QuestionI was in an accident on Dec. 11, 2008. A car turned in front of me and I t-boned his car. I was travelling at 45 mph. and had little time to slow down. The other driver took full responsibilty for the accident and notified his insurance. I hurt my back, neck and ankle. I was wearing my seatbelt but my mouth hit the steering wheel and chipped my front tooth and made 3 other teeth mobile. One of the teeth had a root canal performed on it 4 years ago but had been fine. The dentist sent an estimate for approx. $5,000.00 to stabalize the teeth and do crowns. The insurance said they will not consider this as an accident related expense because I had not seen a dentist for 4 years and that if I was wearing my seatbelt I shouldnt have hit the steering wheel. We have not gotten to the point of settling and I would like your input on their refusal based on those 2 elements. Thanks Annette Christian
AnswerHi Annette,
This kind of insurance adjuster BS response is what makes Dr. Settlement want to volunteer to help injured victims with their personal injury claims. I would like to reach across my desk and throttle the jerk who told you this—ahhhh….but I have mellowed a touch over the years. You get the point: OF COURSE you hit your head, and the seat belt argument is absolute crap and you should not take it for one minute. Hence, I am going to give you a full hour of my time to sort thru this thing. My main focus is going to be on the head injury, because THAT IS A MAJOR factor in your claim.
Likely you know by now that Doctor Settlement teaches auto accident victims how to settle their own insurance injury claims via legal forms and self help information at my website, www.SettlementCentral.Com. BUT I am NOT going to recommend that you go any further on this claim on your own, unless you can get your insurer to pay for ALL DENTAL WORK. Otherwise, if both your insurance and the third party insurance refuse on the dental repairs, YOU NEED AN ATTORNEY ASAP.
There is a really important issue here that REQUIRES LEGAL HELP if no one will buy in on the dental work. The issue is that you hit your head. If no one will believe that, then you have also lost a lot of important damages, since DIRECT trauma to the head (as opposed to whiplash) will likely cause injury symptoms you may not have thought of, but which may be showing up in your life. More below on this.
In other words, this reason alone shows why I do not want accident victims in your position buying a membership at our site and trying to go it on a self help basis. If no one will agree that you hit your head, then there is just too much at stake that only an attorney can do.
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Here is my approach to your issues. First, explain why it is essential to review symptoms of head trauma. Second, find a way to get dental bills paid so that the companies ACKNOWLEDGE the fact that you hit your head. Third, IF your company agrees with direct head trauma, and you have no other post-concussive symptoms but the dental, then—and only then—you can go it alone. But write me back for free pages to review. Fourth, get experienced legal help if necessary.
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#1. Actual head trauma: YOU MUST GET A NEUROPSYCH EXAM ASAP IF ANY SYMPTOMS below are manifesting now.
How hard did you hit your head? It sounds like a pretty hard whack. So, let’s first address that topic of the most significant potential injury, your traumatic brain injury. Research that term, and especially post concussive syndrome and you will see some of the symptoms of that condition. My bet is that you DO HAVE A MODERATE BRAIN INJURY.
Let’s first examine what is a concussion and what is a loss of consciousness. You DID HAVE A CONCUSSION, that much is for sure, since you hit your head. So traumatic brain injury is in play in your claim since you suffered a brain concussion.
Post-concussion syndrome, also known as post concussive syndrome or PCS, is a set of symptoms that a person may experience for weeks, months, or even years after a concussion, a mild form of traumatic brain injury. As many as 50% of patients who have experienced concussion have PCS, and some sources say as many as 90% of patients experience post concussion symptoms. People who have had concussions may experience physical, mental, or emotional symptoms. Symptoms can appear immediately or weeks to months after the initial injury.
Physical symptoms can include:
• headache
• dizziness
• impaired balance
• nausea and/or vomiting
• fatigue or sleepiness
• inability to sleep
• decreased libido
• sensitivity to noise or light
• ringing in the ears
• double or blurred vision
• decreased sense of taste, smell, or hearing
Emotional symptoms may include:
• irritability
• anxiety
• restlessness
• depression
• lack of emotion
• emotional lability or mood swings
• lack of ability to tolerate stress or alcohol
• aggression
Cognitive or mental symptoms can include:
• amnesia or difficulty remembering things
• confusion or impaired cognition
• impaired judgment
• slowed cognitive processing
• difficulty with abstract thinking
• difficulty concentrating
• decrease in work performance
• decrease in social skills
I am going to bet a hundred bucks that loss of consciousness has NEVER appeared in your medical records, even though you DID likely suffer a brief LOC. LOSS OF CONSCIOUSNESS—not essential to diagnosis of post concussive syndrome, but sometimes the length of time unconscious will be used to judge the degree of the brain injury.
The patient is typically the primary source who is asked the most significant question: Did you lose consciousness as a result of your injury? Most of my clients who actually later recalled that they did not remember moments just after being struck in the head, AT FIRST DENIED ANY LOSS OF CONSCIOUSNESS TO THE POLICE AND TO THE EMERGENCY ROOM.
