QuestionI had a car accident about 14 months ago. My medical bill until today is about $15,000 and my PIP was close about 2 months ago. I still receiving treatment and the next step is going to be surgery of my neck (MRI showed cervical problem) and I do not have money to pay the surgery.
I wrote a letter to the 3rd party insurance asking for policy limit, liability.In place of answer what I asked, the new adjuster`s letter said the following:
To date, it does not appear you have provided us a statement in reference to the facts of loss. As this is an intersection loss, I am requesting to secure this from you.
Accordingly, I also need an update on your medical treatment and what injuries are being treated as we are over 1 year post accident. Please be advised that treating does not guarantee payment, and I will need your cooperation with a statement. I will also need to review your complete medical records to determine how this treatment relates to the accident.
I do not understand what the adjuster mean when he said:
·Provide us a statement in reference to the facts of loss.
·This is an intersection loss.
·Treatment does not guarantee payment, and I will need your cooperation with a statement and to review your complete medical record.
How can I do to make the adjuster answer what I need and what can I do about this letter. I did not send a demand letter, I just sent a letter asking for policy limit and liability and every time a wrote a new letter, a new ajuster answer my letter, is that ok to have many ajuster for the same case.
I know the letter is long, sorry about that.
Please help.
Thank you for your time.
Lan
AnswerHi Lan-
I think I can help on some of this. I am assuming that the other driver was found 100% at fault. First of all they are not going to give up the policy limit easily, because that will give you an advantage of how much to sue for. The only way you will be able to get that is if you get an attorney and/or if they see it in their best interest to help their negotiations. They are also going to switch underwriters around just to make it more frustrating for you, because the more frustrated you are the more willing you will be to settle.
Here is one thing that I learned the hard way when my wife was injured in an accident. If you need the surgery because of the accident, get a physician to write down that they feel the surgery is needed and that is most likely from the accident. That way you can be more confident that you have a strong case when you go to settle or go to court.
I am not an attorney, but it sounds like they want a statement from you as to what your medical bills and lost wages etc. are so far. I have never heard the term intersection loss, but it has to do with the statement, so that will get taken care of when you do that.
What they are saying is that they may or may not pay for all of your bills. They may find something in your medical record or lifestyle that may have been a contributing factor and they will argue that they should not have to pay all for all of your treatment for that reason. If your case is strong enough, you shouldn't worry too much about what the policy limits are. Whatever the insurance company doesn't cover will have to come from the assets and wage garnishment of the at fault driver. You can probably judge that possibility somewhat by the age of the driver, what kind of car they were driving and their appearance and attitude.
I hope that was helpful
Sheldon Maughan
Sacramento, CA
