by donti32 » Fri Oct 02, 2009 04:38 pm
I was involved in a pretty big accident 5 weeks ago. I was alone in the car. The other driver was ticketed and was found to be at fault. My car suffered $19,000 in damages. The rental car was about $900. The third party spoke to me and clarified that they are 100% at fault and have payed for these repairs. I bought new car seats for $500. I was told they would reimburse me and to keep the receipts.
I was taken to the ER for neck, elbow and shoulder pain. I had two digits with numbness. The x-rays of the neck indicated a possible fracture and was later ruled out with an emergency CT of my neck. The ER diagnosis was cervical radiculopathy. I was told to follow up with my primary in a few days.
My primary physician wanted to let the inflammation cool off for 2 weeks. He prescribed muscle relaxers and anti-inflammatory medication. I was given a note to work at half my capacity for two weeks. After the 2 weeks the numbness subsided but the elbow and shoulder were bad still. The neck was just tender at the end of the day. I was told to get radiographs of the elbow and shoulder and start physical therapy 3x a week for 6 weeks. The x-rays were normal. Again I was told to work at 50% my capacity
At this point it had been a month since the accident. I still had pain in the elbow, which was diagnosed as lateral epicondylitis (tennis elbow) from the impact with the glass window. The shoulder was still bad after 2 weeks of therapy so I consulted with a orthopod. A MRI of the neck and shoulder were done. The shoulder involved a procedure to inject dye into the joint space. The results were yesterday. I have an extensively torn labrum. They want 4 weeks of additional therapy and a follow-up. If I need surgery I will be not able to work for 2 months minimum. Again I was told to work at half my capacity for 4 more weeks.
I cannot be sidelined for two months. My practice will bankrupt. Can I settle, assuming the therapy will help manage the shoulder, for future medical treatment and lost wages? I know because I asked, the 3rd party does not have minimal coverage. I have underins. coverage of 250/500. I want to get feedback and avoid a lawsuit. Lawyers are salivating over this case.
Oh by the way I work 8 hours a day and earn $230 per hour. My employer is keeping track of my lost wages. It adds up to over $5000 per week plus any lost time for therapy, doctors vists, etc. My car is taken care of. I had the car inspected and appraised. It has lost 8-10k in resale value. My doctors bills will be 15k without surgery.
I need to get better but this is starting to get overwhelming.
I was taken to the ER for neck, elbow and shoulder pain. I had two digits with numbness. The x-rays of the neck indicated a possible fracture and was later ruled out with an emergency CT of my neck. The ER diagnosis was cervical radiculopathy. I was told to follow up with my primary in a few days.
My primary physician wanted to let the inflammation cool off for 2 weeks. He prescribed muscle relaxers and anti-inflammatory medication. I was given a note to work at half my capacity for two weeks. After the 2 weeks the numbness subsided but the elbow and shoulder were bad still. The neck was just tender at the end of the day. I was told to get radiographs of the elbow and shoulder and start physical therapy 3x a week for 6 weeks. The x-rays were normal. Again I was told to work at 50% my capacity
At this point it had been a month since the accident. I still had pain in the elbow, which was diagnosed as lateral epicondylitis (tennis elbow) from the impact with the glass window. The shoulder was still bad after 2 weeks of therapy so I consulted with a orthopod. A MRI of the neck and shoulder were done. The shoulder involved a procedure to inject dye into the joint space. The results were yesterday. I have an extensively torn labrum. They want 4 weeks of additional therapy and a follow-up. If I need surgery I will be not able to work for 2 months minimum. Again I was told to work at half my capacity for 4 more weeks.
I cannot be sidelined for two months. My practice will bankrupt. Can I settle, assuming the therapy will help manage the shoulder, for future medical treatment and lost wages? I know because I asked, the 3rd party does not have minimal coverage. I have underins. coverage of 250/500. I want to get feedback and avoid a lawsuit. Lawyers are salivating over this case.
Oh by the way I work 8 hours a day and earn $230 per hour. My employer is keeping track of my lost wages. It adds up to over $5000 per week plus any lost time for therapy, doctors vists, etc. My car is taken care of. I had the car inspected and appraised. It has lost 8-10k in resale value. My doctors bills will be 15k without surgery.
I need to get better but this is starting to get overwhelming.
Posted: Fri Nov 20, 2009 11:50 am Post Subject:
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...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?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%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 :wink: )...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..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.Posted: Fri Nov 20, 2009 07:40 pm Post Subject:
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??
Posted: Fri Nov 20, 2009 09:31 pm Post Subject:
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.
Posted: Sat Nov 21, 2009 12:16 am Post Subject:
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.
Posted: Sat Nov 21, 2009 12:15 pm Post Subject:
They tried to get me to sign a blank copy.
:shock: That's nuts! :shock: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 :roll: )Posted: Sat Nov 21, 2009 03:47 pm Post Subject:
"you don't need no stinkin' attorney"
Badges?!? We don't need no stinking badges. - Blazing Saddles (1974)
Posted: Sun Nov 22, 2009 01:39 pm Post Subject:
Loved it! "Mongo like cigars"
Posted: Mon Nov 23, 2009 03:36 am Post Subject:
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.
Posted: Mon Nov 23, 2009 11:58 am Post Subject:
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..
Posted: Tue Nov 24, 2009 01:50 am Post Subject:
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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