WHY? First, most people equate loss of consciousness with being unconscious for some time. But in fact, “loss of consciousness” means loss of conscious awareness. Hence, loss of consciousness can range from being briefly dazed to several days of coma. In fact, in order for a brain injury victim to answer such a question, they would have to undergo extensive examination recollecting past events. Any change in mental state can be significant in understanding a patient's condition and if loss of memory (amnesia) occurred immediately before or after the trauma.
When you struck your head on the steering wheel, probably there was a brief loss of consciousness. Even if you never before reported it, now is the time to correct your records with a letter to your doctor explaining that you DID have a brief loss of consciousness. Then, once that letter is sent, you can send a copy to the adjuster with a letter to him, as explained in the link below.
Loss of Consciousness http://www.settlementcentral.com/page0134.htm After Accident or Injury
How do you correct records with the medical providers and the insurance adjusters? http://www.settlementcentral.com/page7004.htm Letters to insurance claim adjuster.
This page talks about how to confirm conversations with the insurance adjuster
http://www.settlementcentral.com/page0460.htm with loss of consciousness notify the insurance adjuster as soon as you recall it.
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TMJ—temporomandibular joint syndrome: possible source for any HEADACHES.
This is another term I want you to research. When an accident victim strikes her head, there is a good possibility that the disc in the condyle, or jaw joint disc, can be displaced. One of the consequences of jaw joint displacement is headaches. All too often in my practice, the doctors treated headaches as having originated from cervical problems, when in fact, they were due to a TMJ.
http://www.lectlaw.com/med/med04.htm
http://en.wikipedia.org/wiki/Temporomandibular_joint_disorder
http://www.tmjdoctorofmaryland.com/
There are two at-home ways to see if your jaw joint is moving. First, find the spot in front of the little lobes on the middle of your ears. These are called “tragus”: http://www.infovisual.info/03/048_en.html
Now, put your fingers just in front of the tragus and over the jaw joint and open and close your mouth. If the disc is far out of place, you will feel a click. Better is for someone to stand behind you as you are seated and perform the same test. That person can feel the click if your jaw joint disc is far out of place.
WHAT TO DO ABOUT REFERRALS: If you feel that you do have any of these symptoms and they are of some significance, I WOULD INSIST UPON TREATMENT for them ASAP. It is best to get your general practitioner to refer you, but you can self-refer if you have to. Your attorney can also be a source of information on good specialists. Here is what you would need: a neuropsychologist to test and to treat the mild brain injury. That is where the big mental help will come from, and of course that is where the BIG INSURANCE SETTLEMENT DOLLARS come from also.
As for the TMJ, a dentist who specializes in that field would be a lot better than an ordinary dentist. The TMJ specialist is adept at diagnosis and treatment, and of course, at making records that will help in making a good insurance settlement. Still, with all the work your dentist is doing, maybe she can diagnose TMJ and send you out for treatment.
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#2. Find a way to get the dental bills paid so that the companies ACKNOWLEDGE the fact that you hit your head.
I take it that you have asked the tortfeasor's company since you mentioned not yet getting to the point of settling. We always like to use the victim's own insurance first. Personal Injury Insurance Claim http://www.settlementcentral.com/page0201.htm Insurance Company Payment of Medical Expenses as Incurred.
Your own auto insurance first party medical coverage will be the best place to submit all of your medical bills. This is known as your PIP or Med/Pay coverage. Once they pay, then they will be the ones to go after the tortfeasor's insurance for the cost of dental care. Plus, that gives you a leg up on the tortfeasor's coverage to argue for head injury damages.
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#3. Third, IF your company agrees with direct head trauma, and you have no other post-concussive symptoms but the dental, then—and only then—you can go it alone. But write me back for free pages to review. Don't go off on your own without looking at some free pages on info from our site.
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#4. Get experienced legal help if necessary.
Finding a good attorney can be difficult, but here is one tip: make sure that the attorney is a member of her state trial lawyers association http://www.settlementcentral.com/links.php
AND you MUST HAVE an attorney who has EXPERIENCE on brain injury and TMJ cases. Insist upon that information being furnished over the phone before you EVER go in for an appointment.
Try to AVOID paying fees on all of the dental charges. Of course if that is the major bone of contention, then the attorney will want to figure her fees on the gross award, which includes the dental costs. So, if at least your company agrees on the dental costs, then be silent as to the third party refusal, since the attoeney's work on proof is mostly done inasmuch as it will be your company that will fight with their compay to get their subrogation paid from your settlement. FYI: http://www.settlementcentral.com/page0459.htm insurance subrogation information page
I hope that you do follow through as I am suggesting, Annette, because you DO need to get acknowledgement by one company of the fact you hit your head. Otherwise, get professional help as I suggested above, and there are a lot of competent doctors, attorneys, and dentists to choose from.
Best wishes for a smooth and quick recovery from your many injuries.
I trust that my time here has produced some information that has been of value to you, and thus I would respectfully request that you take the time to locate the FEEDBACK FORM on this site and leave some feedback for me.
Best Wishes,
Dr. Settlement, J.D. (Juris Doctor)
http://www.SettlementCentral.Com
