QuestionQUESTION: I had a car accident about a month ago where I hit the truck who ran a stop sign coming out on a highway. He was sited for not stopping at the stop sign. I had miltiple open fractures on my right ankle, and multiple fractures on my left wrist. I was in the hospital for 3 weeks, had 3 surgeries so far. My own health insurance was picking up the bills, that are as of today are already over $200,000. The guy who was at fault was insured for 100/300 - person/accident. I don't expect any problem collecting these $100,000 from his insurance company. Now, my question is - will my health insurance company claim any portion of this settlement later, what should I expect from them? I don't want to call them and ask directly cause I'm afraid to "spook" them - so far they were paying for everything, knowing it was a car accident, and the other party was at fault. By the time I fully recover (I hope I will) my bills will be probably over $300,000, especially if I need bone transplant surgery later. I'm going to agree to settle for these $100,000 now though, because it's not gonna get bigger anyway, and I don't want to deal with lawsuit cause I might never collect anyway even if I win. I would be pretty happy with $100,000 if I knew my health insurance would not want any part if it. How do I figure it out?
Thank you.
ANSWER: Hi Tanya,
Most health insurance companies and all HMO health plans contain a clause requiring you to reimburse them for the amounts they paid if you should recover from another party.
Since they have been aware from day one that this was caused by an auto accident, they may have already filed a lien against the other insurance company for their expenses.
You should discretely try to learn from the other company if such a lien has been filed.
If they have not filed a lien, they should be willing to remove this requirement of reimbursement or at least reduce it to a small percentage since you are receiving a settlement that is only 1/5 to 1/9 of the true value of the claim.
With $200,000 in medical expenses, your claim has a true settlement value of approximately $600,000. if those bills climb to $300,000 then the true value of your claim approaches $900,000.
Every state has a Statue of limitations for settling an injury claim. If you live in Tennessee or Kentucky, the time limit is only one year. The majority of states allow 2 years, and a small few allow 3 or more.
If the driver of the truck was a mature person of middle age or older, it is totally possible that he has assets such as land, rental homes or rental apartments and has a high net worth.
It should cost less than $1,000 to hire an independent firm to thoroughly research his financial standing and determine his exact net worth.
If his NET worth equals or exceeds $400,000-$500,000 or more (you should not consider the value of his home because very rarely will a court require him to sell his home in order to pay you), then you should consult with The very best Personal Injury Attorney in your who has TRIAL experience. Be sure he has TRIAL experience because such a large case would definitely wind up being presented to a jury. At least 85% of the personal injury attorneys have never tried a case in front of a jury.
This first consultation with the attorney is usually free in all states. After discussing your injuries with the attorney, showing him your medical bills and the report that you already have of the drivers NET worth, you will be better able to make a decision as whether or not to hire the attorney.
The attorney works on a contingency basis, usually charging his expenses off the top of the final settlement and then keeping 40% of the settlement if the case goes to trial.
This is a case where the attorney would have large expenses and the case would definitely go to trial.
When you win, the driver will be required to liquidate his investments in order to pay you.
Consider all these options and also read your health insurance policy to see if it requires reimbursement before making your decision.
I trust that my answer has been helpful. Please write again if you feel that I can be of more help.
Your feedback by rating my answer will be appreciated.
Sincerely,
Bennie
San Francisco Bay Area 11-02-07 12:42 AM PST
---------- FOLLOW-UP ----------
QUESTION: Hi Bennie,
Your respond was very helpful, thank you very much. I wish I've found this web site before. I want to add a few detalis to my case so you'll have a clearer picture: I have to admit I made a mistake by hiring a lawyer right away, but I couldn't sleep at night while nobody was taking care of my case, and I couldn't do it myself from the start because most of the time for the first 3 weeks I was in such pain that I couldn't think of anything, and when I wasn't in pain I was just drugged and couldn't think straight anyway. Now, after 6 weeks have passed since the accident, and I can assess what my lawyer did, I realize that I could do it myself if I gave it more time. One of my friends was telling me exactly that but I just thought then that it's so complicated and I was so stressed out that I wanted someone else to handle it for me even if it's gonna cost me 33% of the settlement. Now about my lawyer - I don't know if he's the best, but he's not the worst either. He does have a trial experience, he is a trial lawyer, I made sure of that even though I didn't have a clue then why it was important. What I don't like about him that I can't get the answers for my questions, like that one I asked you - about my health ins vs auto ins. He did an investigation though on the guy who caused the accident, and his findings were not very encouraging, the guy doesn't have much, no umbrella insurance, his net worth is not worth filing a law suit against him. Although I know all that from my lawyers words, I didn't see any paper or anything to prove it. Should I ask for it? What would you suggest, how I should deal/work with my lawyer. Up till now, I totally trusted him, and did exactly what he was telling me to do. But now, since I'm facing the fact that I might get only $66,000 for all my pain and suffering, and I'd be totally OK with that if I knew nobody would claim that money later, but the problem is that I can't get a clear answer, and that really makes me doubt my choice of attorney. What do you think? To his defence though, he got me twice as much money than my car was worth, and free of any fees.
