QuestionIn Feb. 2008, I was crossing a street from a school and was hit from behind by a person coming out of the parking lot, I was in the middle of the street. I was unconscious for some time until after the ambulance loaded me, was transferred to a major trauma center because it was suspected that I had a major head injury. My children had been summonsed to the local hospital and were then notified to go the the trauma center about 30 miles away because of a head injury. I had a laceration of the head and scalp, broken collar bone and much bruising of the leg and chest. As a result I was off work for 6 weeks and could not stay at home alone because of the brace that I was required to wear. I had much pain and discomfort and still do have pain in ear near the laceration site and at the site of the clavicle and have a large deformity of the clavicle. My medical bills are about $8000, loss of wages $7500, loss of clothes $300, mileage expenses $380 plus expenses for daughter to fly here from out of state $400. My underinsured auto insurance has paid $5000 of the medical. The other insurance first offered me $19000, then I responded with a request for payment of medical, loss of wages, other incured expenses and $40000 for personal damage. They have counter offered $25000 and requested subrogation waiver from my insurance. Her ins. coverage is bodily injury $25000 per person, property damage $25000 per accident,. My underinsured coverage is $5000 medical (they have paid this) Bodily injury $25000 and property damage $25000. Initially my agent sent me word that I had $75000 in medical coverage because I had 3 vehicles covered with separate underinsured policies, now they say only one policy can be used. I only want what I am entitled to, but I have had much discomfort and my physician says this could last a year or longer, I have spent much time trying to make sure all bills are being paid and now have the worry that some have been paid by Medicare and my suppliment and they must be paid back. What is covered in property damage?
AnswerHi Sara,
I am sorry to hear of your hard crash to the ground where you struck your head. I am also sorry that you have not had a consultation with a neuropsychologist since your head injury will likely be the one that may give you problems for years if not treated properly now. BTW, with proper specialist testimony, that head injury also has the most value to it. I want you to read what I will put together for you and then decide if you have any of the continuing symptoms post-concussive symptoms I am going to list below.
You are ONLY TEN MONTHS post trauma, and with a serious head injury, we CANNOT make a real diagnosis of long term problems this early, especially without a battery of testing by a neuropsychologist. This is one of the reasons I want you to see an attorney BEFORE YOU RESPOND TO THE ADJUSTER.
Just write the adjuster back and tell her that you will respond to her later. Tell her that you may need some assistance in straightening out the subrogation and in other matters regarding your own insurance. You have three policies, and I want an attorney to review why you do not get to stack those and have three UIM limits. That is how Doctor Settlement works against insurance companies for big results; and a good attorney should be able to get those three UIM limits for you.
You may visit my website www.SettlementCentral.Com which helps personal injury victims settle their OWN claims. And you would then wonder why Dr. Settlement is going to recommend that you MUST consult an attorney. The reason is: your brain injury claim is TOO SERIOUS to handle your own claim. We would NEVER encourage anyone with a most serious claim to go it alone, EXCEPT for taking the low hanging fruit. In this case, that easy fruit to pick is the two policy limits of $25K.
Over and above those amounts, an attorney should be useful if she could go after other assets, and ESPECIALLY if your attorney could go after getting more UIM policies stacked on yours. This stacking of UIM policies is a good place for an attorney to earn her fees.
Because it sounds to me that you likely DO have policies that stack, I am going to suggest that you MUST be certain that you do not have policies of UIM that could be stacked. Do you have any idea how many times insurance adjusters have wrongly advised their insureds that the policies do not stack? This is a true emergency need to get some legal advice regarding those three contracts.
You could approach an attorney like this. Tell her that you feel the tortfeasor's $25K and your own UIM $25K are "gimmies". In other words, there is not going to be any legal work necessary to obtain payment of both of those policy limits. You can do that yourself. Or, if it is agreed these policies could be paid with a simple letter, offer the attorney some reasonable fee to write that letter and to make those settlements for you.
BUT, you would be willing to pay the attorney her normal fee on anything she can bring in that is in addition to those two $25K policies, ON CONDITION that she also will defend against the subrogation claim. That defense ought to go fairly well, since the value of your claim sounds like it should be well in excess of $50K. Hence, there is no way that you would be "made whole" by having all of your general damages (i.e. pain and suffering and loss of enjoyment of life) paid in full if your own insurer is able to take part of your award in subrogation.
Thus, the defense against a subrogation claim ought to require no more than one solid letter, and perhaps a follow-up. If the attorney insists, then you could agree to pay a fee on this part of your award as well. For example, if your own PIP or Med/Pay has subrogation, why should they (your own company) be allowed to take part of your third party (tortfeasor's company) limits or your own UIM limits? So this is part of what an attorney can help with.
But your attorney can also guide you on getting to both a neuropsychologist and a dentist who specializes in temporomandibular joint syndrome (TMJ or TMD). Do NOT worry about the money. Your attorney will find the sources to pay for that. One thing I am curious about is the PIP on your own policy. Why have they not paid? Or perhaps you were confused when you cited the $5K as coming from your UIM part of the policy. Most likely that was your PIP. Anyway, your attorney can find the sources for these two services.
Here is some background on a moderate head injury. Take a look at this list and tell yourself how many of these symptoms do you honestly still have.
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
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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.
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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.
As for the question regarding property damage limits, I am afraid that neither company can disguise injury payments as property damage. You can argue to get the clothing covered under that limit, but in truth they likely will insist on taking it out of the personal injury limit.
I hope that you do follow through as I am suggesting, Sara, because you DO need 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
