Insurance man says he can only give me x dollars

November 20, 2022 4:21 PM

So, this happened.

I took some of your advice and lo and behold their insurance man called me and was available when I called back. Amazing what happens when you get a hold of your state insurance commission.

He then told me he is only allowed to pay me for the first month and a half to two months from the date of the accident (My treatments went from June to, I don't know, December), thereby reducing the amount to 1/3 to 1/4 of the original claim. He has all the paperwork.

Have you ever heard of such a thing or is he BSing me? YANM Insurance Agent.

Thanks.

posted by Rumi'sLeftSock to Work & Money (9 answers total)

Response by poster: Oh, this (the other parties' insurance) is Liberty Mutual, in case that matters.
posted by Rumi'sLeftSock at 4:45 PM on November 20, 2022

Read your policy. Usually there is a cap on medical payments. What I have seen is a numerical cap but I suppose there could be a time cap. But that’s beside the point. The med pay cap is one thing- the liability cap is another. You’re looking for what the other guy would have to pay if you sued them. The cap on that should be higher. Call your insurance commission back and the magic words are “bad faith claim adjustment.”
posted by kerf at 6:03 PM on November 20, 2022 [4 favorites]

Have you sought out a personal injury lawyer? All your frustrations will go away if an attorney agrees to take your case.
posted by citygirl at 6:07 PM on November 20, 2022 [2 favorites]

Response by poster: citygirl, I did talk to one (came highly recommended by the one I had that finally retired) and he said as nicely as he could that it wasn't enough ( <1K ) for him to take the case. But, I paid everything out of pocket and it's still a lot of money to me, that I'd like to get reimbursed for.
posted by Rumi'sLeftSock at 7:28 PM on November 20, 2022

I have never heard of a time limit on treatment they will cover. Injuries from accidents can be long lasting and take time diagnose and treat and the insurance company is on the hook for that.

To the extent that the dollar amount it too low for an attorney to get involved you could file a small claims action. Usually if a suit is filed the insurance adjuster will have to hand that file over to a litigation adjuster who will likely see that it will cost them more to respond to the suit than just pay a low dollar claim.

Get copies of police reports, all bills that you have paid for treatment, medical records if any etc. and file suit.
posted by unreasonable at 5:10 AM on November 21, 2022

Sue the other driver in small claims court. The other driver is responsible for all the harms and losses he caused by his negligence. If your medical treatment lasted from June to December, and the records show that it was all related to the injuries you sustained from the wreck, then the other driver is responsible for paying that (and your pain and suffering, etc etc).

If you're only out 1K, another good strategy is to use your own policy's medical payments coverage (I'm assuming you live in a medpay and not a PIP state). Your own insurance carrier can subrogate whatever medpay they pay out from your liability settlement, but if you just want your medical bills paid and then you're going to drop the whole thing you don't have to worry about that.

Insurance adjusters exist to pay as little as possible for insurance claims. Don't trust them.
posted by lockestockbarrel at 6:14 AM on November 21, 2022

The $1000 you paid out are directly for medical fees. What about pain and suffering? That's why personal injury attorneys are important, because they sue not only for direct costs but for the pain and suffering you have suffered. Perhaps you can discuss this aspect with an attorney, or even the person you already consulted. There is a clear understanding among insurers that pain and suffering can be assessed, has value, and settlements are often paid to those experiencing sequelae from an injury. The medical bills will, of course, be paid to you as well.

You might be able to file in small claims court, but I reiterate that a personal injury attorney will make the frustrations go away, but only if you have had pain and suffering that will make taking your case worth his/her while, since attorneys are paid only if a financial settlement is agreed on. You will have to share the settlement, typically 50% of any pain and suffering award, but something is better than nothing, and you will not have to deal with any of the details. Good luck.
posted by citygirl at 7:49 AM on November 21, 2022 [1 favorite]

Seconding what citygirl is saying. I can't imagine handling this without an attorney.
posted by Ahmad Khani at 2:08 PM on November 21, 2022

Some years past, I was injured badly by being hit by a passenger exiting her husband's vehicle while I was in the bike lane. I was able to get an attorney who coordinated communication with both my insurance company and that of the other party.

The attorney did not charge me a retainer, but instead took 33% of the settlement as their fee, contingent upon my being awarded for pain and suffering. They were able to negotiate a much higher (and frankly justifiably higher) settlement than I would have been able to obtain on my own. This more than recouped my health insurance premiums and other costs (such as loss of work salary, due to length of rehabilitation).

What you choose to do is up to you, of course, but from personal experience, I would very strongly recommend to you that you look for such an attorney, because they will have the expertise to deal with insurance companies, representatives, and navigate the minutiae of local and state laws.
posted by They sucked his brains out! at 11:06 PM on November 21, 2022