Partner hit by a car, help with insurance questions
May 18, 2016 9:53 AM   Subscribe

My partner was hit by a car while biking a little over a month ago (we're in CA). It's looking like the ambulance + er visit is going to be already 1.3x the state minimum. We're already speaking a bit with a lawyer, but I have a number of questions about recovery, responsibility and how to make sure we don't end up ok.

So first of all, a month ago my partner was rear-ended while bicycling. The police report pretty clearly states the other driver was at fault and the drivers insurance company has agreed verbally in our talks with them. Obviously this hasn't been the most amazing event ever but nothing was broken and the road rash is healing ok. The bicycle itself was totaled (and we have a written write up of the damage and that it's over the value of the bike itself).

Things were going ok until we got the bill for the ER visit which was around 20k. The rep who had been working ok with us (we haven't signed anything yet for medical or liability reasons) suddenly got a bit cagey about that and said we might be going over the maximums of this particular plan but wouldn't say what those are, where we sit in relation to those minimums or what happens when we do. Additionally he's been telling us that any settlement we receive from the insurance company itself will require us to sign away all ability to pursue them or the driver further, even if we can't recover the full amount or if further complications arise in terms of soft tissue damage. That's not even including the bike, the ambulance ride, the ruined clothes, loss of wages, or anything like that, leading us to worry.

I've a number of questions related to this whole experience. I've never been in this situation before thankfully, but this has left me unprepared to deal with the fact that I have no idea what to expect, or how best to proceed such that my partner can be made whole.

First and foremost, I did call my auto insurance company and they did say that they may be able to help with this situation but would need to hear the exact details before confirming. We haven't followed up on that yet because things were proceeding fine until a few days ago when the huge ER bill arrived. Also my father had expressed concern that if we did engage them they would negotiate not in our best interest and that we could find ourselves 50% at fault and not getting fully covered, plus given that things WERE going smoothly it didn't seem necessary to take them up on it yet. Is it a good idea to take up with them?

Secondly, we've spoken with a lawyer, he had said he likely wasn't going to be necessary if the insurance company didn't contest us on the property charges (which to be fair they haven't). That said, this conversation was before the bill came due and he estimated it would be about 9k for the er visit, which is a lot less than it actually was. My partner has placed a call back to him but he's been in trial the last day or so and thus hasn't been able to reengage. We'll obviously keep speaking with him, but at what point is the cost/benefit analysis worth it to actually have him on our side?

Thirdly, people keep speaking about how even if we were to get money back, my partner's health insurance company would try to recover it all anyways, which confuses me. What are they trying to recover? Why would the come after us and her money for the bike, pain and suffering, that sort of thing? It seems like despite that fact that my partner wasn't at fault we could end up on the hook for a bunch of money? I'm pretty confused an overwhelmed by this whole situation, I'm really not sure what the best course of action is and what happens if we do end up blowing through the limit?
posted by Carillon to Law & Government (21 answers total) 3 users marked this as a favorite
Your partner's health insurance company will go after the driver's insurance company to recover any costs they covered themselves. Not you. This is standard, and I think generally involves a lawyer from each side having a boring phone conversation they've probably had hundreds of times before.

You should probably hang tight until you can speak to your lawyer about this, but you may want to go ahead and put a call in to your partner's health insurance just to find out what their general procedure is. They will likely tell you not to settle with the driver's insurance yet. They may also end up negotiating you a better settlement in the end (your own auto insurance might do this as well). Definitely don't sign anything yet.
posted by Lyn Never at 9:59 AM on May 18, 2016 [8 favorites]

Yeah, the health insurance company will need to get involved at some point. For your googling pleasure, the process of them going after the driver's auto insurance company, as Lyn Never describes, is called subrogation.
posted by slenderloris at 10:07 AM on May 18, 2016 [3 favorites]

Additionally he's been telling us that any settlement we receive from the insurance company itself will require us to sign away all ability to pursue them or the driver further, even if we can't recover the full amount or if further complications arise in terms of soft tissue damage.

Don't sign a release at this stage. It's not wise to do that until you know the full extent of the costs associated with this injury and are comfortable with the amount being offered to you. Ask your lawyer about how long you have to sue from the date of the accident. You don't want to miss any limitation periods while waiting to find out how bad it is.

Thirdly, people keep speaking about how even if we were to get money back, my partner's health insurance company would try to recover it all anyways, which confuses me

I think they're probably talking about the proverbial "double-dip". If your partner's insurance company paid out funds for health care costs or other things, they have a right to recover funds paid to you for the same things. (As an example, say you're driving and some roofing crew drops a big box of shingles on your hood and damages your car. You go to your insurance company and they fix the damage. Then you go to the roofers and say "you caused $2000 in damage to my car, pay me $2000." You have now claimed the same damage twice, and since your insurer paid for the damage already, they can claim that $2000 you got from the roofers as their own). If it's some other type of compensation, like pain and suffering or whatever that's not something handled by your partner's health insurance, I can't see how they have any right to recover any of that.
posted by Hoopo at 10:12 AM on May 18, 2016 [4 favorites]

