i have a few questions regarding an accident (insurance related) [Archive]

timmhaan

11-01-05, 09:05 AM

over two months since my accident - my personal injury claim was denied. i'm pretty much healed up and because my empolyer won't dock me for missed days i'm okay with that.

however, my property damage (damage to the bike) is still is outstanding. i have about $1300 in damages that i need to recoup, but i've not seen anything yet. it's hard to get these people on the phone. but maybe someone has some insight in the meantime - i'm still entitled to property damage, even if my personal injury claim was denied, right??

The Seldom Kill

11-01-05, 09:24 AM

Possibly. It's not definite.

Why was the personal injury claim denied?

timmhaan

11-01-05, 09:44 AM

Possibly. It's not definite.

Why was the personal injury claim denied?

well, after the accident i was admitted to the emergency room. luckly nothing was broken, however i couldn't walk at all due to a blunt blow to the leg. i missed a few days of work because i literially couldn't get down the stairs.

at the time i was filling out paper work, i had no idea if i needed additional health care or physical theapy. so i put all this down on the form. better to be safe now then sorry later, i figured.

anyway, long story stort - the insurance company requires a disability form and a signed letter from the treating physician. i also had to see an independent doctor chosen by the insurance. because my injuries were of the soft tissue type and i'm healed up now (2 months later) the doctor found nothing wrong with me. so, i can't get a disabilty form and it's pointless to try to talk to the original doctor from 2 months ago.

i tried to retract the personal injury portion when i learned i couldn't get the proper forms, but they went ahead and sent me a denied letter anyway.

Little Darwin

11-01-05, 09:58 AM

That sucks!

However, I have some doubt that they could require you to see their doctor in order to validate the claim. If the doctor you saw can give the information needed via medical records, I think it would be enough to do whatever paperwork is needed for you to get reimbursed for your medical expenses. Perhaps you asked improperly for a certain type of injury claim and, if so, you should try to resubmit with the proper type of claim. You should not have to be out of any medical expenses for an accident that is someone else's fault.

I don't know the law, but it would be ludicrous to not be able to be reimbursed for medical expenses because you were not disabled.

Have you seen a lawyer?

Have you signed anything that accepts their denial of your claim?

This could be a negotiation ploy... If the amount you could recover makes your efforts worth while, don't give up. If it is not worth your time, then that is your call. But, I think a lawyer would get you what you deserve, plus his fees. Just a letter from a lawyer would probably make the tight wads change their mind.

Paul L.

11-01-05, 10:02 AM

I'd go get a free consultation with a lawyer just to explore all options. It sounds like you have run up against one of the "foolish" insurance companies that is gambling that you won't get a lawyer by giving you the cold shoulder. Granted you may lose some of your money to the lawyer but hopefully the insurance company will learn something as a lawyer will end up costing them a lot more.

Orikal

11-01-05, 10:03 AM

I would think the property damage portion of your claim would be completely independent of bodily injury. You can prove (pictures, estimates, etc.) that you have damage to your bike, and it will not operate properly without repair. It sounds like the only reason your bodily injury claim was denied is due to lack of proper paperwork.

Ritehsedad

11-01-05, 10:15 AM

Was there a police report? Did the police believe the other party to be at fault? You could also try small claims court against the other party. If you win, it will be up to them to recoup from their insurance.

timmhaan

11-01-05, 10:16 AM

well, just for clarification - i shouldn't incur any out of pocket expenses regarding medical bills. as was explained to me, the emergency hospital bill should be taken care of by the driver's insurance. and even if it's not - i still have medical coverage myself.

i also won't be incurring any lose of wages afterall and my employer sent a letter to that affect to the insurance co.

so, because i'm all healed up now and i won't be losing any money from work, and my medical expenses will be covered i'm not going to contest the denial of my personal injury claim.

however, i'm worried about the property damage part of it. the two seem to be handled by different departments but are all referenced by the same claim number. i don't know if the denial is for the whole claim or just the personal injury part. i really need the money for the damaged bike, as i already bought a new one.

supcom

11-01-05, 10:39 AM

so, because i'm all healed up now and i won't be losing any money from work, and my medical expenses will be covered i'm not going to contest the denial of my personal injury claim.

