QuestionI was hit from behind back on January 31, 2009. I notified the other party's insurance carrier, State Farm the following Monday. I did not seek medical attention @ the time because I was not visible injury and thought I would be okay! The hit was very hard and suddenly but not damage to the car. The next couple of days I only felt a little soreness and stiff. However; 31 days later, March 9, 2009 I went to see a chiropractor because the hit aggravated problems that I was having with my spine and the seat belt tighten on my left shoulder from the hit. My medical bills are a little over $ 5,000. State Farm has been very rude and now they are telling me that due to the delaying of receiving medical treatment they are considering not paying the charges. My insurance company has taken care of the medical charges and need to be reimburse. Should I get an attorney for such small matter? I understand that you are not advising me, I just need to know what to do next. I have tried to settle this account and earlier a rep from State Farm called and asked who told me to seek a chiropractor? Should this be reported? Thanks!!
AnswerHi Janice,
In my opinion, this is how State Farm is looking at your claim. You
reported the accident to them on 1/31/09, your car had Zero damage
and you did not claim any injury. Then about 37 days later you
started treating with a Chiropractor because, according to your words, something had "aggravated problems that I was having with my spine". You now have $5,000+ in medical that you wish reimbursed
and you would probably want some extra thrown in for pain & suffering.
Logically, during this 37 days between the accident and your first
treatment any one of several hundred things could have happened to
cause your back injury such as falling off a ladder or a slip and fall
accident. There is no way that your Chiropractor nor any medical
professional can swear that your injury was caused by the auto accident. State Farm is trying to determine the cheapest way to
handle this claim, either deny it totally or pay you a small amount
just to make you go away. They are fully aware that even IF you
find an attorney willing to take your case, he/she will do so on a
"contingency" basis meaning if he does win he gets a percent of the
settlement off the top and sometimes his expenses off the top, depending on the type of contract you sign. Until the case is
settled, all the expenses come out of the attorney's pocket. This
case is to weak and to small for an attorney to spend the extra costs to take it to a trial, so he will just negotiate with State Farm by letter and do no better or worse than you can do on your own (and if you handle this on your own, no attorney gets 1/3 of the settlement
plus possibly his expenses).
The entire insurance industry (auto, health and medi-care) is
extremely anti-chiropractic, anti-massage therapist, anti-acupuncturist) because they treat without any supervision
and are not allowed to order tests such as a MRI or CT scan
which may be necessary to properly diagnose an injury and they
are not allowed to write prescriptions. Many health insurance
companies and medi-care long ago re-wrote their policies to only
allow up to $1,500 per year in chiropractic care.
If I made a list of the care givers most respected and trusted
by the insurance companies, first would be an orthopedic doctor,
followed by a general doctor and somewhere at or near the bottom
would be a chiropractor.
You state "My insurance company has taken care of the medical charges and need to be reimbursed". You didn't state if these bills were
paid by your auto insurance medical payment or PIP coverage or if
they were paid by your health insurance company. If your bills were
paid by your auto insurance policy, I am not aware of any company
that requires reimbursement if you recover from a 3rd party. Since
I haven't read every policy in all 50 states and D.C., there may
be some that require reimbursement. Practically all health ins co's
require reimbursement.
In either case, reimbursement is ONLY required IF you recover from
a 3rd party and then they want full reimbursement or the full
amount that you collect if it is less than the total of the bills.
You can never be required to reimburse an amount greater than the
amount that you collected.
Based on the 37 day delay before starting any treatment and the
fact that this injury aggravated a pre-existing condition, in my
OPINION, State Farm will make you an offer that is LESS than the
total of your medical bills. Depending on the size of that first
offer, you may be able to negotiate it upward to cover the full
bill plus a small amount for your pain & suffering.
The fact that a representative ask you who referred you to a
chiropractor is totally irrelevant. They can ask any question
they want to, you just don't have to respond unless you are
giving testimony under oath.
Based on my experiences of being in the insurance industry since
1961 and have been reading and answering questions like yours
for the last 9 years, I have tried to give you an idea of how
State Farm is looking at this claim and how it will be handled
by an attorney should you choose to retain one.
The final decision is yours.
I hope that you find this information helpful. Your feedback
by rating my response will be appreciated.
Bennie
San Francisco Bay Area
