Settling after an accident
June 18, 2014 11:52 AM Subscribe
How do I negotiate an accident settlement without getting taken advantage of?
On May 30, I was in an accident; I was driving through a yellow, and another driver turned and hit me. She was cited for failure to yield to oncoming traffic. My car has been taken care of; I have already received a settlement and purchased a new car. The only thing left is dealing with the other driver's insurance company and settling for medical and pain and suffering. I had some nasty looking bruises on my wrist, chest and abdomen that took about a week to heal, but that's it as far as injuries. I declined an ambulance at the scene, but went to the ER by car later and had x-rays of my wrist and chest and an MRI of my abdomen. I don't anticipate any further health issues as a result of this accident.
An adjuster from the other driver's insurance company has been in touch a few times, and he wants me to fill out a release for my medical records. Is this a terrible idea? I have already made a recorded statement, which may have been a mistake, I don't want to screw this up any further. Should I write a demand letter? My health insurance paid my medical bills, and the adjuster mentioned that those would be paid to me, plus other money.
I really just want to settle this and move on, but I also don't want to accept less that I could get. I feel like the limited extent of my injuries and the fact that I declined an ambulance would make getting a lawyer a waste.
On May 30, I was in an accident; I was driving through a yellow, and another driver turned and hit me. She was cited for failure to yield to oncoming traffic. My car has been taken care of; I have already received a settlement and purchased a new car. The only thing left is dealing with the other driver's insurance company and settling for medical and pain and suffering. I had some nasty looking bruises on my wrist, chest and abdomen that took about a week to heal, but that's it as far as injuries. I declined an ambulance at the scene, but went to the ER by car later and had x-rays of my wrist and chest and an MRI of my abdomen. I don't anticipate any further health issues as a result of this accident.
An adjuster from the other driver's insurance company has been in touch a few times, and he wants me to fill out a release for my medical records. Is this a terrible idea? I have already made a recorded statement, which may have been a mistake, I don't want to screw this up any further. Should I write a demand letter? My health insurance paid my medical bills, and the adjuster mentioned that those would be paid to me, plus other money.
I really just want to settle this and move on, but I also don't want to accept less that I could get. I feel like the limited extent of my injuries and the fact that I declined an ambulance would make getting a lawyer a waste.
Normally your insurance company does this. In this case your health insurance should probably do it (your health insurance will come back and go after them if you incur additional costs as a result, and they may come after you if you receive a settlement and they do not).
You may want a lawyer for yourself as part of this process, however.
posted by Lyn Never at 11:58 AM on June 18, 2014 [2 favorites]
You may want a lawyer for yourself as part of this process, however.
posted by Lyn Never at 11:58 AM on June 18, 2014 [2 favorites]
I feel like the limited extent of my injuries and the fact that I declined an ambulance would make getting a lawyer a waste.
You don't know that. Neither does anyone here. The thing to do, when being asked to waive or settle your legal rights, is to get the advice of someone licensed and able to advise you as to the implications of that waiver. That person is a competent attorney in your jurisdiction.
Your insurance company may be obligated by your policy to provide counsel, or to pay your costs of obtaining your own counsel; that is certainly worth a phone call.
Your lawyer is the only person who can adequately explain the answers to this question to you.
posted by gauche at 12:00 PM on June 18, 2014 [2 favorites]
You don't know that. Neither does anyone here. The thing to do, when being asked to waive or settle your legal rights, is to get the advice of someone licensed and able to advise you as to the implications of that waiver. That person is a competent attorney in your jurisdiction.
Your insurance company may be obligated by your policy to provide counsel, or to pay your costs of obtaining your own counsel; that is certainly worth a phone call.
Your lawyer is the only person who can adequately explain the answers to this question to you.
posted by gauche at 12:00 PM on June 18, 2014 [2 favorites]
The typical recovery in a PI settlement is 5 times what you're out in medical expenses to compensate for Pain and Suffering. This is true, with or without a lawyer. A PI lawyer will take 33% of the settlement, and for something like this, you can probably negotiate for yourself and keep more money on your side.
