, just to see what happens...can't hurt..
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"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
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Lori
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| Posted: Tue Nov 24, 2009 1:50 am Post subject: |
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| should I have asked for the loss of consortium under the at fault drivers policy? I have not accepted anything thus far. They did tell me they needed my wife to release the claim as well. |
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donti32
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| Posted: Tue Nov 24, 2009 11:23 am Post subject: |
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I don't think it matters, since everyone is in agreement that they don't have high enough limits to cover your claim.
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Lori
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| Posted: Thu Nov 26, 2009 2:24 am Post subject: |
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The follow up with the surgeon was not good. There is a leak in the shoulder and fluid is escaping the joint. This will eventually put pressure on te nerve and cause muscle weakness. Surgery is scheduled for March. I spoke with my UIM adjuster. She seemed a bit annoyed by the call and also told me they would not settle until i was done with treatment and 100%. I told her who was going to pay my bills for the 6-8 months I will be out of work/ limited capacity? She didn't respond. This is my insurance what can I do to make sure this doesn't happen. The UIM would be 150k and the 100k form the at fault party to total 250k. Can I request to speak to a manager. Can I file a complaint with the division of insurance to push the issue?
I reviewed the laws in Illinois. My policy covers only bodily injury and therefore loss of consortium would not be covered. Illinois law places this loss as personal injury. The policy never states personal injury as being covered. I think as lawyers were able to successfully argue and get coverage the insurance companies quickly rewrite policy verbage. I still asked for a claim to be opened anyway for my wife.
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| Posted: Thu Nov 26, 2009 1:46 pm Post subject: |
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| Quote: | | She seemed a bit annoyed by the call |
Tough! See this is what ticks me off about some adjusters (well could be docs, lawyers, servers doesn't matter)...we all have issues in our life BUT when you're working, you need to focus on that ONE person you're dealing with like they/it is the only thing you have to do...once that 'moment' has passed and you've handled it, move on....sorry a little bit of a 'mama lori vent' there. | Quote: | | would not settle until i was done with treatment and 100%. |
first of all that's a 'recommendation' (i recommend the same)..but not a requirement..you can settle whenever YOU want to settle..the only thing that would hold up a UIM settlement, is you have to have permission and be paid the policy limits by the at fault party. Now, if you wait could you get a higher settlement? In most cases yes, in your's I doubt it...you don't have high enough limits as it is..
| Quote: | | This is my insurance what can I do to make sure this doesn't happen |
I'm sorry...to make sure 'what' doesn't happen.?  | Quote: | | Can I request to speak to a manager. |
Of course, most claims orgs. are really big on the 'chain of command' you'll probably need to speak with her supervisor first, then if not happy ask to speak to their boss and so on... | Quote: | | Can I file a complaint with the division of insurance to push the issue? |
You could, but I wouldn't recommend it (yet)..I dont see a complaint that they could do anything about just yet...I'm sorry doc, what is it that you want her to do? Is your only issue (with your carrier/adjuster) at this time, that you want them to settle your UIM asap, for your policy limits of 150k? Is that it? if so I understand..just clarify for my thick head the issue... | Quote: | | I still asked for a claim to be opened anyway for my wife. |
Good...with the at fault carrier right? Because if they consider it, i don't think she has an excess claim. Hmmm IL doesn't allow loss of consort. BUT your wife has to sign the release? those two things don't gibe do they?
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"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
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Lori
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| Posted: Thu Nov 26, 2009 5:04 pm Post subject: |
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Thanks again for the help!
The at fault party has offered the policy limits in writing. I have submitted this to my insurance. I have 250/500 UIM. I has told there is no stacking and therefore I would only be able to receive up to 150k minus the 5k medpay.
Before I go under the knife I need to secure that I will be able to pay my personal bills. I am the only wage earner and without my income we can survive for only so long. I have already been using my savings during the last few months.
I didn't understand you on the loss of consortium. I have not asked for loss of consortium with the at fault carrier. I have sent a request for a claim of loss of consotium with my carrier. It is my carrier that in the policy states "bodily injury." A loss of consotium by IL law is a "personal injury" not bodily injury. I will on monday let the at fault carrier know I want to open a claim for my wife.
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donti32
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