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 Posted: Fri Nov 27, 2009 12:11 pm Post subject: |
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| Quote: | | 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 |
Ok, wait, (again sorry)...these numbers don't make sense...I understand no stacking...so do you have 250/500 limits on each vehicle or do you have 125/250 on each vehicle? If 125 and they subtracting the 5k med pay then that's 120k..please straighten this out for me..what is your UIM limit on one vehicle..????? | Quote: | | 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." |
No, a BI claims is what your (and maybe your wife) are collecting from the at fault carrier..that's the coverage they will be paying you under (BI)...I can't imagine a way your wife can get 'her' injury settlement under your policy unless 'her' claim was deemed over their 250 policy limits, (which I sincerely doubt)... | Quote: | | 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. |
Wouldn't hurt, and I've only handled a small handful of claims from IL and that was years ago, but it certainly wouldn't hurt to advise them...
I think I understand (correct me if I'm wrong ) your issue with your carrier is..you want to have the at fault carriers limits and your UIM limits on hand and in the bank before you have surgery, so you are assured a way to meet your financial obligations is that correct? If so, then I would ask my carrier to evaluate my injury as it sets right now, if I remember correctly you have more than enough to reach your policy limits before the surgery..
As to your recovery, after a few weeks, would you be able to still see patients etc.? Work in the office, perhaps (duh) not do any surgery, but still maintain your office hours?
Also do you have any type of short term disabilitly policy?
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Lori
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| Posted: Fri Nov 27, 2009 4:04 pm Post subject: |
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I have 250/500k in benefits per auto. The way it was expalined to me is the 100k will be advanced to me from my insurance to preserve their right to go after his personal assets. If he has nothing they will allow me to accept the money from the at fault carrier ans release him of any more liability. The 100k will be setback from the 250k total.
Do I need to open a new claim independant of my claim, to each insurance, for my wife? If so and the at fault carrier pays me 100 for my injury and my wife 15k for her loss of consortium will my insurance then setback the 115k from the UIM total of 250K?
To clarify - Do I ask both insurance companies to open a seperate loss of consortium claims for my wife indepedent of my claim.
I have disability insurance for 2/3 of my income. It kicks in after 90 days of a job ending injury. This wouldn't apply.
I would after 6 weeks be able to do some light duties. Fortunately my partner will cover my hours and patients during this time. THe rehab is 6-8 months from the surgery.[/quote] |
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donti32
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| Posted: Sat Nov 28, 2009 12:35 pm Post subject: |
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| Quote: | | I have 250/500k in benefits per auto. The way it was expalined to me is the 100k will be advanced to me from my insurance to preserve their right to go after his personal assets. If he has nothing they will allow me to accept the money from the at fault carrier ans release him of any more liability. The 100k will be setback from the 250k total. |
Ok so your limit is 250. I thought they had given you the ok to accept his policy limits? If so (and get that in writing)...sign their release, then tell your carrier your demand to them is your UIM policy limits. | Quote: | | Do I need to open a new claim independant of my claim, to each insurance, for my wife? |
I would tell the at fault carrier your wife has a claim..... | Quote: | | If so and the at fault carrier pays me 100 for my injury and my wife 15k for her loss of consortium will my insurance then setback the 115k from the UIM total of 250K? |
no, your wife would be settling HER claim with the at fault carrier within their insured's limits..she wouldn't nor couldn't have a UIM claim unless her claim was worth more than their policy limits (and I doubt it would be).
| Quote: | | To clarify - Do I ask both insurance companies to open a seperate loss of consortium claims for my wife indepedent of my claim. |
She would have to file her claim against the at fault party (the one that caused HER loss). Then the only way she could get a UIM claim with your carrier would be if her claim exceeded their policy limits..of 100k
Dang...90 days huh? That's an awful long time for anyone to go without a salary...Well it was worth a thought.. 
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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: Mon Nov 30, 2009 6:46 pm Post subject: |
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| What would be realistic settlements you've seen or heard of for a loss of consortium claim like this. I do not want to be unrealistic. |
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donti32
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| Posted: Mon Nov 30, 2009 8:01 pm Post subject: |
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| Don't bother. The at fault carrier has informed me that the policy limits are paid out. My wife would not be able to have a claim as she is a derivative of my injury and could only add value to my claim. I asked for this in writing. |
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donti32
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| Posted: Mon Nov 30, 2009 10:49 pm Post subject: |
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Then 'perhaps', just 'perhaps' she too would have a UIM claim, or it would increase yours, if you run into any difficulty with your carrier paying out limits.
To determine the value of her claim...figure out how many days, you were not the same 'wonderful' husband you've always been. What slack did she have to pick up? and for how long?
