I made a bad insurance decision--based on misinfo from the adjuster
March 8, 2019 9:24 AM Subscribe
An insurance adjuster encouraged me to accept a low amount in the settlement, saying I would receive a large medical payment amount --that's now been reduced by $3K. I would never have settled for $4300 for a head injury/mild concussion, arm injury and missed work, and was never told that there was a chance that I would receive thousands of dollars less that what the adjuster told me, incorrectly, that I would receive. I don't think I need an attorney. But do I have any leverage in making my insurance company take responsibility for giving me bad information that caused me to make a bad decision?
The kicker is that I didn't know any better and signed off on a $350 settlement with my carrier.
AND: This is not a large case; I've already been advised that a trial isn't worth it.
I was in a car wreck. The at-fault driver's insurance company backed out, saying she was under-insured (there was a limits issue; others involved had serious injuries), and I needed to look to my own carrier.
The adjuster promised me, verbally, that he would "personally" see to it that I would receive any unused portion of my medical coverage as part of my settlement, which he told me would total about $7300, which he said was typical for the injuries I had received, and that I should settle. In other words, he misled me and misrepresented what I would receive, instilling false confidence that in following his instruction I would receive a fair amount.
He then disappeared. I didn't hear from him for months. When I finally checked back in, I was told that he had a new position with the company, and my claim would now be handled by someone else.
The previous agent had clearly just dropped the ball, and Liberty Mutual had made no effort to continue handling my claim. And also, in the interim, a large, $2900 medical bill had come in from an entity called The PHIA Group, which seems to represent the cost **to my health insurance company** of my my health insurance coverage and lost work,
I was told I could now expect $2900 less from Liberty Mutual: a grand total of ~$4300 for a head injury and lost work.
Liberty Mutual isn't delivering what it promised, and by deducting the PHIA Group's charges from the settlement, is in essence forcing me to pay for my own medical/work expenses, before insurance.
Do I have legal options? Do I have options as a consumer?
The kicker is that I didn't know any better and signed off on a $350 settlement with my carrier.
AND: This is not a large case; I've already been advised that a trial isn't worth it.
I was in a car wreck. The at-fault driver's insurance company backed out, saying she was under-insured (there was a limits issue; others involved had serious injuries), and I needed to look to my own carrier.
The adjuster promised me, verbally, that he would "personally" see to it that I would receive any unused portion of my medical coverage as part of my settlement, which he told me would total about $7300, which he said was typical for the injuries I had received, and that I should settle. In other words, he misled me and misrepresented what I would receive, instilling false confidence that in following his instruction I would receive a fair amount.
He then disappeared. I didn't hear from him for months. When I finally checked back in, I was told that he had a new position with the company, and my claim would now be handled by someone else.
The previous agent had clearly just dropped the ball, and Liberty Mutual had made no effort to continue handling my claim. And also, in the interim, a large, $2900 medical bill had come in from an entity called The PHIA Group, which seems to represent the cost **to my health insurance company** of my my health insurance coverage and lost work,
I was told I could now expect $2900 less from Liberty Mutual: a grand total of ~$4300 for a head injury and lost work.
Liberty Mutual isn't delivering what it promised, and by deducting the PHIA Group's charges from the settlement, is in essence forcing me to pay for my own medical/work expenses, before insurance.
Do I have legal options? Do I have options as a consumer?
Every state has an insurance commission. They will be under the Attorney General's website. They will know the laws in your state and should be able to give you information. That's where I'd start.
posted by theora55 at 9:58 AM on March 8, 2019 [3 favorites]
posted by theora55 at 9:58 AM on March 8, 2019 [3 favorites]
You can get a lawyer (MeFi Wiki) to help explain what your legal options are, including options for undoing an insurance contract based on misrepresentation and/or fraud, etc. There may also be consumer protection assistance available from your state Attorney General's office, but your own lawyer in your state can explain all of your options, including small claims court, which may be worthwhile, depending on how the law applies to your specific situation and the jurisdiction of the local small claims court (i.e. sometimes available for claims under $10,000).
posted by Little Dawn at 10:01 AM on March 8, 2019
posted by Little Dawn at 10:01 AM on March 8, 2019
You should get an attorney. My partner was hit on her bike by a driver and without an attorney it would have been even worse that it was. Talk to a lawyer and they can help you, I wouldn't try and do this solo.
posted by Carillon at 10:31 AM on March 8, 2019
posted by Carillon at 10:31 AM on March 8, 2019
I am an attorney (not your attorney). You may need a lawyer but Theora's suggestion to check out your state's insurance commission's consumer-facing website first is a reasonable one. Some states have administrative processes that would be less daunting to navigate as a layperson.
posted by snuffleupagus at 8:04 PM on March 8, 2019 [1 favorite]
posted by snuffleupagus at 8:04 PM on March 8, 2019 [1 favorite]
If i am reading this right, the unexpected bill of $2900 from PHIA is the reason for the drop in payout of $2900. It sound like what the original adjuster told you was right - you are getting the excess but the excess is much lower than expected due to the unexpected additional charge?? I think you want to at least investigate if not push back on the PHIA bill.
posted by metahawk at 1:34 PM on March 9, 2019
posted by metahawk at 1:34 PM on March 9, 2019
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posted by msamye at 9:43 AM on March 8, 2019 [4 favorites]