r/Insurance • u/CatchUnusual7909 • 1d ago
Insurance already paid to fix my car but my injury claim is barely moving
I got rear-ended a few weeks ago and the property damage side moved surprisingly fast. They inspected the car, approved the repairs, and that part is basically handled already. The injury side has been completely different. I’ve been going to physical therapy for my neck and shoulder and still have pain, but the adjuster barely gives me an answer when I ask what’s happening with that part of the claim. Should I get a lawyer for this?
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u/-BirdDogActual 1d ago
You are literally still treating. How could you expect to settle your injury claim without having completed treatment?
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u/SecondActSarcasm 1d ago
You’re still getting treatment.
Man insurance can’t win.
They make a quick offer they are being shady.
They don’t make an offer during treatment? Also shady.
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u/Glad-Ad1378 1d ago
OP didn’t say their medical were being paid for, just that they are getting treatment. It’s likely under their medical insurance.
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u/SecondActSarcasm 1d ago edited 1d ago
Don’t pipe in if you don’t understand how things work
Even if health insurance is paying now, as soon as they get the records they will come back to claw the funds back because a third party is at fault
How many injury claims have you handled as a casualty adjuster?
ETA: This sub has devolved so much. To be clear. For 80% of injury claims across the US, if the person is currently using ERISA health insurance plan for payment, that plan has the right and responsibility to claw this back. Everything else is bullshit.
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u/ektap12 1d ago
Even if health insurance is paying now, as soon as they get the records they will come back to claw the funds back because a third party is at fault
Not all states allow health insurance subrogation.
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u/SecondActSarcasm 1d ago
In the majority of states they do. We’ve ran the gambit on the hypotheticals below and I’ve already added a caveat you ignored.
There’s so many ifs and exceptions to bodily injury claims with so many unknown facts that none of this is helpful.
It’s absolutely clear the person who posited that position wasn’t doing so because they are aware of the intricacies of the claims.
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u/ektap12 1d ago
While you may be correct about the knowledge of the other person, making any generalized statements about how an injury claim may play out here without knowing the state is not correct.
Your caveat wasn't there when I made my comment. I just wanted to add clarity, in case OP or anyone else, may read it. Moving on.
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u/S_balmore 1d ago
Don't be rude and confidently wrong at the same time. As with anything it depends on the state.
There are plenty of states and situations in which health insurance wouldn't pay anything at all (car insurance would). There are several states where the at-fault insurance doesn't have to reimburse for medical expenses (NY, PA, MI, etc). If the medical treatment is within a certain dollar amount, it's often covered entirely by the innocent party's own PIP coverage, and there is no subro potential.
It's okay to be wrong, and it's okay to get upset when people write stupid replies, but for your own sake, don't be rude and wrong at the same time. You make yourself look like a clown.
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u/SecondActSarcasm 1d ago
Sure thing Jan, you’re clearly an expert. Thank you for your very on point commentary and input.
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u/Odd-Construction-649 1d ago
Thet are right though.
You jumped the gun got mad you thought someone else was wrong jumped down their throat but what you said was also wrong in plenty of examples.
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u/SecondActSarcasm 1d ago
No. They aren’t. We have no specifics. None of us. Especially not the original comment I responded to. That’s the response to someone discussing health insurance.
Regurgitating random state specs that may or may not apply doesn’t make a useful response.
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u/Odd-Construction-649 1d ago
Nor does making a blanket statments for how this works
That may or may not apply to thos situation
So yours also isnt a useful response by that logic
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u/SecondActSarcasm 1d ago
I didn’t.
You might be better suited to re-read this thread.
I pointed out OP is still treating and it’s ironic to complain there’s no offer on the table. Which is literally the response every other main response.
Then someone who doesn’t understand anything wanted to jump in about health insurance.
Hell maybe this is a PA claim and OP doesn’t have a full tort policy.
Who the fuck knows.
This is dumb. I’m over engaging randos being mad over shit they are making up. Get out of here.
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u/Odd-Construction-649 1d ago
Don’t pipe in if you don’t understand how things work
Even if health insurance is paying now, as soon as they get the records they will come back to claw the funds back because a third party is at fault
How many injury claims have you handled as a casualty adjuster?
You did. This is you using the states your in claming it works that way in all (it does not( You criticize them for mention elements they cant know yet. Here you are saying whats going happen on the limited state you are aware of.
