QuestionGood Day, Thanks for taking the time to answer my question.
The backgroung is that my wife, 8 year old daughter and I were involved in a traffic accident on the freeway in California, going about 65 mph. Another vehicle swerved into the passenger side of our vehicle and threw us into the center divider. My 2001 volvo s60 was totalled, and the other driver's insurance company paid out approximately $15000 for it, having admitted full responsibility for the accident and actions of their insured.
I am now dealing with the other driver's insurance company. The property claims adjuster was very good to deal with, and a fair price was given to me(after a bit of civil discussion) for my vehicle. The personal injury adjuster is not as easy.
My wife had no significant injuries and missed one day of work. We closed out her claim for about 3times her lost wages($1200 total)
My daughter was shook up and banged her head and was taken by ambulance to the ER to get checked out and also one follow up visit to her pediatrician. Her total medical bills were about $1300. No lasting injuries.
I have neck and back pain and went to get treatment from a chiropractor. I received treatment at his office, along with adjustments. My total bills after about 3 months of visits were $4400.
I am now trying to close out my daughter's claim and mine. The insurance company, after some negotiating, is willing to close out my daughter's claim for $2600. This seems fair, at 2x her bills, and the fact that she had little injuries, besides being scared and shaken up.
In regards to my injuries the insurance company is claiming that the bills by my chiropractor($4469) are on the high end. They feel that the bills should be around $3500 for the services rendered. They don't seem to have a problem with the number of visits, just the cost per visit. They are offering me a total of $6000 to settle-only $2500 above my "adjusted" bills.
My questions are as follows:
1. Does my daughter's offer seem reasonable?
2. Can the insurance company refuse to pay the complete cost of my bills, claiming that the doctor is charging too much per visit? They seem ok with the number of visits, just are complaining the cost per visit is too high. They stated that the cost for a doctor visit, traction and other treatment should be around $100 per visit, and not the $138 charged by my doctor. Or is this not allowed and they must pay the bills in full?
3. Is the amount of pain and suffering($2500) fair? I guess it comes down to whether they can adjust my medical bills totals as too high? I know the norm/average you mention is 2-4 times your medical bills, and even if they are allowed to adjust the bills, their offer still seems too low.
I also don't follow their logic in terms of my claim and my daughter's. When they made the offer on her claim, the adjuster told me that since her injuries were very minor, they would only pay out a grand total of 2x the medical bills. But my bills are much more, my injuries more severe, and the treatment was much longer and they only want to pay out less than 2x my bills. I would have thought if they were willing to pay out 2x the bills for my daughter, then they should be willing to pay out 3x my bills due to the increased severity of injury, pain and treatment received.
Sorry I seem to go on and on. I just want to paint the whole picture for you.
Thank you very much.
AnswerHi Alex,
I know this whole process can seem quite confusing, and it is that way by design. Contrary to popular belief, the first job of an insurance adjuster is to NOT pay claims. The insurance company has spent years developing systems, formulas and talking points to help there adjuster to NOT pay claims.
That having been said, it's all about negotiation. The claims adjuster is not a doctor. If the claims adjusters says that your bills seem too high, then ask him/her to call your doctor to get the doctor to accept what the insurance company thinks is fair. If he won't do that, then tell him he has no choice but to pay the full amount or you will file suit against his insured. And yes, with your extent of injuries and treatment, 3 times the meds is fair.
As for your daughter, under the circumstances, it seems fair.
You just have to be willing to stay in the game. The first one to flinch, loses. Just keep telling the adjuster about your pain and suffering, your inconvenience, your time off work, etc..
I hope this helps
Richard Hixenbaugh