I am so completely not your lawyer, and not a California lawyer. But when I google California car insurance minimum, it suggests that the driver must have $15k liability insurance for personal injury AND $5k liability insurance for property damage. So all I am saying is, even if an injured person's health insurer ended up getting all that $15k from the driver's liability insurer in "subrogation" (see above), the injured person might also be entitled to have the driver's liability insurer pay separately for the bike.
posted by sheldman at 10:30 AM on May 18, 2016

The bike might be covered under a homeowner's policy, which I know sounds kooky but check it out. Lawyers good!
posted by fixedgear at 10:40 AM on May 18, 2016

Get a Personal Injury attorney and pay no bills. This process can take a couple of years, but don't fret, that's how these things work.

Keep track of days missed at work, medical bills, physical therapy, etc. These are all compensable expenses. You can run all the medical bills through your health insurance, THEY'LL go after the motorist's insurance company under the legal doctrine of subrogation.

But get a good PI lawyer, they typically take 1/3 of the settlement (after expenses) but settlements are higher when lawyers are involved and you don't want to hassle with all of this any more, do you?
posted by Ruthless Bunny at 11:08 AM on May 18, 2016 [3 favorites]

I was hit by a car while biking back in 2006 that resulted in a hospital visit and multiple broken bones. I am also in CA so I have been there/done that. Use the lawyer.

Let the attorney deal with everything. Do not sign anything and direct all questions to the attorney. It is not worth you trying to navigate this yourself given the bills you have noted. They will get you a higher settlement and depending on the policy limits of car insurance vs the medical bills, may be able to negotiate them down in what they take for settlement which they will likely not do for you.

Your health insurance will recover anything they paid out from any settlement you receive from the other party's insurance. Also, check your own car insurance coverage to see if you have uninsured/underinsured coverage. If you do and if the limits are higher than what the other party has in their own coverage, *your* insurance can also be used to cover bills, pain ans suffering and property damage to the bike.
posted by CoffeeHikeNapWine at 11:22 AM on May 18, 2016 [4 favorites]

Response by poster: So lawyer AND talk to USAA my car insurance company? Just want to make sure, I'd heard it would be one or the other from a few sources so I want to make sure I'm not screwing that up.
posted by Carillon at 11:24 AM on May 18, 2016

Why are you talking to us or ANYBODY who is not a personal injury attorney??

Call every PERSONAL INJURY LAWYER in your area immediately. Find one you like and hire them. This is non-negotiable. This is not for AskMe. I am in CA and needed one for an auto accident. This is the only way to handle this responsibly and cost-free.

Start dialing.
posted by jbenben at 11:25 AM on May 18, 2016 [5 favorites]

I have dealt with USAA as the opposing insurance company in another accident. They are lovely, but they can't tell someone making a claim against them to get a lawyer. Which you should. I'm surprised since they are YOUR company, they did not just politely between the lines tell you the right thing to do.
posted by jbenben at 11:28 AM on May 18, 2016 [1 favorite]

Check with your insurance provider (USAA) to see if you have uninsured/underinsurned coverage and if so, what the limits are for your policy. It is your policy and they have to tell you this. If you can get the other guy's insurance to tell you what those policy limits are for that policy, you will then know if your policy, if you have that coverage, is even potentially going to come into play.

Then, even if you don't have the coverage, I would let the lawyer deal with everything. They are more likely to get more in settlement, potentially negotiate down what you have to repay to your health insurance. They are totally worth their fee just so you don't have to jump through the hoops and red tape dealing with 2, possibly 3 insurance companies whose single, sole, purpose is to pay out as little as possibly/recoup as much as possible.
posted by CoffeeHikeNapWine at 11:29 AM on May 18, 2016

Response by poster: Because I'm waiting to hear back from the lawyer? I'm confused as to my options and get some of the information second hand from my partner so turned to askme to make sure I'm thinking of everything and that I can get questions answered while we wait rather than freak out?
posted by Carillon at 11:35 AM on May 18, 2016 [2 favorites]

For what it's worth, it is perfectly legitimate to go to the drivers' insurance company and say, "I'm willing to settle the case for the entirety of the drivers' insurance policy, but only if the drivers' insurance policy is state minimum [or sufficiently small as to make a lawyer not worth it] and you certify that's the case".

I agree that in most cases, having a personal injury lawyer handle this is appropriate. However, in the very specific case of a state minimum insurance policy that is less than your damages, a personal injury lawyer will literally cost you money. You will almost definitely get exactly the same settlement from the insurance company as you would without a lawyer (specifically the entirety of the policy's value), but you'll have to take 1/3 of that and give it to the lawyer. It is exceedingly hard to recover damages beyond insurance maximums - in general, people that have state minimum policies don't have a lot of money, and hence, can't give you much money.

I have successfully used this approach to determine whether an insurance policy is "big enough" to justify a lawyer. In my case, the insurance company politely declined the offer and I went to a lawyer.

