QuestionA auto insurance claim was filed by the driver who hit me, in a crosswalk, while I was walking through. I also filed a claim with my auto insurance company and am submitting some doctors bills to my insurance company as per their instructions. However my physical therapy and CT Scan was done at UCLA and I assume went through Medicare. My question is: the drivers insurance company is sending me correspondents as to what they will pay and who is at fault. So, do I answer back to the drivers insurance and CC my auto insurance or just inform my insurance company of the letter and phone call I have received from the drivers insurance company?
AnswerHi Don,
The question you asked falls within the area of subrogation rights (of your own insurer) and subrogation duties (of you, the one whose claim they will tap to get repaid—in full or in part or not at all depending upon your state and facts of your case). But most likely, your insurance company will get repaid a major part of what they put out to cover your medical expenses.
The best direct answer to your question is to answer (some or part of, as I will discuss below) the tortfeasor’s adjuster, sending a copy to your own first party carrier. The reason is: as part of your duty to your own company (i.e. you must protect THEIR interests in your award), you will need to communicate with the tortfeasor’s company. And, of course you are correct: you will want to keep your company up to speed on what is happening. Sidebar here: below I will address the possibility that you might have an underinsured tortfeasor, leading you to make a claim against your own Uninsured Motorist Coverage (UIM).
That is the end of my answer, as you asked it, Don, and the end of the response from most experts here—they give that short answer and tell you to go and find an attorney since with your doctor feeling it necessary to use a CT scan, you must have significant injuries. Hence, “send the letter, copy to your insurer and find an attorney” is what you would have received for your answer from most experts here.
To the contrary, I am going to make you do some work—to read some free pages on our self help insurance claims www.SettlementCentral.Com online legal advice website. NO, you do NOT have to purchase a membership with us—the pages I am going to give to you are free and you can find a lot of free legal advice SettlementCentral.Com online insurance help, with no need to shell out a membership fee.
So, Don, having received the answer to your question, you can skip what I am going to give to you, or you can invest some time to get up to speed on bodily injury www.SettlementCentral.Com insurance claims. All I am going to do is to put it out there for you, since I DO see it as my duty to you to give you as much information as necessary to cover a serious claim. Please take a moment to re-read that: I am—at least in my opinion as an expert here—duty-bound to assume the most serious scenario of each claim, and to respond to each claim as if it were in fact a serious claim. That way, I will have given you a lot of information, and you can pick and choose what you want to read and what you want to skip. And my feelings will not be hurt if you skip a lot of my “stuff” (my newest legal term=”stuff”!). And even if you were to open every page I give to you, I would expect you to just skim most of them so you get a general idea of the bodily injury self help claims process, and you also know where to come back to in case you need additional information. OK, Don? Let’s get started then.
Because the only question you really asked has its basis in the subrogation area, I will address that first. Here is the background information on “subro”, which is the forced payback to YOUR OWN insurer from your personal injury award http://www.settlementcentral.com/page0459.htm
Once you have had a look at that page, we can move forward to understand that you have a contractual duty owed to your own company to “do no harm” to your claim, to protect your claim for the benefit of your own insurer, and to cooperate with your own insurer. All of this does not mean you are without weapons to fight subrogation, but that is another separate topic.
If you want to fight your own company’s subro claim, or any part of it, you may write me again with the details and I will see what help—if any—there might be to defend the claims. In that case, be sure to tell me what state your contract was issued in and what state the accident was in since your rights to defend subrogation depend a lot upon whether you live in a “red” state, where the legislators are in bed with the insurance industry, or a “blue” state, where they listen to the trial lawyers who speak for the injured victims, who had the foresight to buy insurance and hence claim that subrogation is an equitable right, not a contractual right.
UIM CLAIM?
The only tangential topic I will toss in here, Don, since we are on subro rights, is to be aware of your duties should you have a claim with value far in excess of the tortfeasor’s policy limits. In that case, there are specific duties owed to your company that are conditions precedent to your right to (1) defend your own company’s subro claim, and more importantly, (2) to bring any claim at all under your own Underinsured Motorist Coverage (UIM). So read the following and write to me again if this turns out to be the case.
Directory of Legal Information on Liability Insurance Policy Limits Settlements in Personal Injury Insurance Injury Claims http://www.settlementcentral.com/page0451.htm Car Accident Injuries
My concerns about LIABILITY & RECORDED STATEMENTS.
In this part, I am going to discuss what you wrote that gives me pause about liability and how that impacts your decision on whether or not to give a recorded statement. And do not skip all of it just because you already may have given a statement—you might want to learn additional topics they might come back to next time they ask for a follow-up statement. AND at the end, I will tell you what to do if you have already given a recorded statement.
OK, Don, moving on to parts of your question. You mention two times words that give me pause that this is not one of those “hit-me-in-the-crosswalk” undisputed liability claims. First, you stated that the tortfeasor made a claim, but you do not say what it was for or to whom he made the claim. Was this just a claim for repair of his vehicle made on his own company, or was it a claim against YOU made to your own liability carrier?
And the topic of liability comes up once again in the next-to-last sentence where you state that his insurer is writing to you “as to what they will pay and who is at fault.” I am not at all troubled about the part discussing “what they will pay” since these days it has become their job to fight every dime of medical care. So their pursuit of that might end up showing itself in your life in two ways: (1) they will want to grill you on the phone as often as they can, because they will be able to find discrepancies between what they get you to say, versus what your medical records say; and (2) later, if your care continues, they may likely as not require you to undergo a so-called “independent” medical examination (IME).