If the insurance company paid all the medical expenses and you had no financial loss from missed days at work, what is the basis of your personal injury claim? Sounds like you have no ongoing medical condition that needs treatment. Since the insurance company paid for the medical treatment you did receive, they must have accepted liability for the accident and did, in fact, pay for your personal injury.

I would think you are in a good position to recoup your property losses as well. You may need to keep on them to push the claim through the system.

timmhaan

11-01-05, 10:53 AM

If the insurance company paid all the medical expenses and you had no financial loss from missed days at work, what is the basis of your personal injury claim? Sounds like you have no ongoing medical condition that needs treatment. Since the insurance company paid for the medical treatment you did receive, they must have accepted liability for the accident and did, in fact, pay for your personal injury.

I would think you are in a good position to recoup your property losses as well. You may need to keep on them to push the claim through the system.

exactly. as of now there is no basis for a personal injury claim. enough time has passed that it's clear i'm healed up nicely. at the time i filled out the paper work all i knew was i couldn't move off the couch. also had no idea if i'd lose money from missing work or not so that's why i submitted a personal injury form. in hindsight - i wish i never bothered with it. it's made it somewhat more complicated and time consuming.

well, i'm gald to hear most people think the property losses can be recouped. i'm still going to pursue it, but it's good to have some informed opinions before going in for battle. this is the first time i've dealt with big insurance.

chemcycle

11-01-05, 12:45 PM

I see, you did the paperwork "just in case." Which was probably the right thing to do.

Now, with that rejection, you want to know if you can collect on your bike. I would think you should be able to. Property can still be destroyed without anyone getting hurt......I would say that rejection is narrow in scope and should not affect your property claim...

Brian

11-01-05, 02:30 PM

Damages and injuries are handled by different departments, as they're generally each too complex for one person. There will be a BI portion of the claim with one adjuster, and the PD with another. It's still only one claim, just two kinds of coverage.

Could it be that in your state, you can't pursue the other party for pain and suffering? You've already been made whole for your medical expenses, from what I've read. So there's nothing for them to pay out.

As far as your bike, you should send a written time demand, with copies of any documentation to support the amount you are demanding. If liability is not an issue, they should provide a reason why your PD demand has not been paid, or pay it right away. Was your bike a write-off? Be sure to document what you paid, and what a similar one would cost. If there's a plus side here, it's that you can generally work with a bike shop to get you a bike nicer than what you had. I'm not advocating fraud in any way, just pointing out that a bike more than a year old can usually be replaced with a better one at the same price, especially with end of year/Christmas sales coming up.

mandovoodoo

11-01-05, 05:00 PM

Expat has a good position in my assessment. The other driver is the one to go after. The insurance company just represents them.

We work everything this way:

1. Friendly phone call.
2. Friendly certified demand letter
3. Certified demand letter indicating suit will be filed.
4. Certified letter withdrawing demand letters and indicating intent to file suit immediately
5. File suit for everything that isn't laughable, generally throwing in consumer protection statute, punitive damages etc. Try to get into a court of record, otherwise you'll face an appeal etc many reasons.
6. Decline to talk when frantic phone call arrives
7. Negotiate to settlement of 3x what demand was for.

This seems to work pretty well. Crisp, friendly, firm, brutal. I like the laughing while hanging up the phone on the defendant (but never on his lawyer).

Keep in mind that the other party in the matter is the other party himself, not his insurance company. Unless something arrives saying clearly that he is represented by some specific attorney, deliver everything directly to him. Certified mail that makes him go to the PO himself is a real pain. Being painfully friendly and matter of fact is a real torture to the other side. As if you're saying "Of course you'll pay - what else is there to do?"

Anyway, an attorney will help a great deal.

Brian

11-01-05, 05:15 PM

Crisp, friendly, firm, brutal.

I swear, that could have been my motto. I always got a laugh when the claimant told me they had an attorney. I had to tell them right away that I could no longer legally talk with them, that they would need to have their attorney contact me. That bluff never helped anyone.

Brian

11-04-05, 04:40 AM

Tim, can we get an update soon?

timmhaan

11-04-05, 08:34 AM

i wish i had an update. i contacted them on Monday and Tuesday - both times being led to a voicemail box. No return phone call, so I've tried emailing to get status of the claim. nothing. It's like they just want me to go away. but everyday i'm going to keep pushing. i think getting money from these people is about as difficult as winning the TDF.

