Chriss

need adivce on dealing with insurance companies

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I have a feeling my brother is going to need to get a lawyer. He is in the state of NV

I am hoping to find out for him.

What kind of lawyer would be best to have? (I am guessing one in consumer law.)

What information does he need to start keeping track of?

Think would be possibly to get a lawyer on a contingency basis on this matter?

basically he was parked at a red light when a lady hit a car behind him which then hit him. So their is absolutely no argument on who is at fault.

The issue is Farmers insurance is liable on paying him for his injuries, but are Calling him and harassing him. They are up to tricks that remind me alot of collectors, but this is in reverse.

Here is what my brother wrote as example of calls he is receiving. I have replaced the insurance reps name with Insurance REP :p

"

Insurance REP left a message on my recorder. Insurance REP stated that soft tissue injuries only take 6 to 8 weeks to

heal. He is ready to do a settlement. I tried to call on Monday, but did not realize it was after hours so I

left him a message stating that I was still having treatment and not ready for a settlement since I am still

recovering from my injury.

Thursday late afternoon I received a letter from him saying “ We are prepared to settle your injury

claim as soon as we receive all of the records and bills associated with your treatment. Please contact

our office at your earliest convenience so we can discuss your claim.”

I returned his call first thing Friday morning this is the basically how the conversation went

When I returned Insurance REP call on October 7th the conversation didn't get much better.

He rudely was explaining to me how soft tissues somehow recover between 6 to 8 weeks I tried to tell

him what my doctor says and he never let me get a word in and was telling me how I need to start my

settlement and that they are only going to pay me what they felt is fair. I told him that I'm still seeing

my doctor and been going through treatment still and he claims my doctor has never given him my

billing records. So I decided to let him go with a goodbye to call my doctor. When I called my Doctor

and told him the situation I found out my doctor has never received the paper work from Farmers to

send Insurance REP the information he requested.

I immediately called Insurance REP back after speaking with my doctor. I reminded him that I still have jaw

pain. I cannot eat certain foods. He stayed very uncooperative and stated again about the 6 to 8

weeks. And was threatening me that my insurance claim will only last until 7 months.(Law in NV is 2 years on this.) I told him that

he needs to send my doctor the forms in writing to his address which I gave to him a second time and

he claims he all ready sent it twice. Then he reminded me again about the healing recovery between 6

to 8 weeks and was pretty much talking rudely like I am some kind of criminal.

Insurance REP was very rude would not except that I'm still seeing the doctor and that I still need adjustments.

"

I will add hes been calling other family members asking about his injury as well.

Anything you guys can suggest, would be appreciated.

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He needs a personal injury lawyer soon.

Those attorneys are everywhere, with most having full page ads in the yellow pages.

Claims reps are ruthless and want to settle as quick as possible, with as little out of pocket as possible. Again, your brother needs a personal injury attorney, once he/she is retained, the claims rep will quickly change their tune.

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If he has auto insurance, which I assume he has, he should immediately contact his agent. I also assume he reported the accident to his insurer, which means the wheels are in motion. It is the duty of the agent to process all claims. The insurance company must defend any claim against your brother by law, or pursue any legitemate claim he may have for damages. If the other insurance company calls, tell them not to call again, but to contact the agent or the attorney assigned by the company. He has the option of hiring an attorney to sue the other parties, but he must have some legitemate provable injuries and or losses. "My neck hurts" doesn't fly these days. Good luck, stay on the agent who sold the policy, this is HIS job.

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If he has auto insurance, which I assume he has, he should immediately contact his agent. I also assume he reported the accident to his insurer, which means the wheels are in motion. It is the duty of the agent to process all claims. The insurance company must defend any claim against your brother by law, or pursue any legitemate claim he may have for damages. If the other insurance company calls, tell them not to call again, but to contact the agent or the attorney assigned by the company. He has the option of hiring an attorney to sue the other parties, but he must have some legitemate provable injuries and or losses. "My neck hurts" doesn't fly these days. Good luck, stay on the agent who sold the policy, this is HIS job.

Yes he is well insured, I have a feeling my brothers agent being lazy on this from hearing this from you. I always thought that was the law on that.

What would you suggest my brother telling the agent ? Or what kind of notes should he be keeping on all this?

edit my brother going to be signing up here at the site . So anymore questions he can ask =). Thanks again guys for the fast replies

Edited by Chriss
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I did this type work for 10 years with a major insurance company. I have literally handled hundreds of this exact type claim. It is important to your brother, as it should be, but about as run of the mill injury claim there is, as far as, the insurance company is concerned.

A few things base on my experience.

The rep is correct about soft tissue, minor, by my back and neck hurts claims. They have programs to run the injury, time of treatment, and bill through. It will spit out what should be the time frame and approx med bills.

No broken bones, fractures, scars, burns, hospital stay, or major follow up, it's a minor claim (in the insurance world).

In your brothers favor-

The most obvious, there is no contribuatory neglegence. He was stopped and got rear ended. Liabilty or a percent offset is not going to be an issue. The insurance company client is 100% at fault.

Although no visible or permant damage, he has a valid claim.

It appears he has not overtreated yet.

He is entitled to some money for general damages (pain and suffering, inconvience, ect..).

The insurance immediatley set a reserve when the got the claim. That means they took money that was in the general fund gathering interest and set it aside to pay this claim. It's just sitting there making the company no money. Most likely they set a reserve of 10,000 (would the very worst case to pay in their opinion.) So they want to settle quick, but nothing like if they had 1,000,000 set aside for a major accident or fatality.