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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: Sun Dec 13, 2009 2:49 am Post subject: |
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two questions:
1. My UIM sent me a letter indicating it was too premature to offer the policy limits. She is awating more info and a salary/work form from my practice. Should I at this point ask what info and get it for them? Can there be anything done to push he process along?
2. I have a lien attached to the 3rd party settlement. The physical therapist has submitted the bill to my personal health and auto med pay. Med pay payed $900 or so and the rest went to my PPO health insurance deductable. They are not billing my health anymore and have never removed or plan on removing any of the contract PPO fee reduction. By my calcualtion the $8400 lien should be around $2800 if the PPO excess is removed. Any idea on the legality of this. My health insurance is talking to their fraud division and the physical therapist. My idea is to get the settlement checks sent to me and keep the physical therapist portion in a safe until everyone agrees on the law. I understand I will not be able to cash it as it will be in two names. This is what the claims adjuster adviced.
These doctors want full fee. I would love this but I follow my PPO contracts. |
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donti32
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| Posted: Sun Dec 13, 2009 12:11 pm Post subject: |
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| Quote: | | Should I at this point ask what info and get it for them? Can there be anything done to push he process along? |
Absolutely you can ask what EXACTLY they need so you CAN help move this along. | Quote: | | They are not billing my health anymore and have never removed or plan on removing any of the contract PPO fee reduction |
Why? They can't pick and chose, to do that if they have a contract..I'd insist that my health carrier pay the bill. then your health carrier will likely subro, (or place a lein) against your settlement but it will be less than this, (gouger IMO)... | Quote: | | These doctors want full fee. I would love this but I follow my PPO contracts. |
Tough...yes, of course hold on to the money, until this is sorted out...But I'd talk with my PPO, and I'd tell the therapist (in writing) that I want my bills submitted and paid by my PPO, per the contract, and their lein released toot sweet!
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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 Dec 19, 2009 6:13 pm Post subject: |
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| After a nasty fight I finally got the physical therapist to submit to my insurance. I estimated the bill will be $2500 total not $8400. THey were not happy. I now seek treatment somewhere where they charge me a cash price and I pay as I go. I will keep and submit the receipts. I have asked the third party to cut checks and pay the liens. I suspect the physical therapist will hold things up until the EOB's are all in and calculated. |
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donti32
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| Posted: Mon Dec 21, 2009 12:42 pm Post subject: |
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| Quote: | | THey were not happy |
TOUGH! and my Grandma used to say, "they can get glad in the same pants they got mad in" | Quote: | | I suspect the physical therapist will hold things up |
I wouldn't be surprised, one more way to 'get to you' after you won the battle...you know it's people like that, that give others in the field a bad name...just makes you want to knock 'em down a peg...and it appears that you did! good for you! one for the 'good guys'!
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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: Sun Jan 24, 2010 4:46 am Post subject: |
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| just in case anyone was wondering. I forced the in-network physical therapist to submit to my health insurance first. This took alot of fighting. The ppo adjustment was around 3/4 off. Finally received the checks from the third party at fault insurance for 100k. I am waiting for my UIM to get back to me. As of now my UIM has sent my file to the medical review dept and now is at the settlement authority dept. She also explained that they will be taking the 100k off the UIM as they are allowed to. I hope this is a positive sign that they will come back with the policy limits. ??? One could hope. |
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donti32
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| Posted: Sun Jan 24, 2010 12:49 pm Post subject: |
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I think so....also now Donti, it's entirely possible that your health carrier will slap a lein on this..'if' your policy has subro rights...and I've never seen one that didn't. On the up side you might be able to them into backing off if you can show your loss exceed all coverages..(just a little heads up there:)
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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 Jan 26, 2010 7:06 pm Post subject: |
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thank you. Fortunately my health carrier has only directly payed around $1000. The major savings was from the ppo network write off.
Still waiting for my ins's UIM to get back to me. I was told it is at the claim authority dept. Not sure what that means for the claim. I hope they come back with my demands of the policy limits and not some crazy response.
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| Posted: Tue Jan 26, 2010 11:21 pm Post subject: |
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| Quote: | | I was told it is at the claim authority dept. Not sure what that means for the claim |
I would assume that means the adjuster has sent it up the ladder for 'authority' to pay "blah blah". If it's any consolation, based on what you have posted (solely), if it were my claim I would recommend policy limits...not that it really matters what I think
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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: Wed Jan 27, 2010 11:14 pm Post subject: |
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I called the adjuster to day to find out "she is no longer with the company." AHHHH!!! Now I need to deal with her manager. Someone please. I am losing my mind!!
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