QuestionQUESTION: Hello, I live in oregon.
I had a car accident about a year ago and next week is going to be the termination of my (PIP)benefit. The question is what I have to do in order to make the insurance company to pay my medical bill. My doctor told me that i will need more treatment or maybe a surgery in order to reach the maximum improvement. What are the options. I do not want to hire an attorney if i can do it by myself.
hope you can help.
thank you.
ANSWER: ***************FOLLOW UP *************************
Hi Ian,
I answered the following question in very specific detail.
You have yet to provide a fair rating for my previous answer.
You are now asking me to spend at least an hour of my time to explain in detail how you go about handling your Personal Injury Claim.
I feel that in all fairness you need to rate my previous answer before I spend more time dealing with this issue.
Once you rate my previous answer, I will be happy to provide the extra hour + that it will take to answer your follow up question.
Sincerely,
Bennie
10-23-07 10:48 PM PST
Hi Ian,
An Insurance Policy is a legal contract between you and the Insurance Company. Within that contract, the Insurance Company states that they will pay your medical bills during the first year following the accident up to the amount of coverage stated in your declarations page.
There is absolutely no way that you or any number of Attorneys are going to be able to have the coverage extended past the one year date.
If you have health insurance, either through your employer or through a private plan, you can turn to them for your future medical bills.
If you do not have health insurance and were not at fault in the accident, I'm sure that you have already obtained a Personal Injury Attorney to collect pain and suffering from the adverse party. He can petition the adverse insurance company for an advance payment against the final settlement to secure funds to pay your future medical bills. Most companies are very co-operative in situations like this.
I hope this has been of help. Please write again if I can be of assistance.
Sincerely,
Bennie
San Francisco Bay Area 10-17-07 11:33 PM PST
---------- FOLLOW-UP ----------
QUESTION: I do not have any attorney. the idea is to try to do it myself. and again how can i deal with the adverse insurance company and make them pay my medical bill.
thank you for you time in answering the above question.
sincerely,
Lan
ANSWER: Hi Lan,
The Statue of Limitations for settling an injury claim in Oregon is two years.
This means that you must reach a settlement agreement with the adverse insurance company and have a check in hand at least 1 day before before the 2 year period, or file a lawsuit against the other driver which will extend the statue for an additional time which is usually one more year, if you fail to settle and then fail to file a lawsuit, you lose all future rights to collect.
It appears that you have slightly less than one year before the expiration of that time period.
This means that you need to immediately build two identical files, one to present to the adverse insurance company along with your settlement demand and one for your own records.
In each file place a copy of each and every medical bill that you have incurred and all other financial losses. This
will include any Ambulance charges, Emergency room visits, each Doctors visit, any CT scans or MRI, prescription drugs, documented wage loss statements from your employer and a log of the round-trip mileage for every trip you made to visit the doctor, physical therapy and trips to the drug store at $0.43 per mile.
If you desire to claim future medical expenses, then you will need a full narrative report from your doctor which fully explains his diagnosis of your condition, his treatment to date and FIRMLY state the exact amount of future treatment and it's expected costs. He will have to firmly state that you WILL require surgery (just a possibly or maybe is not adequate) and an estimate of the cost of that surgery and the number of days that he expects you will lose from work. Your Doctor will make a charge for this narrative.
Total all the bills and other financial losses that you have already incurred, add in the costs from your Doctors narrative for future expenses and include the amount of what your wage loss will be for the time he feels that you will miss from work
following the surgery.
Total all your past and future losses and multiply by 3.2.
Now prepare a demand letter to the other insurance company for this amount and demand within that letter that they respond within 10-15 days. You will present this demand letter and one of the files containing your prior losses and your doctors narrative of your future losses. The adverse company needs this documentation in order to evaluate your claim. The insurance company is required by law to respond within the time frame stated in your demand. Their first offer will be far less than your demand, probably only offering 2 times your total losses.
Now you have two amounts on the table and the process of negotiation starts. You can expect them to slowly increase their offer and you will have to slowly lower your demand.
You can reasonably expect to settle this claim for 2.5-2.75 times your total losses.
If you have not been able to come to a reasonable compromise within 6 MONTHS from today, you need to make an appointment with the very best Personal Injury Attorney in your area who has trial experience.
This first consultation is usually free in every state.
When you go for this appointment, take the second file containing all your previous expenses and losses, the narrative report from your Doctor, a copy of the demand letter that you presented to the adverse insurance and copies of any written responses that they have made.
After you have this consultation, you can decide if you are able to continue representing yourself or if you need to retain the attorney.
An Attorney needs a minimum of 4-6 months do do his investigation and get a lawsuit filed before the statue of limitations expire.
I trust that this information will be of help. Good luck, I hope you are able to secure a proper settlement.
Sincerely,
Bennie
San Francisco Bay Area 11-05-07 11:25 PM PST
---------- FOLLOW-UP ----------
QUESTION: Thank you for the above answer. but my concern is, i have to continue my treatment right now and my own insurance is not going to continue to pay my medical bill. so again the question is how i am going to pay my bill if i decide to continue my treatment until i reach the maximum improvement. I AM NOT FINISH MY TREATMENT YET, WHO GOING TO PAY MY FUTURE (NOW AND TOMORROW ETC.) MEDICAL BILL. I DO NOT WANT TO PAY THE MEDICAL BILL OUT OF MY POCKET. I just stop to go to the chiropractic because i do not have money to pay the bill (I do not want to pay the bill with my own money); so how or what steps i have to do in order to make the adverse insurance company start to pay my medical bill so i can continue to go to the doctor.(i plan to write the demand letter after i have reach the max improvement)
I am not sure if i undertood your answer. you mind that i just write a demand letter which everything i have until now and collect the money from the adverse insurance and use that money for future treatment. what happen if the process of negotiation take very long? should i stop my treatment during the process of negotiation?
Thank you for your time
Sincerely,
Lan
THANK YOU FOR YOUR ANSWER.
AnswerHi Lan,
If you don't have any kind of health insurance, either a personal plan or one through your employer, You can petetion (ask) the adverse insurance company to give you an advance against your future settlement. They will usually consider this option, but there is absolutely no way that you can force them to make an advance payment for medical expenses, especially since you are treating with a Chiropractor which is going to lower any future settlement by 50% as opposed to your treading with a Medical Doctor
who had been prescribing Physical Therapy.
If you have absolutely no health insurance, then, in my opinion, you should talk to the Chiropractor and ask him to continue your treatment by accepting a lien against your future settlement. That way, when you finally do reach a settlement agreement, he will be paid first and you will get the balance.
Sincerely,
Bennie