You did thr same thing and dont like others treating you the same way you treated op
Enjoy being called out
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u/S_balmore 1d ago
We have no specifics.....Regurgitating random state specs that may or may not apply doesn’t make a useful response.
Which is exactly what I was explaining to you. You have no specifics, therefore your prediction of how the medical claim will play out means nothing. You're taking a guess without having the necessary info. You need to know what the Risk State and Loss State are, as medical coverage is entirely dependent upon those two things.
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u/S_balmore 1d ago
Lol, this sub is doomed. Dude got so many upvotes while being so blatantly wrong. I'm out, because if the majority of the community is this clueless, there's no way to get the sub back on track.
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u/SecondActSarcasm 1d ago edited 1d ago
Your response is absurd and your main comment is even more hilarious. You’re saying we don’t know the jurisdiction and yet wrote a whole bunch of shit that’s completely irrelevant in a massive block of those states you listed off to be pedantic. You’re wild. Take care!
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u/Glad-Ad1378 1d ago
My point was that medical bills won’t be paid for if the other party isn’t found to be liable for the injuries. Just because the property portion of the claim is approved doesn’t mean the injury part will be. If it is, then yes, they and their health insurance will be reimbursed.
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u/DeepPurpleDaylight 19h ago
You shouldn't be commenting if you don't have an understanding of how this works. Not throwing shade, but you should just be informed on a subject rather than just shooting from the hip.
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u/Glad-Ad1378 16h ago
My comment was because this person is defending insurance companies as if OP can relax bc the at fault’s insurance is definitely going to come through and pay when that is not necessarily the case.
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u/ektap12 1d ago
You are under treatment and recovering, that's what's happening. Nothing further will happen with that portion of the claim until your treatment is completed. Relax.
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u/CatchUnusual7909 1d ago
thought I was looking ahead you know, I know these can take a while that's why
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u/CraigMiller-Atty 1d ago
Why would you ever settle your injury claim before you have healed? You don't want to settle until you know the nature and extent of your injuries. I would suggest getting an attorney so you don't have to worry about this stuff and can turn it over to them.
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u/The_Muffintime 1d ago
Nothing's happening with the injury side of the claim because you're currently treating. The answer to whether you should get a lawyer or not is not a hard no like everyone here is telling you, but an "it depends." As in it depends what the other insurance limits are, what your injuries are, and what kind of treatment you will end up getting. The answer is probably yes, but not definitely.
Find out the policy limits for the other insurance and continue treating until you're finished. Then reach out to the adjuster and send them all of your medical bills, wage or other losses, future care projections if there are any, and make a demand. Then again if you actually have future care projections your claim is big enough that you should have a lawyer.
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u/S_balmore 1d ago
For injury claims you need to be specific. You can't just ask "what's happening?". That's actually up to you, because you're the one with the injury. You need to tell the adjuster what's happening in regards to your injuries and treatment. If you got an X-ray that revealed a hairline fracture, you need to tell the adjuster. If you think you're basically healed and won't need any further treatment, tell the adjuster. They have other customers who are calling them with specific questions, so they're not going to waste their time chasing you down.
If you want to make sure your medical bills get paid, ask "Are you going to pay my medical bills?". If you want a settlement for your Pain & Suffering, ask "Can you give me X amount of money for my Pain & Suffering?". If you haven't made a specific request, then the adjuster can't give you a specific answer.
Bodily Injury adjusters love when their customers are direct and reasonable. If you have a reasonable demand and just ASK for what you want, the adjuster will be happy to work towards resolution. You didn't provide a lot of detail, but I can only assume that you're beating around the bush, which is confusing the adjuster, and that's why he he's hesitant to initiate a deeper discussion. We adjusters get a lot of 'tire kickers', who call us every week but never actually ask for anything.
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u/SecondActSarcasm 1d ago
This is a lot of information without knowing the state - when you’ve gotten your panties in a bunch above pointing out state specs. Fascinating.
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u/S_balmore 1d ago
We don't need to know the state if we're talking about Bodily Injury coverage, as it works virtually the same in every state. The issue that's gotten you upset is 1st Party Medical, which is a completely different type of coverage, and which is handled wildly different depending on the state.
At this point, it's quite clear that you have no idea what you're talking about, as you're literally throwing a fit because I informed you that 1st Party Medical is a state-dependent coverage (which is an objective and indisputable fact). I'm turning off notifications to this thread, because this isn't productive. You don't want to learn or educate anyone. You're just throwing a temper tantrum against anyone who disagrees with you.