So:
Medical Bills (it doesn't matter if they were paid by insurance, that's a basis)
Physical Therapy
Hours lost at work
Any OTC medications
Pretty much any money you lost or spent due to the accident, times five. LET THEM OFFER FIRST! If it's MORE than 5 times your expenses, run to the bank with the check. If it's a lot less, hondle a little bit.
posted by Ruthless Bunny at 12:02 PM on June 18, 2014 [1 favorite]
So:
Medical Bills (it doesn't matter if they were paid by insurance, that's a basis)
Physical Therapy
Hours lost at work
Any OTC medications
Pretty much any money you lost or spent due to the accident, times five. LET THEM OFFER FIRST! If it's MORE than 5 times your expenses, run to the bank with the check. If it's a lot less, hondle a little bit.
posted by Ruthless Bunny at 12:02 PM on June 18, 2014 [1 favorite]
The issue is that later on your medical insurance will find out that it paid for things that should have been covered by some other insurance, namely the other driver's auto insurance. It's not a big deal for you, you will still be covered, still got treated, but it will take years to settle out if you don't get all the various insurances talking to eachother.
Only annoyances for you: if you need any further treatment, you will need to claim against auto insurance. This can be very annoying as the vast majority of doctors offices will not claim to auto insurance, only medical. You'll need to figure out your service provider's policy regarding payment, as you might have to pay at time of service, and wait for reimbursement.
Annoyance #2: Should you have something happen to your wrist in the future, insurance may want you to claim against other driver's insurance. Even if it was something like "burned wrist on frying pan", they'll see "left wrist" pop up and throw some mail at you.
If you are happy to walk away with being made whole again, no need to contact a lawyer. But you will probably not get much cash, if any.
posted by fontophilic at 12:03 PM on June 18, 2014
Only annoyances for you: if you need any further treatment, you will need to claim against auto insurance. This can be very annoying as the vast majority of doctors offices will not claim to auto insurance, only medical. You'll need to figure out your service provider's policy regarding payment, as you might have to pay at time of service, and wait for reimbursement.
Annoyance #2: Should you have something happen to your wrist in the future, insurance may want you to claim against other driver's insurance. Even if it was something like "burned wrist on frying pan", they'll see "left wrist" pop up and throw some mail at you.
If you are happy to walk away with being made whole again, no need to contact a lawyer. But you will probably not get much cash, if any.
posted by fontophilic at 12:03 PM on June 18, 2014
Get a lawyer. If your injuries really are as limited as you think you are, a lawyer wouldn't take the case (they wouldn't make any money). If you can get a lawyer, your injuries are not as limited as you think they are. You will really quickly determine your situation via one or two (free) consultations with a couple lawyers.
From my experience, the benefit of getting a lawyer is not primarily in the extra money you'll get, but in getting all parties coordinated as to who is paying for what. Until you have a serious accident, it's not actually obvious that none of the parties involved (medical or automotive) care about the accident; they only care about getting paid. Further, insurance companies are incentivized to pay as little as possible, so you will very quickly find yourself talking to people that expect to be paid regardless of your insurance situation and insurance companies that don't want to pay anything without being legally forced to. It isn't a fun situation to be in, and the lawyer will help you navigate through the bureaucracy.
Finally, note that your medical insurance company has not really paid your bills. Your medical insurance company has paid bills but is still part of the insurance process via subrogation. Your medical insurance company expects to be reimbursed for the bills they pay.
Normally your insurance company does this.
This is incorrect. If the OP has liability-only car insurance, the OP's insurance company has no part in this exchange, since they paid no money. If the OP has comprehensive car insurance, the OP's insurance company will only get involved to the point of getting the money associated with the physical damage to the car reimbursed. In general, the OP's medical insurance company will not actively take part in the reimbursement process, since they get reimbursed via settlement. Unless the OP settles for a truly ridiculously low amount (less than their medical bills), the medical insurance company will not do anything, since they will end up fully reimbursed. Personal injury lawyers also attempt to get medical insurance companies to accept less-than-full reimbursement, which gets a bit more money back.
In other words, only the OP or the OP's lawyer is responsible for reimbursement beyond actual costs incurred (for instance, pain and suffering settlements).
The typical recovery in a PI settlement is 5 times what you're out in medical expenses to compensate for Pain and Suffering.
