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: Tue Nov 24, 2009 11:23 am Post Subject:
I don't think it matters, since everyone is in agreement that they don't have high enough limits to cover your claim.
Posted: Thu Nov 26, 2009 02:24 am Post Subject:
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.
Posted: Thu Nov 26, 2009 01:46 pm Post Subject:
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. :roll: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..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.? :?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...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...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?Posted: Thu Nov 26, 2009 05:04 pm Post Subject:
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.
Happy Thanksgiving[/quote]
Posted: Fri Nov 27, 2009 12:11 pm Post Subject:
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..?????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)...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?
Posted: Fri Nov 27, 2009 04:04 pm Post Subject:
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]
Posted: Sat Nov 28, 2009 12:35 pm Post Subject:
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.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.....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).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 100kDang...90 days huh? That's an awful long time for anyone to go without a salary...Well it was worth a thought.. :wink:
Posted: Mon Nov 30, 2009 06:46 pm Post Subject:
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.
Posted: Mon Nov 30, 2009 08:01 pm Post Subject:
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.
Posted: Mon Nov 30, 2009 10:49 pm Post Subject:
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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