QuestionI was a passenger in an auto that was invoved in an accident with the driver being at fault. He has Farmers Insurance with no med pay, I have kaiser helath Ins and AAA Med pay. Kaiser has paid most of the hosiptal and ambulance bills, leaving only the copay for me to pay. Farmers stated Kaiser will come after them for reimbursement, my Insurance AAA says they will send me my entire amount of med pay due to the total amount of my bills. Do I have to reimburse anyone or exactly how does this work? Also how does the pain and suffering work. Med Bills over $20K so far. Car was a total loss, but that was covered and paid directly to the owner of the car.
Thanks
AnswerHi Jennifer,
I'm sorry to learn of your injuries and wish you a full recovery.
I am assuming that you are a California resident, and my answers are based on that assumption. If you reside in a different state, let me know because the answers could be slightly different.
Kiaser has a clause in their plan that requires they be reimbursed for the amount they paid out in medical bills if you recover from a 3rd party.
Your personal injury claim against the driver (and Farmers) will be considered as recovery from a 3rd party. Kaiser will, or already has filed a lien with Farmers to be paid from your settlement.
Before you consider retaining an attorney, you should ask the driver how much Bodily Injury Liability coverage he carries on his policy.
The value of your 'pain and suffering' claim is based on many factors.
The total of your medical bills, the cost of travel for medical visits @ $0.46 per mile, your documented wage loss, the severity of your injuries such as broken bones, scaring, long term or permanent type of injuries that will affect your lifestyle and future medical bills related to the accident.
Clearly, your claim already has a value in excess of $50,000. If the driver/owner of the car carried Bodily Injury Liability in an amount of $50,000 per person/$100,000 per accident or LESS, you will be able to settle the claim against Farmers for the policy limits without the assistance of an attorney. Hopefully, he carried even higher limits and you will be able to settle with Farmers for the true value of the claim.
If the driver carried $50,000 or less, there are two possible sources for the additional amount that you are due as a proper settlement.
If you carry higher limits on your AAA policy than he has with Farmers and you carry matching limits of Under Insured Motorists Coverage (ie. he has 50,000/100 and your carry 100,000/300 WITH
$100/300 UNDERINSURED MOTORIST COVERAGE) you can file a claim with AAA for the DIFFERENCE between his limits of coverage and your limits.
In order to do this, you must reach a settlement agreement with Farmers for their policy limits and then get permission from AAA to
settle with Farmers and open an Underinsured Motorist Claim.
A policy with AAA in California states that you can not sue your own insurance company, but have to settle through arbitration. (We can go into that in detail at a later time if necessary.)
If you don't have higher limits of coverage that allow you to file a claim with AAA, then your only choice would be to retain an attorney
and sue the driver of the car for his assets to cover the true value of your claim. You probably know the driver well enough to know if he has any assets.
If you find it necessary to consult with an attorney, be sure he has
TRIAL experience. If you don't know an attorney in this category, call your county attorney referral service (it's free) and they will give you the names of many attorneys in your area with the experience that you will need. If you do retain an attorney, be sure to stipulate in his contract that his fee will be a percentage of the NET amount after the Kiaser lien is satisfied.
I hope this information will be of help, although I'm positive that it has raised additional questions. Please feel free to write me a follow up with your questions. Please mark any follow up questions as PRIVATE.
Your feedback by rating my answer will be appreciated.
Sincerely,
Bennie
San Francisco Bay Area