This statement is incorrect and should be ignored. Even a quick Google search reveals this not to be the case.
posted by saeculorum at 12:06 PM on June 18, 2014 [4 favorites]
From my experience, the benefit of getting a lawyer is not primarily in the extra money you'll get, but in getting all parties coordinated as to who is paying for what. Until you have a serious accident, it's not actually obvious that none of the parties involved (medical or automotive) care about the accident; they only care about getting paid. Further, insurance companies are incentivized to pay as little as possible, so you will very quickly find yourself talking to people that expect to be paid regardless of your insurance situation and insurance companies that don't want to pay anything without being legally forced to. It isn't a fun situation to be in, and the lawyer will help you navigate through the bureaucracy.
Finally, note that your medical insurance company has not really paid your bills. Your medical insurance company has paid bills but is still part of the insurance process via subrogation. Your medical insurance company expects to be reimbursed for the bills they pay.
Normally your insurance company does this.
This is incorrect. If the OP has liability-only car insurance, the OP's insurance company has no part in this exchange, since they paid no money. If the OP has comprehensive car insurance, the OP's insurance company will only get involved to the point of getting the money associated with the physical damage to the car reimbursed. In general, the OP's medical insurance company will not actively take part in the reimbursement process, since they get reimbursed via settlement. Unless the OP settles for a truly ridiculously low amount (less than their medical bills), the medical insurance company will not do anything, since they will end up fully reimbursed. Personal injury lawyers also attempt to get medical insurance companies to accept less-than-full reimbursement, which gets a bit more money back.
In other words, only the OP or the OP's lawyer is responsible for reimbursement beyond actual costs incurred (for instance, pain and suffering settlements).
The typical recovery in a PI settlement is 5 times what you're out in medical expenses to compensate for Pain and Suffering.
This statement is incorrect and should be ignored. Even a quick Google search reveals this not to be the case.
posted by saeculorum at 12:06 PM on June 18, 2014 [4 favorites]
I will say that I waited a while after my injuries were well and truly healed before settling. (Years) but I was pretty messed up. But, if you and your doctors are sure that you're okay, and that there are no lingering effects, you can feel good about setlling.
There is also Subrogation, which gives your Auto and Health insurance the right to go after the other guy for their expenses. They will do this, it's nothing to do with you. Just make sure that your settlement is for Pain and Suffering ONLY.
posted by Ruthless Bunny at 12:06 PM on June 18, 2014
There is also Subrogation, which gives your Auto and Health insurance the right to go after the other guy for their expenses. They will do this, it's nothing to do with you. Just make sure that your settlement is for Pain and Suffering ONLY.
posted by Ruthless Bunny at 12:06 PM on June 18, 2014
Also see if your employer offers any health insurance navigation hotline, and for that matter, legal counselling services.
posted by fontophilic at 12:06 PM on June 18, 2014
posted by fontophilic at 12:06 PM on June 18, 2014
This is incorrect. If the OP has liability-only car insurance[...]
OP's *health* insurance. Who have already paid for treatment, and will not want to have paid for treatment if they find out someone else should have paid for it.
posted by Lyn Never at 12:08 PM on June 18, 2014
OP's *health* insurance. Who have already paid for treatment, and will not want to have paid for treatment if they find out someone else should have paid for it.
posted by Lyn Never at 12:08 PM on June 18, 2014
Came back to say that saeculorum may be right. It's been a few moons since my settlement, but that is what my lawyer told me.
Here is more indepth information on the subject of the ballpark of a settlement.
Here's a calculator that uses what my lawyer told me though, so I'm not talking entirely out of my ass.
I'm not a lawyer, this is not legal advice per se, just some things to consider.
posted by Ruthless Bunny at 12:13 PM on June 18, 2014
Here is more indepth information on the subject of the ballpark of a settlement.
Here's a calculator that uses what my lawyer told me though, so I'm not talking entirely out of my ass.
