QuestionI'm so happy to find this website and you!
I'm going to try to lay out as much of the facts for you as I can so that you can see the picture clearly and answer in the best way possible.
Here they are:
My boyfriend lives in Oregon, but his car insurance company is located in California. He hurt his knee and required surgery (after of all things tripping in a pothole while getting out of his car#. Crazy I know but his PIP covered it since he was touching the car. He filled all the required forms and his medical was covered as well as wage loss. He went through his surgery and months of physical therapy. He got all the required doctor's signatures for 6 months of work exemption #could be longer but he hasn't seen the doctor in 2 months#. He hasn't because while the company is still willing to pay for his medical bills they are not willing to pay any more wage losses. The reason for this is a little complicated.
See, he's a construction worker, registered with the union, but the job he currently had was only scheduled to last 2 months longer. Work is pretty steady though, with only about 2 months a year that he is out of it (thanks to being in the business for over 10 years). The company he worked for at the time filled the correct forms, but the insurance company wants a new form for every doctors work exemption form (with the dates matching). He explained to them that the job ended and they said that was still okay and to still have that company fill out the new form with the same way but with the new dates. We fought with the company to have this done because they felt it was fraud, but they eventually gave in and sent in the new form. A month later we received a letter and phone call explaining that they could not pay us the lost wages because the job had ended (exactly what we told them from the start).
So now they want a letter from the union stated that he would have guaranteed employment if he wasn't hurt but the union can not do that since he just started with them for the last job he was on and so they don't have a job history for him, nor can they guarantee he would have landed any of the other jobs that came through since they are not the employers themselves.
So here in lays the problem.
Everywhere I have looked on the internet says that he needs a new doctor form for every time period he is out of work but I can find nowhere that says he needs a new employer wage form every time the doctor fills out his form. I feel they should still be paying him but they won't.
We have two kids to support and bills are still coming in. I would have made him go get a lawyer but we can't afford one when we can't even pay our utilities.
Any help you can give or information on other websites or people to contact would be greatly appreciated.
Thank you
AnswerI think the insurance company probably made the right decision. There is no way to know whether he would have had work beyond the 2 month job.
One thing you could try: check his tax returns for the past 3 years and average his monthly salary. You could then make the argument that based on his history, it was reasonable to believe that he would have earned x amount during that time.
Depending on the law in your state, you might be able to get an attorney to take your case on contingency. this means you pay no fees, but they take a percentage of what they get for you. usually 33-50%. If your state has first party bad faith, you might find an attorney who will do this. Can't hurt to make some calls - look in the yellow pages or ask a friend for a referral.
You could also choose to look at it this way: he was really lucky he got them to cover what they did. He tripped over a pothole and only got it covered because of a technicality. The auto policy is not really designed for this type of thing. You may just want to count your blessings and stop there.