The first part of this, above, you and I can deal with today. And I am going to give you a brief link to an IME free www.SettlementCentral.Com online insurance help page. But if they do request an IME, then write to me right away since that is an entirely different topic. Our insurance claim website SettlementCentral.Com has an IME Module with a ton of “stuff”, much of which I never even thought of when I was practicing.
For our purposes today, what is the significance of the tortfeasor signaling that it is challenging liability?
FIRST and foremost AVOID all phone calls and ESPECIALLY do not agree to let them record you. The tortfeasor has no right whatsoever to make a recorded statement, and there is absolutely NO ADVANTAGE to you in doing so. NO, Don, you are NOT going to out-wit the adjuster or “baffle her with bulls#&t”. The recorded phone conversation is her turf, and even what you think went well for you will have surprisingly adverse impacts down the road. She knows how to go after the information she wants, and she can pin you in a corner without too much effort.
Here is why I do not want you to give any recorded statements. Recorded Statements to Insurance Adjusters: http://www.settlementcentral.com/page0206.htm
Here is the “Communicate” page of our 5 Easy Steps to Do-it-yourself insurance claim settlements http://www.settlementcentral.com/page0105.htm
If you do decide to give any adjuster a recorded statement, then please read the following two pages so you can get a general idea of the scope and depth of the inquiry—and thus will not be surprised and lose track of your thoughts. Oh, and in case it is not in these pages, do not guess about any answer. If you are not sure about anything, just say so. OK?
Outline of questions to be expected from insurance claims adjuster http://www.settlementcentral.com/page0190.htm
Detailed listing of questions to be expected from insurance claims adjuster http://www.settlementcentral.com/page0207.htm
QUESTION by DON: “But I did not know all of this, and I ALREADY gave a recorded statement. What should I DO NOW?”
Insurance claim expert Dr. Settlement ANSWER: No worries, Don. Here are two pages that tell what to do now if you have already given a recorded statement to the adjuster.
http://www.settlementcentral.com/page0058.htm Recorded or Written Statement To The Adjuster After Injury Accident?
http://www.settlementcentral.com/page8014.htm What to do if you have already given a recorded statement to the insurance adjuster
Final note on the general topic of “communications”. As I am going to tell you at the end of this: try to do most of your business via e-mail since the phone is the home turf of the adjuster. This page tells you to respond to her offer of settlement via writing.
Responding to Settlement Offer From Insurance Claims Adjuster http://www.settlementcentral.com/page0244.htm
QUESTION by DON: “I wanted my bills to go through my own insurer. Was that the best thing for me to do, and should I CONTINUE to use my own insurer to pay the bills?”
Insurance claim help Dr. Settlement top online expert ANSWER: YES, Don, you did the right thing, at least in my opinion. If it were my own claim, I would use my health insurance first, my own auto insurance second, and never ever use the tortfeasor’s insurance unless absolutely necessary (i.e. my own limits are exhausted and the doctor will not accept an irrevocable lien).
Who should one select to pay the medical bills as you continue to treat? Here is a page with information on the advantages and disadvantages of using your own auto insurance versus your own health insurance versus relying upon the tortfeasor’s insurance.
Personal Injury Insurance Claim: Insurance Company Payment of Medical Expenses as Incurred http://www.settlementcentral.com/page0201.htm
And here is a page about the so-called “Independent” Insurance Medical Examiner
http://www.settlementcentral.com/page0044.htm
You might want to give me a shout, Don, if you do get one of those ominous letters that tell you they have scheduled you for an IME. We have an entire IME Module in the auto wreck injury www.SettlementCentral.Com insurance claim help online website.
Serious claim or not? When I saw that note about the CT scan, I kind of wondered whether yours might be a more serious claim. I have a number of free pages that can give you some guidance on how to make such a claim on your own, without hiring an attorney. Too bad, though, that those pages cannot work magic: someone still has to do the work that the attorney’s staff was going to do. Hence, we do have lists of instructions and ideas on how to proceed at that car accident www.SettlementCentral.Com bodily injury claims website.
And if you were to give me another question once you learn from the doctors just how serious your claim is, I can provide you with a few free pages of information and tips to give you a good start.
Learn how to communicate with the insurance adjuster: FINAL TOPIC—COMMUNICATE IN WRITING AND "DEMAND" NOT "ASK"
FINAL TOPIC, Don: Effective communication with insurance claims adjusters. Establish Firm, Professional, and Positive Relationships With the Insurance Injury Claims Adjuster http://www.settlementcentral.com/page0059.htm
Always communicate with the adjuster in writing, showing your own analysis of value. It is OK I guess to have one call or so, but no more. Always have your information and ammunition in writing to give to the adjuster. E-mail is the preferred means since it is fast and provides evidence of what was said.
Let her know that you are FIRM IN YOUR RESOLVE to get what you are demanding (NOT "asking", since that invites a counter-offer, but instead "demanding" as fair and reasonable compensation) by asking her what the options are to resolve the matter fairly should he not agree to a reasonable claim value. In other words, let her know that you will go through with a court filing if need be.
Remember these tips, do your homework, print out your evidence, show resolve to get your fair settlement, and you will DO JUST FINE.
I trust that my extra time here has produced some information that has been of value to you, and thus I would respectfully request that you take the time to locate the FEEDBACK FORM on this site and leave some feedback for me.
Best Wishes,
Dr. Settlement, J.D. (Juris Doctor)
http://www.SettlementCentral.Com
subrogation duties, Dr. Settlement, UIM, www.SettlementCentral.Com, recorded statement, write to adjuster