I'm not a lawyer, this is not legal advice per se, just some things to consider.
posted by Ruthless Bunny at 12:13 PM on June 18, 2014
Lawyer up. Personal injury attorneys work on contingency. They'll take about a 1/3 of your settlement, so if you don't get anything they don't either. My wife walked away from an accident a few years ago, yet the settlement still ended up about $11k for medical, pain and suffering. That was about 2-3 times our out of pocket on medical, IIRC.
posted by COD at 12:40 PM on June 18, 2014 [1 favorite]
posted by COD at 12:40 PM on June 18, 2014 [1 favorite]
Get a lawyer. It's honestly probably the least amount of hassle, because your lawyer will do all the talking to the various insurance companies and will ensure you don't get screwed. Frankly, I think not having to deal with the paperwork and talking to people is worth the contingency cut a PI laywer will take.
posted by yasaman at 12:58 PM on June 18, 2014 [1 favorite]
posted by yasaman at 12:58 PM on June 18, 2014 [1 favorite]
I have nothing to say about whether or not you should lawyer up or whether or not you have already made any mistakes in how you have handled this. And I know nothing about things like pain and suffering compensation. But I was an adjuster, so I will address this piece:
An adjuster from the other driver's insurance company has been in touch a few times, and he wants me to fill out a release for my medical records. Is this a terrible idea?
The release for medical records they are requesting is in compliance with federal law (HIPAA) and they need it in order to find out what treatment you got and what it cost. Since they are not your health insurance company, they cannot request any records of yours without a signed authorization. As far as I know, this in no way is an agreement concerning what they owe you. It is a formality so they can start acquiring records at all.
If you have standard American health insurance, you are likely used to your health care provider handling all this and just sending bills to the insurance company. It is probably all very out of sight, out of mind. But, whether you recall it or not, you had to sign an authorization with them at some point which they have on record or they could not do that. Any time an insurance company which is not your default major medical insurance needs records of this type, they need an authorization from you or they can do absolutely nothing.
So the odds are good that you can't get any medical reimbursement until you sign the release so they can start the process of gathering records. Some options include asking to make sure the release specifies that it covers only treatment from x date to x date related to this specific accident (under HIPAA, it is illegal for them to ask for more records than they really need here -- digging around in other records is a potential HIPAA offense/fine) or asking if you can get copies of records and bills yourself and forward them to the insurance company. But if you want money from them, somehow, they need records to base it on.
Source: I paid insurance claims (accident insurance -- supplemental health, not auto) for over five years for a Fortune 500 company. I had annual HIPAA training and I routinely requested authorizations so I could then request medical records so I could cut a check. No records = no check.
posted by Michele in California at 2:07 PM on June 18, 2014 [1 favorite]
An adjuster from the other driver's insurance company has been in touch a few times, and he wants me to fill out a release for my medical records. Is this a terrible idea?
The release for medical records they are requesting is in compliance with federal law (HIPAA) and they need it in order to find out what treatment you got and what it cost. Since they are not your health insurance company, they cannot request any records of yours without a signed authorization. As far as I know, this in no way is an agreement concerning what they owe you. It is a formality so they can start acquiring records at all.
If you have standard American health insurance, you are likely used to your health care provider handling all this and just sending bills to the insurance company. It is probably all very out of sight, out of mind. But, whether you recall it or not, you had to sign an authorization with them at some point which they have on record or they could not do that. Any time an insurance company which is not your default major medical insurance needs records of this type, they need an authorization from you or they can do absolutely nothing.
So the odds are good that you can't get any medical reimbursement until you sign the release so they can start the process of gathering records. Some options include asking to make sure the release specifies that it covers only treatment from x date to x date related to this specific accident (under HIPAA, it is illegal for them to ask for more records than they really need here -- digging around in other records is a potential HIPAA offense/fine) or asking if you can get copies of records and bills yourself and forward them to the insurance company. But if you want money from them, somehow, they need records to base it on.
Source: I paid insurance claims (accident insurance -- supplemental health, not auto) for over five years for a Fortune 500 company. I had annual HIPAA training and I routinely requested authorizations so I could then request medical records so I could cut a check. No records = no check.
posted by Michele in California at 2:07 PM on June 18, 2014 [1 favorite]
I am a lawyer. I often recommend to my clients that they wait until at least six months after the accident to think about making a claim, filing suit, determining the extent of injuries, etc.
I agree with Michele that asking for a medical authorization is routine. They will want to review the records to determine what your injuries are. So will the lawyer you consult.