I have another case with the insurance company for my daughter who was in the car with me. Fortunately she didn't get injured as badly as I was, only concussion and very minor injury to her eye - she's totally OK now - but is there any way to claim other than medical expences on her case to kinda compensate for underpayment in my settlement? The guy's coverage is 100/300? The things like her dropped grades because she missed a week of school while all of the final tests were given, and in the long run it might affect her eligibility for scholarship for college. Or that she had to give up her piano lessons because I can't drive her now.
See, this is what I don't like about my attorney - I would expect him to give me answers, instead I have to search internet for them.
Anyway, thank you very much for your respond, and I hope to hear more from you soon.
Tanya, and I live in GA
ANSWER: Hi Tanya,
I see no reason to doubt your Attorneys statement that he did a thorough check on the other drivers assets.
To have failed to have done that would have left him open to a malpractice suit from you. He would also done this in his own financial interests because 33% of $600,000-$900,000 is a lot more than 33% of $100,000.
It appears that he has done everything on this case that he is legally required to do.
He is properly qualified and owes you the obligation of reviewing your health insurance policy and letting you know if there is a clause in that policy requiring you to reimburse you health insurance from any settlement that you receive.
There is a strong possibility that such a clause exists, that your health insurance is already aware that he is representing you and have filed a lien with him requiring that he reimburse them directly from the settlement check.
If such a clause exists, you are going to wind up with $0
compensation for your pain and suffering.
On a nationwide basis, Attorneys are rated as being less scrupulous than used car dealers.
As I stated, he may already have been contacted by your health insurance ,or, based on other cases that he has handled is fully aware that your 66% will go back to the health insurance company and you will wind up with $0.
Right now, since your claim is already at the $600,00 value, he is assured of the $100,000 being made and 33% going into his bank account. He is not going to disclose any bad news to you unless he has is legal required to do so by the state laws of Georgia.
He is fully aware that if he gives you the bad news that you are actually going to wind up with $0 that you could fire him (it's complicated, but can be done) and he would only be entitled to fair payment for his time and expensed over the past month. Right now, his work is done, all he has to do is sit back and wait for the $100,000 check to come to him, deposit it in his trust account and then disburse the balance to the legally entitled recipients under Georgia Law.
If you can't get your attorney to read your health insurance policy and render it's legal requirements back to you, then you should study the policy yourself to learn their reimbursement rules. If you can't fully understand the legal wording then do the following:
If your health plan is through your employer or you have a friend insured by the same type of private policy, I suggest that you have a co-worker or friend call the insurance company and pose a question to the company by asking "If I'm an an auto accident and you pay $5,000 for my medical bills and I recover a $12,500 settlement from the other driver, do I have to reimburse you the $5,000 from my settlement?".
At least you will have the good or bad news right now instead of having to wait a year to learn.
Look at your own auto insurance policy, if you carry
300/500
Bodily injury and 300/500 uninsured motorist/underinsured motorist then you should be able to recover another $200,000 from your own company. This again would require an attorney and still be a total waste of effort if your health insurance company is going to recover all their payments from your recovery. It would only put more money in the attorneys pocket and none in yours.
If your attorney is not willing to read your health policy and render a decision about it's reimbursement stipulations and you can't clearly understand the legal wording and your friend or co-worker calls and doesn't get a satisfactory answer, then I recommend that you send a certified letter to you attorney demanding that he disclose if a lien has been filed against your portion of the settlement by the health insurance and if not, what has been his past experience in dealings with that same health insurance company. Include a demand for a written response and keep a copy of your letter for your files.
