QuestionI was rear ended on Nov 14 and my pick up truck did great (minimal
damage). The other person's insurance company (her fault) already
reimbursed me for the damage to my truck ($700). Unfortunately, I didn't
fare so well, as I had your typical sore neck, back, and what my doctor and
chiropractor is suggesting as a rotator cuff injury. Since the accident, I've
visited the doctor twice, the physical therapist about 6 times and after no
noticeable results, I conferred with my doctor and began treatment at a
chiropractor office (neck/back adjustments and muscle massage). Although
my back and neck are feeling much better, I have an appointment to see a orthopedic specialist for my shoulder next week to further examine my
shoulder. I've seen the chiropractor three times a week for three weeks and
have had a muscle massage twice a week for three weeks.
Everyone I've received treatment from (doctor, physical therapist,
chiropractor) have all told me not to sign anything from the other insurance
company. I've never been in a car accident (well, I have but I wasn't injured
and never filed a claim) so I'm not sure what a settlement is and what its
suppose to achieve. How does this work? Co-workers have told me about a
certain formula but that seemed pretty dishonest. Because of my own
personal insurance policy, all of my medical bills (I believe) are being billed to
my insurance company and they will bill the other insurance company. I've
missed approximately 45 hours of work but I've used my sick leave that I've
accumulated for all of my doctor's appointment.
Can you shed more light on the whole settlement issue?
AnswerHi Nick,
I'm sorry to hear of your injuries and do wish you a speedy recovery and certainly hope that you don't have a rotor cuff injury. I am dealing with such a problem now (not from an auto accident), my orthopedic surgeon is treating me with physical therapy and cortisone injections. It's a long and painful recovery.
Every state has a Statue of Limitations within which a personal injury claim must be settled or you lose all rights to recovery. If your accident happened in Tennessee or Kentucky, that statue is ONE year. Most other states allow two years and a few allow 3 or more years.
Right now, your auto medical coverage is paying your medical bills. This is a coverage that you have paid for and are entitled to use. They will pay your bills up to the limits of coverage that you carry. They will not require reimbursement when you receive a settlement for 'pain and suffering', nor are they billing the adverse company for their expenses. If and when you exhaust the limits or time frame of your coverage, you will need to turn to your health insurance for the balance of your treatment and the majority of them DO require reimbursement in cases where you collect from a 3rd party.
You stated that after 6 physical therapy visits, with no apparent results, that you consulted with your Medical Doctor and stared seeing a Chiropractor. If your MD recommended a Chiropractor or even indicated that such treatment has his approval, it becomes my first case in 43 years in the business. Most Medical Doctors look upon a Chiropractor as a glorified masseur. I personally enjoy a good massage 3-4 times per year and always go to a highly quality maseur.
You should be made aware that all insurance companies, Auto, Health and Medi-Care are extremely anti-chiropractic.
The majority of Health Insurance policies and all Medi-Care policies have a clause that limits chiropractic treatment to $1,500 per year.
When it comes time for a settlement for your pain and suffering, your chiropractic bills are only worth about 50% toward your settlement as opposed to bills from a Medical Doctor, Prescribed Physical therapy and charges by your Orthopedic Surgeon.
Your settlement for pain and suffering is based on your total economic losses. You will need to have your employer prepare a documented wage loss statement showing what your wage losses would have been if you had not used your sick time. This is an economic loss, because you no longer have those hours in the event of an emergency illness or injury.
You need to start building two folders, one to present to the adverse company along with your claim demand and one for your own records. In each folder, put in a copy of every Medical Doctors visit and a copy of his bill, every Physical Therapy visit and a copy of the bill, every Prescription Drug receipt, The initial consultation with the
Orthopedic Surgeon and that bill, along with any other visits and bills, every Chiropractic visit and a copy of that bill plus the round trip mileage for every visit for treatment and to pick up prescription drugs at $0.43 per mile.
Once you are fully recovered, submit copies of all these bills for economic losses (even if your auto insurance medical paid all your bills) and a demand for 3.2 times these losses to the adverse insurance company as settlement for your pain and suffering. You should be able to negotiate a settlement of 2.5 to 2.75 times these economic losses as compensation for your pain and suffering, except for the portion of your bills relating your chiropractic care. For those, you can only expect a settlement of 1.2 to 1.5 times those bills.
I hope this has been of help, when you write again, please give me the name of the state where this accident occurred so I can provide you with the true Statue of Limitations for that State.
Your feedback by rating my answer will ne appreciated.
Sincerely,
Bennie
San Francisco Bay Area 12-18-07 9:23 PM PST