Give them the authorization on the condition that they provide you with a copy of the records that they obtain, at their expense.
posted by megatherium at 3:10 PM on June 18, 2014 [2 favorites]
I agree with Michele that asking for a medical authorization is routine. They will want to review the records to determine what your injuries are. So will the lawyer you consult.
Give them the authorization on the condition that they provide you with a copy of the records that they obtain, at their expense.
posted by megatherium at 3:10 PM on June 18, 2014 [2 favorites]
The typical recovery in a PI settlement is 5 times what you're out in medical expenses to compensate for Pain and Suffering. This is true, with or without a lawyer.
Chiming in to say this does not sound right. In my experience, PI settlements are so fact-specific that they are hard to generalize, but if I had to generalize, a 5x multiplier on medical expenses to reach a pain and suffering figure sounds high.
posted by craven_morhead at 3:18 PM on June 18, 2014 [2 favorites]
Chiming in to say this does not sound right. In my experience, PI settlements are so fact-specific that they are hard to generalize, but if I had to generalize, a 5x multiplier on medical expenses to reach a pain and suffering figure sounds high.
posted by craven_morhead at 3:18 PM on June 18, 2014 [2 favorites]
My health insurance paid my medical bills, and the adjuster mentioned that those would be paid to me, plus other money.
Some others have kind of talked around this, but to be clear, you will have to give the money for your medical bills to reimburse your medical insurance company.
posted by empath at 3:24 AM on June 19, 2014 [1 favorite]
Some others have kind of talked around this, but to be clear, you will have to give the money for your medical bills to reimburse your medical insurance company.
posted by empath at 3:24 AM on June 19, 2014 [1 favorite]
Another reason they are asking for medical records is that they are fishing for a way to blame you for the accident. Take a prescription drug that makes you drowsy? Maybe it was affecting your ability to drive. This is not hypothetical. In the accident I referenced above, the other drivers insurance company tried to use my wife's Type I diabetes against her. Luckily our lawyer basically told them to either produce a blood sugar reading from the time of the accident, or GTFO. Do you have that kind of backbone to stare down a team of lawyers?
Another thing, a lawyer will make sure the medical release form is clean, and not full of extraneous legalese that impacts your right.
Don't trust either insurance company, both are primarily interested in minimizing their payout, and if you are collateral damage, they don't care. The only one on your side here is the lawyer you hire.
posted by COD at 5:22 AM on June 19, 2014 [1 favorite]
Another thing, a lawyer will make sure the medical release form is clean, and not full of extraneous legalese that impacts your right.
Don't trust either insurance company, both are primarily interested in minimizing their payout, and if you are collateral damage, they don't care. The only one on your side here is the lawyer you hire.
posted by COD at 5:22 AM on June 19, 2014 [1 favorite]
Get your insurance company involved. Including health insurance. If they paid out money to treat you for injuries the other insurance company is on the hook for, they are probably going to want that money back -- whether from you (if you had settled the case already) or the other insurer (if you have not).
posted by J. Wilson at 5:31 AM on June 19, 2014
posted by J. Wilson at 5:31 AM on June 19, 2014
Your auto insurance company is normally who handles this. They're likely already involved for a major accident with injury, and you have a claim number. Don't answer anything from the other driver's insurance company; refer them to your insurance company's claim rep.
In response to suggestions to lawyer up: Your auto insurance company employs lawyers whose full-time job is to deal with medical claims of this type; they should put you in touch with one of their lawyers, and that lawyer's fees will be covered by your policy. If you hire your own lawyer (which you can certainly do), you will need to pay him or her out of your own pocket.
Note that the other driver's auto insurance company also employs such lawyers.
It is best to have your auto insurance company handle this.
The one time I was involved in an accident where I was injured, my health insurance company declined payment of any related medical bills, saying it was the result of an auto accident and therefore the medical bills were supposed to be handled by my auto insurance company. I sent that notice and the bills to my auto insurance company and the bills were all paid. (The accident was 100% the other driver's fault.)
I think the health insurance will only kick in if your medical bills exceed the amount covered for personal injury by your auto insurance policy or the other driver's policy.
posted by tckma at 8:48 AM on June 19, 2014
In response to suggestions to lawyer up: Your auto insurance company employs lawyers whose full-time job is to deal with medical claims of this type; they should put you in touch with one of their lawyers, and that lawyer's fees will be covered by your policy. If you hire your own lawyer (which you can certainly do), you will need to pay him or her out of your own pocket.
