QuestionQUESTION: My 20 year old daughter was rear-ended in TX at a stop light by a person travelling approx. 25 mph who was not insured or was under-insured (we did not know the complete answer as our Insurance Company handled the claim). Our insurance company totaled my daughter's (really my) car and gave a pretty fair amount. After replacing the car with another with some added money to do so, my insurance company has also paid for 11 visits to a chiropractor/wellness center for my daughter. They have paid all her medical to this point. After receiving a call from my insurance company to check on my daughter's progress since it had been a few months since she has been back to the chiropractor, they offered me a $750 settlement. I thought this to be much too low as I know many people, including myself that have suffered for many years in their neck and back from similar rear-end collisions. The Dr. that treated her sent me a letter stating at the end of the letter ...
"Due to the patient's age and muscle work involved with each treatment, we were able to get her to a maximum medical improvement state in 11 visits. I do however feel that she will continue to experience periodic exacerbations of her mid-back pain that will possibly impede her activities of daily living."
Based on the fact that she is now 21 and what the letter stated, I am trying to get some advice on what would be my approach to arriving at a fair and equitable settlement without getting my attorney involved. My thoughts are that for sure I would want my daughter to get enough to help her with treatment for at least 10 years. Any thoughts and help? Thank you in advance.
ANSWER: Hi Ron,
Since your own company is offering an injury settlement, it's very clear that the other party was uninsured.
When your own company is paying a 'pain and suffering' claim under the uninsured motorist liability portion, they have a right under the legal wording of the policy to deduct what they have paid out in medical bills from the settlement.
If your daughter had treated with a Medical Doctor and he prescribed Physical Therapy, you could expect a settlement of about 2.5 times her 'specials', less the amount the insurance company paid in medical bills. Specials are a total of all bills, doctor,therapy,prescription drugs and round trip mileage at $0.43 per mile for each visit.
All insurance companies, Auto, Health and Medi-care are extremely anti Chiropractor. Health insurance policies and
Medi-Care usually set a maximum annual benefit of $1,500 for Chiropractic care. When an auto insurance company is settling an injury claim based solely on Chiropractic care, they usually consider something around 1.2 times specials as a fair and adequate settlement. After deducting medical bills paid, that's why you have the low offer of
$750. It's very likely that you can negotiate with the adjuster and get the offer raised to $900-$1,000. It's very unlikely that they will consider anything higher.
In my opinion, based on 43 years of experience, that even if you get an attorney involved, he will get no more than $1,200 and he would keep 1/3 of that as his fee.
I hope this has been of help, please write again if you have any questions.
Your feedback by rating my answer will be appreciated.
Sincerely,
Bennie
San Francisco Bay Area 11-28-07 1:52 PM PST
---------- FOLLOW-UP ----------
QUESTION: Thanks for the response. May I ask your thoughts on the following?
Do you think it be adviseable for my daughter to go to an Osteopath or similar type of Medical Dr. for another opinion? Since we haven't settled yet, she should be able to still be covered under the claim, correct? Then after seeing her if they found that she would need further care for the future, would that be a better plan for her rather than settling with what we currently have been offered? Thanks!
PS. My mother's name is Bennie!
AnswerHi Ron,
You never mentioned the exact date of the accident. The standard wording in an insurance policy is that medical bills will be paid for up to one year following the date of the accident.
The Statue of Limitations in Texas to settle a personal injury claim is two years.
You certainly have the right to follow through with a visit to an Osteopath MD or any other MD.
I can provide you no encouragement that this will increase the value of your daughters claim. This claim must be fully settled and releases signed before the two years are up. There is no way to leave the claim open for future medical bills, although on a very serious injury, an award's value will be increased to compensate for these fully documented future medical bills.
This is not going to happen on a case that the insurance company considers a minor 'soft tissue' injury.
You can't sue your own insurance company. The legal wording in your policy states that any dispute in the amount of settlement for injuries from the uninsured motorist coverage be handled through arbitration.
This means that you secure an attorney, the insurance company hires an attorney to represent their interests, the two attorneys meet and jointly agree on a third attorney who becomes the arbitrator. The legal wording of your policy states that both parties are bound by the decision of the arbitrator. The process is then handled like a 'mini' trial. Your insurance company would demand a medical examination of your daughter. That doctor will not only examine her and review her medical records, he will testify against your daughter during the arbitration process. Your attorney can call the Chiropractor as a witness as well as other expert witnesses. The insurance company's attorney will cross examine him, just like in court. The offer made by the insurance company becomes void and can't be mentioned in arbitration. This process will take 1 1/2 - 3 days. The arbitrator will then state that he will render a decision in 20-30 days. This decision could be more or less that what you were first offered, but now you are out the cost of the attorney and the charges made by the people who appear to testify.
Quiet frankly, I believe you will wind up better off by my suggestion of trying to get the insurance company to increase their offer by a few hundred dollars.
If you really want to a different opinion, then you should make an appointment for a consultation with an attorney.
In Texas, the standard charge for the first 30 minute consultation is $20.
Please take a moment to rate my answer.
ps I was named after a great uncle Benjamin and always spelled my name Benny until I enlisted in the Air Force in 1957 and learned that the attending physician had misspelled it as Bennie. It's been that way ever since.
Sincerely,
Bennie
12-06-07 2:28 PM PST
