Insurance: Minor, but persistant back injury after auto accident?

September 7, 2006 9:42 PM

Auto Insurance: I was rear-ended in a 3-car accident about a month ago at slow (<15 mph) speed. My back has been hurting...how do I handle this with the liable insurance company?

First the facts:

Accident details: Car #1 = Me. Driving in traffic, when traffic stops. Car #3 doesnt stop, hitting Car #2, which hits Car #1. Elderly lady in Car #2 taken to hospital due to chest pains.

Insurance details: Car #3 has taken full responsibility (State Farm Insurance), and is paying off my deductable and rental car while my car's in the shop.

Medical details: Neck was a bit stiff after the accident. Went to doctor the next day complaining of stiff neck and some back pain. She checked me out and said it may get worse over the next week or so. It did indeed, then it got somewhat better, but I'm still getting back pain (sometimes lower back, sometimes upper back), particularly when sitting for a long period of time (like on car trips). This is abnormal.

Followup insurance details: Speaking with the State Farm rep, he's indicated that they are not willing to pay off any settlements, and if I want any money for my injury, I would have to go get treated, release my medical file to them, and they will determine whether they wish to reimburse me.

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State Farm's "go spend money, and maybe we'll pay you back" is not the most reassuring thing I've ever heard. What do I do at this point? If possible, I would rather go to a private doctor than my doctor at Kaiser. From an insurance standpoint, is a chiropractor a doctor? Seems like there's not very much hard diagnostic stuff to do about back muscle pains.

I feel somewhat uncomfortable bitching and moaning about nondescript back muscle pain that isn't there all the time, but the fact of the matter is that I didn't have this before the accident, and it hasn't gone away after almost a month. Where is the ethical line between what's reasonable and what's trying to screw the insurance company?

Anyone been in this position and have some advice?

posted by sdis to work & money (8 answers total)

This exact scenario happened to me years ago, and I did get paid for medical bills and loss of wages. The key is documentation. You need to document an actual loss, not just talk about your pain in general terms.

So essentially, State Farm is right here. The insurance adjuster isn't going to authorize a payout just because you say you're owed some money.

In other words, it's the difference between "my back hurts, pay up" and "My back was hurting after the accident so I went to a doctor and paid X dollars and he said I was suffering from condition Y, which was likely caused by the accident."
posted by frogan at 9:49 PM on September 7, 2006

I was involved in a similar situation, but I didn't go through the other driver's insurance at all. My insurance company took care of all my expenses, then collected from the other driver's insurance on my behalf.

It might be worth contacting your insurance company and finding out what they recommend; at least then you've got a professional advocate without having to hire an attorney.
posted by jknecht at 10:06 PM on September 7, 2006

P.S. - I had the same kind of back pain you're decribing (the pain went away several weeks after adopting a regular morning and evening stretching routine). Something tells me that it's not unusual, and you shouldn't have any problem collecting for doctor visits and prescriptions.
posted by jknecht at 10:09 PM on September 7, 2006

you will face quite some trouble considering you waited this long. go see the doc again, maybe you can get away with calling it continued treatment. the insurance company will most likely try to get away with not paying by saying you waited this long, ergo it must have been caused by something else.

good news is you were rear-ended. the other party is at fault. period. their insurance will have to cover the cost in the end, making your insurance a lot less inclined to be nasty to you, who after all does pay premiums to ...oh yeah, them! oh, golly.

call their insurance. get a chiropracter.
posted by krautland at 10:14 PM on September 7, 2006

IANAL, but a very similar thing happened to my then-girlfriend a few years ago (rear-ended at low speed). We had to go into a protacted settlement negotiation. Here is what I learned:

1) The other driver is at fault, and thus liable for whatever costs you incur as a result of the accident, including all medical costs. Period. This includes material costs of fixing the car, car rental costs, medical expenses, lost time from work, etc.

2) Everything is negotiable. Do not take their initial refusal to pay for something as the final word. In my GF's case, they wound up paying for physicians, physical therapy, and a chiropractor. You are not screwing them out of money - you are being justly reimbursed for the expenses incurred from an accident that was not your fault.

3) Do not settle prematurely. Wait until you have a good idea of what all of your expenses are before signing a final settlement (I do hope you haven't done so already). The insurance company may try to settle as quickly as possible, probably by offering a lump sum that sounds like a nice big number but may not actually cover all of the eventual costs.

4) Do not underestimate the damage that has been done, or the time it takes for you to heal. In a rear-end collision, even a low-speed one, there is the possibility that injuries will take weeks to become evident. My GF was hit by a driver who was only going about 20 MPG, but still had a bad case of whiplash and pain and back problems that lingered for months, led to missed days of work, and required several forms of therapy.

5) Document everything. This includes all medical expenses, as well as specific details of your pain (e.g., a diary). Documenting things indicates the seriousness of your claim, and strengthens your position.

6) If this develops into a significant amount of money, you might consider seeing a lawyer before negotiating a settlement, to get advice on how to approach the negotiation. I paid a lawyer $100 for an hour's worth of advice on how to present my case and what to expect, and it was well worth it.

I also agree with the advice of contacting your own insurance company, who may (or may not) act as an advocate for you.

Good luck.
posted by googly at 11:54 PM on September 7, 2006

It sounds a lot like when my sister got whiplash. Can't really offer any advice re: the insurance situation, but DO get treated!
posted by antifuse at 1:05 AM on September 8, 2006

You didn't mention what state you live in, but in some states, you must go through your own auto insurance company if you're injured. For instance, in Florida you have Personal Injury Protection coverage (and only after your 10K limit is exhausted would the other party's Bodily Injury coverage apply - or your Uninsured Motorist coverage if you carry it), in some states you'd carry Medical Payments coverage which would serve the same purpose.

If you live in a state where it's routine for the tortfeasor's Bodily Inury coverage to apply, then your doctor's office may be willing to direct bill the insurance company (you'd need to take your claim number with you and whatever other pertinent information you have).

FWIW, IAAIA (I am an insurance agent, but possibly not where you live, and coverage conditions differ from state to state). I encourage you to contact your own insurance company. Even if you don't live in a medical no-fault state, you might carry an optional coverage like Med Pay that will take care of your medical bills.
posted by mewithoutyou at 6:17 AM on September 8, 2006

Get a lawyer. Get a lawyer. My wife is in pretty much the same position as you are, and having a lawyer makes the whole process much, much easier. Not all personal injury lawyers are slimy ambulance chasers; get a recommendation, do some research, but, by all means, get a lawyer. You likely won't have to go to court, won't have to go through a whole big lawsuit routine--it doesn't have to be a big deal. It's immensely comforting to us that there's an expert who's dealing with the insurance company, translating all the legal stuff for us, taking care of all the administrative stuff. If you're in the DC area, I can even give you a referral.
posted by MrMoonPie at 6:56 AM on September 8, 2006