Note that the other driver's auto insurance company also employs such lawyers.
It is best to have your auto insurance company handle this.
The one time I was involved in an accident where I was injured, my health insurance company declined payment of any related medical bills, saying it was the result of an auto accident and therefore the medical bills were supposed to be handled by my auto insurance company. I sent that notice and the bills to my auto insurance company and the bills were all paid. (The accident was 100% the other driver's fault.)
I think the health insurance will only kick in if your medical bills exceed the amount covered for personal injury by your auto insurance policy or the other driver's policy.
posted by tckma at 8:48 AM on June 19, 2014
The typical recovery in a PI settlement is 5 times what you're out in medical expenses to compensate for Pain and Suffering. This is true, with or without a lawyer. A PI lawyer will take 33% of the settlement, and for something like this, you can probably negotiate for yourself and keep more money on your side.
This sounds really off to me, pain and suffering isn't something that's automatically compensated. If you are looking for something like this you really, really need to talk to a lawyer. This is also something that varies drastically on a state-by-state basis. For example, in New York, you must sustain a "serious injury" to get compensation beyond medical bills.
I don't know what state you are in, but what was probably supposed to happen was that your medical bills should have been covered by your auto insurance and/or the auto insurance of the other driver. The auto insurance company wants those records so your medical bills can be paid, it's pretty routine. The authorization will probably be limited to the release of medical records specifically related to the accident.
posted by inertia at 9:03 AM on June 19, 2014
This sounds really off to me, pain and suffering isn't something that's automatically compensated. If you are looking for something like this you really, really need to talk to a lawyer. This is also something that varies drastically on a state-by-state basis. For example, in New York, you must sustain a "serious injury" to get compensation beyond medical bills.
I don't know what state you are in, but what was probably supposed to happen was that your medical bills should have been covered by your auto insurance and/or the auto insurance of the other driver. The auto insurance company wants those records so your medical bills can be paid, it's pretty routine. The authorization will probably be limited to the release of medical records specifically related to the accident.
posted by inertia at 9:03 AM on June 19, 2014
Another reason they are asking for medical records is that they are fishing for a way to blame you for the accident. Take a prescription drug that makes you drowsy? Maybe it was affecting your ability to drive.
This is part of why I suggested putting limitations on the authorization. By law, they should only be requesting stuff pertinent to this accident. But it is in your best interest to be a bit paranoid, skeptical and assume the worst about their motives.
If they find out you have cancer or AIDS or whatever, hey, enough foot dragging and you die on them and they never pay. Profit! for them.
I worked for a very ethical insurance company and I was trained to look for a reason to pay rather than a reason to deny. I have heard that most insurance companies train their people to look for a reason to deny rather than pay. So, yeah, don't trust them farther than you can throw them and all that but they do still need access to, as a minimum, the bills and enough information to know that those bills are related to this accident.
Also, what empath said: Letting your insurance company pay the medical bills and letting this insurance company reimburse you in cash is basically insurance fraud and can land you in a court of law and, possibly, jail.
posted by Michele in California at 12:03 PM on June 19, 2014
This is part of why I suggested putting limitations on the authorization. By law, they should only be requesting stuff pertinent to this accident. But it is in your best interest to be a bit paranoid, skeptical and assume the worst about their motives.
If they find out you have cancer or AIDS or whatever, hey, enough foot dragging and you die on them and they never pay. Profit! for them.
I worked for a very ethical insurance company and I was trained to look for a reason to pay rather than a reason to deny. I have heard that most insurance companies train their people to look for a reason to deny rather than pay. So, yeah, don't trust them farther than you can throw them and all that but they do still need access to, as a minimum, the bills and enough information to know that those bills are related to this accident.
Also, what empath said: Letting your insurance company pay the medical bills and letting this insurance company reimburse you in cash is basically insurance fraud and can land you in a court of law and, possibly, jail.
posted by Michele in California at 12:03 PM on June 19, 2014
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posted by grouse at 11:54 AM on June 18, 2014 [4 favorites]