You can easily handle your daughters claim, but they are not going to overcompensate her to make up for your inadequate settlement. Each claim is separate and stands on it's own merits.
Your daughters compensation will be based solely on her expenses. She is not entitled to compensation for inconvenience such as missed school or missed piano lessons.
Itemize her expenses such as Ambulance, ER, Doctors visits, prescriptions and if someone had to drive her to various appointments the round trip mileage @ $0.43 per mile.
Make a written demand for 3.2 times her total expenses and include a time frame that they must reply within 15 days.
You will need to also provide them copies of these expenses. Their first offer is going to be less than your demand, but you should be able to negotiate a settlement of between 2.5 and 2.75 times her expenses. In most states, when the claimant is a minor, once you reach an agreement, both you, your daughter and the insurance company representative must appear before a judge who will review everything to determine that it's a fair settlement and after approval, require the insurance company to deposit the funds into a controlled savings account that your daughter can't receive until age 18.
I'm afraid that I've painted a rather gloomy picture, but the bottom line is that until you learn the legal requirements that are contained within your health insurance policy, it will remain gloomy.
I trust that this has been of some help. Please write me again anytime you feel that I can offer help or support.
Sincerely,
Bennie
11-03-07 5-20 AM PST
---------- FOLLOW-UP ----------
QUESTION: Hi Bennie,
Yes, the picture is rather gloomy, but at the same time it's also clearer - thank you again. So I understand that my lawyer is not responsive (so to speak) because he's gonna win either way, that's one thing. Another, I don't need to blame myself for hiring the lawyer because if my health insurance is after my settlement, I would get nothing anyway. Summary: if my health insurance is gonna get back the money they paid for me, I wouldn't get $66,000 if I have an attorney, or I wouldn't get $100,000 if I was doing everything by myself without an attorney. So it looks like hiring an attorney was still a smart decision - at least I didn't do all that work he did for nothing :)
Now, the problem is that I don't have my health insurance policy in writing, all I have is their web site (www.evergreenhealthplan.com - in case you're wondering), and I was all over that web site but found nothing related to my question. Your advice of having my friend with the same insurance (we both got it through our employer) to call them and ask, sounds very good, and she's gonna do it first thing on Monday. My uninsured limits were lower (50/100) than the other party (100/300), and I'm really very much embarassed to admit that up until this accident I had no clue at all what they meant, much less that they are actually for my own protection. Well, now I know, and on my next policy I'll make sure I'll have the max.
Now, next question: if I'm not happy with my attorney regarding my case, and I want to handle my daughter's case myself, I will still have to pay him something, right? He will have to present me with what he did so far and put a price on it, right?
Well, thank you Bennie, you're extremely helpful, and I hope you'll find some more time for me.
Thank you,
Tanya
AnswerHi Tanya,
This site becomes available for new questions at 1:00 AM GMT which is 7:00 PM EST. Ask any new question shortly after that time and you should be assured of being able to get me.
Bennie
11-05-07 12:28 AM PST
Hi Tanya,
I agree that you can't fault yourself for hiring an Attorney. After all, he did all the leg work to get you a much more than adequate settlement for your car and did follow through to learn if the driver had any assets.
This is the first time that you have mentioned that you also hired him to handle your daughters case.
I seriously doubt that he has yet done any work on her case.
You should ask him to release her case back to you without any charges. If he becomes reluctant, you can gently threaten to fire him, which would mean he would wind up with less than $10,000 instead of the $33,333 that he is presently guaranteed to receive. This will be adequate motivation for him to release the case back to you with no charge.
I read your health insurances web site and it is just a lot of general information and does not contain any specific policy language. In order to comply with different state laws, their policy is slightly different in each state that they do business.
Your employer has master copies of the original policy and is required by law go give you a copy upon request.
Request a full and complete copy from your employer and then have your attorney read it to learn of any reimbursement requirements and try to find any loopholes that would require them to only accept a percentage reimbursement if your settlement is far less than your medical bills. The odds are strong that such wording exists which would mean that you at least get to keep a portion of the settlement.
When you increase the coverage on your own auto insurance policy, be sure to add the maximum amount of Medical Payment coverage to your policy and if there is ever an accident in the future, have your auto medical pay first because they do not require reimbursement.
Again, I trust this answer has been helpful and remember I'll be available for future assistance as needed.
Sincerely,
Bennie
11-04-07 12:18 AM PST