(Also, for what it's worth, this strategy was recommended to me by two separate lawyers as a way to determine if hiring them was worth it.)
posted by saeculorum at 11:44 AM on May 18, 2016 [8 favorites]

Please try to calm down. This will not get resolved today. You have some time to talk to a PI lawyer. The only thing you need to do in the meantime is agree to nothing and sign nothing with respect to the other person's insurance company.
posted by lizbunny at 11:45 AM on May 18, 2016 [4 favorites]

Please try to calm down. This will not get resolved today.

I'd like to emphasize this, as I think it's the general answer to your question.

One thing I was surprised about with my own personal injury case was how long you can wait in actually paying medical bills. I had more than a few providers that would send me weekly mail warning me to pay the bill, and some of them adding non-trivial late payments after a couple months.

A year later, my case was settled, I paid off the providers, paid no late payments, and magically all the mail I was receiving to pay my bills stopped as if nothing had happened.
posted by saeculorum at 11:48 AM on May 18, 2016 [6 favorites]

You should look at your own insurance policies and give your insurers a call in the meantime, to see whether you can recover against any of your own policies as well.

Please note that if your insurance will respond, it will only respond to the amount excess of what is recoverable from the driver's policy.
posted by lizbunny at 11:50 AM on May 18, 2016

I was involved in a bike crash in 2008. I went through a lawyer for everything on the advice of my local bike advocacy group, and I definitely got better results than friends I've known in similar situations who didn't lawyer up. If possible, you want someone who specializes in bicycle and pedestrian crashes vs. any old personal injury attorney.

For my case, it was two and a half years until everything was resolved.
posted by smich at 12:01 PM on May 18, 2016 [2 favorites]

Nthing lawyer (after saeculorum's trick, which I did not know -- thanks).

The lawyer deals with everyone else on your behalf, and gets it right; this is what earns them their money, and is a TON easier and better than you solving the quandries that led you to post this question in the first place. Find a good bike lawyer through local bike advocacy groups.

I was doored from the left in 2009, and eventually paid in 2012.
posted by Dashy at 1:23 PM on May 18, 2016 [2 favorites]

Just wait and speak to your lawyer. Don't call USAA. You'll just aggravate yourself and no insurance company will speak to you once you've lawyered up (this is a GOOD thing.)

Just keep your records nice and neat, and let anyone who calls about those bills know that there's a case in litigation and once they've settled with you, you'll settle with them.

This is along process, a couple of years at least. Concentrate on your boyfriend and his mending up. Then go about your lives, letting this grind quietly in the back ground.

Take pictures of your poor boyfriend, nice, gory, ugly pictures. Document the road rash, the bruises, the swelling.

Thank goodness it's no worse than it is.
posted by Ruthless Bunny at 1:29 PM on May 18, 2016

Yes, get a lawyer and let them handle it. I've been in a bike accident, and had USAA as my insurer.
USAA had very little involvement with the settlement process as far as I could tell.
As 'bikehike' wrote, your medical providers will recover their costs from the settlement paid by the othe party's insurance company, legally called 'subrogation'.
In my case the final settlement $$ was split about 30% for the lawyer's contingency, 30% subrogation, and 30% to me.
posted by TDIpod at 2:49 PM on May 18, 2016

Nthing sign nothing. IANAL, but I was involved in a not-at-fault accident with serious injury, and some highlights of what's going on here:

- the medical people will wait to get paid, and when all the dust settles, they will. Settle, that is. For less than what they're billing now, and with anything adversarial taken off your credit report. This alone could be worth a lawyer.

- subrogation is a real issue (it held up my settlement for a while), but (and this is another area where your lawyer comes in), your health insurance company's right to subrogation has often been held by courts to be at least mitigated by your partner's rights to get something for wages lost, potential limitations in the future, if any (and they don't have to be documented/proven, just potential). This is a gross oversimplification of a complex topic, and definitely where a lawyer might be in order, but I'm just saying they don't have an unmitigated right to get theirs first while leaving you stuck holding the bag.

- lastly, and this is again an area where a lawyer can advise you better on your state law, if the at-fault party has inadequate insurance, your own insurance will sometimes step in - we usually think of it as "UN-insured motorist," but it can also function as "UNDER-insured" motorist. This is (again) oversimplified, but your own insurance may, standing in your place, look at the potential case for suing the other party to collect ALL the losses (not just his policy limits) and say it would be cheaper or more foolproof to just - pay it themselves. (this is a complex decision that involves looking at all the insurance policies in play, the assets of the other party, etc.)

This may or may not work in your case, but as it sounds like you have a case where no one is really denying anything, and all parties are insured (I think) - you might be able to hire an attorney OTHER than a typical contingency-case-30-40% taking type, and get an attorney who will just charge by the hour. And that might be less, as this might be very simple indeed, if your expectations are reasonable and the losses and damages aren't too bad. In my case I actually found an attorney who more typically represented insurance companies - he said "as long as it doesn't turn adversarial I can take this case." And I ended up paying only about 5-10%.
posted by randomkeystrike at 3:31 PM on May 18, 2016 [3 favorites]

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