Brian

11-04-05, 02:16 PM

Send a registered letter, with a time demand. Show them you mean business. The Department of Insurance sets standards giving them x amount of days to respond to letters. They can BS their way out of VM and email, but nothing is quite as effective as a registered letter. Or, you can go to the DOI now. Especially since you've been waiting a while. See if the DOI has a website for your state, and file a complaint anyway. Costs nothing, but it will force them to respond, or risk a fine.

timmhaan

11-08-05, 12:31 PM

update: i was finally able to get someone on the phone. they hadn't done anything with the property damage claim! it was just kind of sitting there apparently. wtf? anyway, after talking to them they've sent my information on to an adjuster who is supposed to investigate how much my bike is worth (remember that i've already submitted estimates, reciepts, photos, etc.) and then get back to me tomorrow. oh boy. we'll see. i can't wait until this chapter of my life is closed.

Brian

11-08-05, 01:10 PM

timmhaan

11-08-05, 01:27 PM

I'm curious as to which company this is. PM me if you don't want to post it here. Don't forget to use this delay as leverage if they give you any crap. You have every right to be hot under the collar.

just sent you a PM. probably best not to post while it's still outstanding.

i've been keeping a log of every phone call, letter, email, etc. it's filled up with a lot of:

"called to check status....left voice mail with _______"

Brian

11-08-05, 01:49 PM

Start quoting from that if you get any flak. It also couldn't hurt to view the DOI website for your state, then you'll know your rights, and can remind them of their duty.

mandovoodoo

11-08-05, 04:40 PM

I swear, that could have been my motto. I always got a laugh when the claimant told me they had an attorney. I had to tell them right away that I could no longer legally talk with them, that they would need to have their attorney contact me. That bluff never helped anyone.

Exactly, if you really have an attorney the attorney will tell you not to deal directly with the other side. So saying you've got one is simply stupid. No bluffing allowed!

In the HP deal I described above HP folks tried to bluff. I don't know if the phone log reflects my laughter and "Wow, this will be cool - you guys ever defend yourselves in Loudon County, Tennessee?"

Really important to be very friendly and smiling all the time. I figure I'm winning if someone loses their cool.

Brian

11-08-05, 04:52 PM

Always smile. You're the only one without a personal stake in the outcome. Things are different for timmhaan, but for the adjuster, it's just a job.

timmhaan

12-14-05, 09:14 AM

*sorry to drag this up again, but i hope someone learns something from my experience.*

another months passes. but now at least i have an offer. it's a fraction of what the actual damages are, however, so i'm not happy with it. basically i couldn't buy a new rear wheel with it. their investigation found that i did nothing to avoid the accident and the appraisal figure they came up with is less than half of what i submited. both of those things just aren't right. so, i tried calling back but had to leave another message. how much bargaining room do i have here? any adivce at this stage? you guys have been very helpful so far.

ajay677

12-14-05, 09:44 AM

timmhaan

12-14-05, 10:14 AM

How much is the limit for a small claims action in NYC? Are lawyers allowed in small claims court in NYC? In my jurisdiction, your claim amount would fall under the limit ($10000). A lawyer is not needed as the proceedings are generally more informal and the court staff understand you are not familiar with court procedures so they will work with you. As I see it, there are 3 options:

1. Take their offer while accepting no liability for any damages incurred by the other party.
2. Attempt a mediated settlement.
3. File in small claims court against the other party for the full amount of your damages.

I'm not a lawyer and this should not be taken as legal advice. After screwing around with this for a couple of months, these are the next steps I'd be considering.

thanks - regarding small claims: it is a $5000 limit, so i'd be good there. not sure about lawyers though, but if i went this route i'd probably do it myself as i feel my case is very strong and well documented. plus i have all the witnesses' information still.

anyway, i'll see if i can up the amount from the examiner themselves before doing anything else. thanks for your suggestions.

Brian

12-14-05, 01:02 PM

Tim, play hardball. Tell them you see no reason why you should be out of pocket, and that you want to be made whole. It's good to use those phrases too. Let them know that you will consider taking their insured to small claims court, but make it sound sincere, and don't say it in anger. Also, don't make that threat unless you plan to follow through.

I'll read through the whole thread again later, and see if I have any more advice for you.