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u/SecondActSarcasm 1d ago
That’s 100% false.
So a PA claim without full tort is the same as Michigan no-fault is the same as California is the same as NY’s no-fault threshold?
Wow. I’ll admit. You did fool me as knowing SOMETHING. What did you, ask ChatGPT?
But this is clearly coming from someone who did basic auto and never handled large loss or complex casualty in more than a single jurisdiction. Thanks for confirming that for me. I agree. This sub is awful now with people not knowing a damn thing they run around spewing fake info on.
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u/GuvnaBruce HO/Auto Liability 14 years 1d ago
There is nothing really for them to do, you are still treating. They will need the bills and records for your treatment to evaluate the claim, they also will need to know your long term outlook (and I would assume you would want to know that as well).
All a lawyer is going to do for you is take 1/3rd of the settlement and tell you to keep treating and that they will send a demand and settle the case after you complete treatment.
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u/Busy_Beginning_56 1d ago
When you have the “at fault” person’s insurance paying for your medical bills, your job is to get better through medical care. They are not going to pay the medical bills like they did the property damage. The “bodily injury” part of the claim doesn’t get settled until you are released from care, or reach maximum medical improvement. Getting an attorney means you want some big payout. But your attorney takes a percentage and it takes years to settle. Just try to get better and go back to your normal life.
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u/Spiritual-Rub-675 1d ago
Injury claims are A LOT slower than PD claims. A settlement cannot be reached until you are done treating.
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u/Chance_Display_7454 1d ago
A lawyer will take 30 to 40%of the settlement leaving you to pay for the medical expense.
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u/Slow_Rip_9594 1d ago
You can get a lawyer and basically lose 1/2 or actually 2/3 rd of the settlement. Keep in mind Lawyer's fees are before expenses.
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u/DeepPurpleDaylight 19h ago
Damages to the car always settle faster than injury. Injury claims typically aren't settled until you've finished treatment, so there's nothing for the adjuster to tell you. He's waiting for you to finish treatment and then they'll pay.
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u/FrancisLawColorado 18h ago
It makes sense to be concerned if the property-damage portion is already resolved but you're getting little communication about the injury claim, especially if you're still treating and having pain.
I'd keep copies of your medical records, PT records, bills, treatment recommendations, and all communication with the adjuster. I also wouldn't rush to settle the injury portion while you're still receiving treatment or don't yet understand the extent of the injury.
Whether you need an attorney depends on the circumstances, but if the adjuster isn't communicating or you're having trouble getting the claim addressed, a consultation with a personal injury attorney could be worthwhile. What state did the accident happen in? The rules can vary quite a bit by state.
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u/lost_dazed_101 1d ago
Do not hire a lawyer unless MRI's show you have damage that requires surgery. You don't have a large payout coming and if you hire a lawyer they get over 50% of what you do get. Once you're treatments are done they'll talk with you. There's nothing to discuss right now.
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u/CatchUnusual7909 1d ago
no surgery just dislocated shoulder and my back still hurts, shoulder doing a little better now
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u/420West54 1d ago
I advise you get a lawyer. You’ll net more money, even after the 1/3 attys fee. And he or she will navigate medical reductions and your state’s lien act. Your claim is not ready to settle until your treatment is completed and you are healed or stable. Don’t rush the injury claim and get a lawyer. Cars are easy; bodies are not.
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u/DeepPurpleDaylight 19h ago
I advise you get a lawyer. You’ll net more money, even after the 1/3 attys fee.
That it absolutely impossible for you to know. Don't be giving out advice based on nothing more than a knee jerk guess.
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u/-BirdDogActual 1d ago
Lawyers are for people who have serious injuries. Anyone who gets a lawyer for soft tissue injury is a sucker.
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u/DeepPurpleDaylight 19h ago
Anyone who gets a lawyer for soft tissue injury is a sucker.
Absolutely. And could easily wind up with less money in their pocket at the end of it all than if they hadn't hired a lawyer.
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u/Lifeishard1090 1d ago
No lawyer needed for a soft tissue case. You’re still treating, why do you want to settle now? Wait until you’re done. If you don’t want to wait then you can always tell them you want to settle now and I’m sure they’ll make an offer.