QuestionI was rearended 2 months ago. I have been going to Physical Therapy since the accident for soft tissue and ligementous injuries. I have scoliosis which never bothered me before this accident. However, since the accident I have had pain every day in the neck, shoulder, mid, and lower portions of my back. Luckily the pain moves around. I was scheduled to have surgery for an unrelated issue prior to the accident. However I had to cancel the surgery because my other Dr refused to the do the surgery when I mentioned being treated for the accident. Due to pain I can no longer stand I must get released from my back Dr in order to have the surgery. I feel that my back is not completely healed yet but have no choice other than to be released. Is my claim closed once I am released? Is there some type of settlement for still being in pain although I am released? I have been using my health insurance for my treatment bills and they want to be paid back. Will my health insurance consider all future claims to do with my back as part of this accident and deny them?
AnswerDear Mendy,
This is a tough choice inasmuch as you stand to lose either way. Of course it is easier for me, since I am not in your shoes. But if you were my client, I would caution you that is best to put off the surgery until your accident injury condition TRULY stabilizes and you KNOW what to expect in the future, AND, FURTHER, you are willing to live with that degree of intermittent pain.
Here is why. Your surgery does not seem to be an emergency, whereas this soft tissue injury seems to have some potential for life-long pain and suffering. I deduce this from your statements:
“I have had pain every day in the neck, shoulder, mid, and lower portions of my back. . . . Due to pain I can no longer stand. . . I feel that my back is not completely healed.”
Those words tell me that the soft tissue injury has the possibility of lingering and growing worse with any physical stressors you put on your body. There are two reasons to treat the soft tissue injuries until they are mostly resolved.
The first is your long term life free from pain and suffering, and the second is to achieve a larger settlement award that is more closely based upon your actual injuries, as opposed to something done now, which might be computed without knowledge of any years of future suffering.
Let me answer your questions to set the stage for a discussion of why we do not want to settle your personal injury claim too soon. Since we do not have HTML capability here, I will simply USE ALL CAPS for MY answers to your questions, which will be in lower case. OK?
1. Is my claim closed once I am released? YES, THE INSURANCE COMPANY WANTS TO BE DONE WITH YOU, AND THE SOONER THE BETTER. THEY WILL NEVER PAY SOME NOW AND LEAVE IT OPEN TO PAY SOME LATER AS YOU GET WORSE. THAT IS GOING TO BE YOUR RISK, ONCE YOU SETTLE.
2. Is there some type of settlement for still being in pain although I am released? NO. SEE ABOVE. BUT YOU CAN INCREASE YOUR SETTLEMENT AMOUNT WITH GOOD MEDICAL RECORDS THAT HAVE A STRONG PROGNOSIS OF FUTURE PROBLEMS. THUS, YOU WILL ACCOUNT FOR THE MEDICALLY-PREDICTED FUTURE PROBLEMS BY ASKING FOR MORE MONEY NOW, AT TIME OF SETTLEMENT. For example, if a claim has a value of $30,000 based upon the present treatment and prognosis, what would the adjuster pay for it if the prognosis was for another $5,000 in medical costs and continuing pain and suffering intermittently and restrictions on physical activity? See the difference? You have to get your doctor to write a narrative letter. If you need help on defining or working thru a narrative report or letter, send me a new question on that and I will get back to you.
3. I have been using my health insurance for my treatment bills and they want to be paid back. Will my health insurance consider all future claims to do with my back as part of this accident and deny them? THIS IS TRICKIER BECAUSE OF THE SUBROGATION CLAIM AND YOUR NEED TO BE COVERED IN THE FUTURE. WHAT YOUR HEALTH INSURER IS DOING IT TO EXERCISE ITS RIGHT TO BE PAID BACK FOR ITS EXPENSES WHEN YOUR INJURIES ARE CAUSED BY A THIRD PARTY FROM WHOM YOU ARE COLLECTING A SETTLEMENT. THIS IS KNOWN AS SUBROGATION. THERE ARE TWO ISSUES ARE AT WORK HERE. THE FIRST IS THE SUBROGATION CLAIM OF YOUR HEALTH INSURER. CHECK WITH YOUR STATE INSURANCE COMMISSIONER http://www.settlementcentral.com/links.php regarding subrogation rules in your state and whether or not there are any recognizes defenses to such claim, such as when the tortfeasor (the at fault party) has insufficient policy limits to pay the value of your general damages (pain and suffering, loss of enjoyment of life).
As for your question regarding future care, that is the TRICKY part. If you settle up with a tortfeasor and you are cleared and released by your doctor, then any further problems should be treated by your health insurer just the same as any other kind of illness. There is no subrogation since the doctor already released you and the claim has settled.
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DON'T SETTLE YOUR PERSONAL INJURY CLAIM TOO SOON
You have asked me for tips on delaying surgery versus getting a medical release and taking surgery now. The reason I am making a big deal of your injuries is because your description of them (as quoted above) implies a more lasting injury, and because in only two months you really have not put your body through the rigors of daily life as you used to live it during the summer months.
"Deep" soft tissue injury can be lit up months after ending treatment. Wait until you have gone through your summer season with all of its physical activities.
What your own description above tells me is that your body may not have had sufficient time to heal from just passive treatment. I am worried that if you were to go through even half of your summertime outdoor activities, you will start noticing pains at night or the day following physical activity.
Even now there may be a dull ache at night following some physical activity or pain the next morning. In this case, I would first give yourself a thorough self-examination to see when you recall the little nagging pains in your neck or back. I would see a doctor about those ASAP. It is not too late.
There may be a dull ache at night following some physical activity or pain the next morning. DO NOT LET LITTLE PAINS GO UNATTENDED SINCE YOU DO NOT KNOW WHETHER THEY WILL CONTINUE OR GO AWAY. We all hope and believe that such little pains will disappear soon. But on the other hand, we have no way of knowing since this is the way serious soft tissue injuries can behave.
So, when this happens, even if a couple months or more post-treatment, do not hesitate to SEE A DOCTOR AND ATTRIBUTE THE PAIN TO THE ACCIDENT WITHOUT EQUIVOCATION. It is NEVER TOO LATE TO REPORT PERSONAL INJURIES FROM A CAR ACCIDENT http://www.settlementcentral.com/page0104.htm
According to Our http://www.SettlementCentral.Com Members, Chiropractors are Most Effective in Severe Whiplash and Soft Tissue Car Accident Injuries http://www.settlementcentral.com/page8010.htm
Managing Medical Care After Auto Accident: http://www.settlementcentral.com/page0203.htm
"No medicine: no money"; medical costs increase worth of personal injury insurance claims http://www.settlementcentral.com/page0045.htm
Here is another page from my website that shows in detail why you should never make an early personal injury insurance claims settlement http://www.settlementcentral.com/page0211.htm
And, of course, once you settle, that is it: no one will be there to pay for your future medical or chiropractic care; nor will you ever see another dime in pain and suffering money. By the way, did you know that getting an early settlement is a favorite trick of the insurance adjusters? Please see my website wherein we show Insurance Claim Adjuster Secret Tactics http://www.settlementcentral.com/page0092.htm
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Well, Mendy, I cannot make the decision for you: it is a dilemma, I know. But for my own claim and my own injuries, I would come down more on the side of taking care of my auto accident personal injuries first, so that they have a solid basis for healing.
Best Wishes,
Dr. Settlement, J.D. (Juris Doctor)
Http://www.SettlementCentral.Com