Going against your brother-

It's a soft tissue "minor claim."

He did not get an attorney immediatley. He can still get one but the time for the atty sending him to his doctor buddy and "running up the medical portion of the claim," has sailed. They will still take the claim don't you worry, however, it won't cost the insurance company near as much at this stage. To maximize the settlement the atty needs to work the system and use his contacts from the start.

The rep is correct about the average time to treat.

While an insurance company is not the public's favorite, they are like God compared to a junk debt buyer or collection agency. A jury is not going to give him a huge judgement simply because they will hate the Defendant.

It's soft tissue and a minor injury. Juries do like to return huge judgments on these type of claims. They watch the TV commercials where an atty:

Will dress as a baseball player and yell he is a big time hitter and insurance companies hate seeing him step up to the plate;

pushing an old lady in a wheelchair into court;

rapping and dancing, "if your in a wreck, you need your check."

Your saying your brother's doctor. I bet you mean chiropractor. Huge difference treating with a medical doctor and/or physcial therpaist. The insurance can usually destroy a chiropractor if it goes to trial. They will show tons of similar cases and ask what was unique about this case. They are usually able to be painted as just helping run up the bills in an effort to get more general damgaes. Also when they describe the treatment it is usually made, with success, to look like a glorified massage. If it really is a doctor (medical, that can actually write RX) then take this and reverse it and put it into the in the brothers favor side. He is not getting a huge verdict based on chiro treatment and being sored.

He will have to give the atty 33%. Very popular argument is to offer (just an average amount, not related to this particular claim) 4K. 2500.00 chiro or other med provider, 1500.00 general. Your brother says hell no I'll get an atty. Fine your going to have to get at least 6K with an atty to even get what my offer is right now and I have a check ready right now.

Also his own agent has nothing to do with this claim. They have no duty to assist, but will to some extent just to make the customer happy. However, a phone call or offering to fax something is about it. This is a third party claim and your brother is a first party. In other words this is not a first party claim so the policy offers no required action by his own company. If they were required under the policy, they would be helping for sure. They want no part of a bad faith handling claim. Also it would not be the agent assisting, if required, it would be the claims dept. Most agents don't know the claims process past filing the claim and filling out a few forms.

Unless your brother has signed a med auth to get the bills. No other party is going to get or release the med bills.

You say the rep is being pushy and rude. A very good chance of that. However, something to think about. It is very common on these type of claims for the rep to try and push the person into getting an atty.

The reason, these claims need to be close within 90 days if they are non-atty rep. That is about the goal the reps are up against. However, if the person gets an atty, at this low level the claim rep is probably at, they can't hand atty rep claims. So if your brother gets an atty, the rep does not get hit for keeping the claim open too long. It gets transferred to a higer level rep and the expected open time is around, for this type claim, 6 months.

So it's not uncommon to try and tick off the person that won't settle or is being unrealistic (thank that policy limits automatically means that's what they get) in an effort to chase them to an atty.

My favorite was to offer 5K. The person would be mad and say, I can't believe your telling me my claim is only worth 5K. I would then say, oh no, I don't think it's worth 5K. It's worth about 3K but we need to get it settled so I'll overpay the claim. It's not even close to be actually worth what I'm offering. That usually had them mad enough to go and hire an atty to show me how wrong I was. :p Thanks!! was my unspoken response.

The atty and the insurance company already know what it is going to settle for and both will just go through the motions to justify the settlement, on both ends. Insurance company has to show they are fighting tooth and nail to protect their insured. The atty also can show their client how they fought for every dime and did not just take the first offer.

If your brother treats the average time and the bills are average for the injury and market your brother is located. He can walk away with meds paid and about 75% of the meds amount for general damages.

In other words if there are 3K in meds, the med provider gets 3K, your brother gets $2250.00.

The rep will probably set a settlement range of 4K - 7.5K with a target settlement of 5K, all inclusive.

This is general and of course there can be other factors that would add or decrease the range. The other driver is drunk or it's a little old lady that will come across as Aunt Bee can up the offer.

Like it or not, your brother will be sterotyped. Not black or white, male or female, but how he will come across in court. If he appears to be a hot head, yells and makes unreasonable demands and statements, or makes a ton of legal threats that have no shot or basis in law, the insurance company will have no issue calling the bluff.

If your brother does fall into the latter, I would recommend getting an atty even this late in the game. Regardless of what an insurance company will say, such as, we pay what the claim is worth regardless of an atty involved or not, they don't want him to get an atty. The rep working the claim might want him to get one, but the insurance company does not.

Bottom line, they pay more on the claim if an atty is involved. Their client does not necessarly get more but the insurance company is defiantley going to be forced to pay more.

Most attys won't go for this, but can't hurt to try. Have him get an offer from the insurance company. Then have him contact attys. Have him try to get the atty to agree to only take their fees only on the amount above what your brother has already negiogated.

In other words if insurance offers 5K and he gets an atty that gets 8K, tell the atty they get fees on the 3K difference. That would save your brother about 1.5K.

This is just my experience and of course different states, areas even within that state, and different claims can all be different.

Edited by Coltfan1972
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The one plus he has going for him their is physical evidence from the doctors of the injury. His jaw popped out from it. He was hit at about roughly 40 miles per hour+(My guess on the speed to do everything the impact did to the vehicles involved) the car hit the car behind them and it then hit them in a 1 ton van . their were 1 foot of rubber marks from the van skidding. Quite a bit of energy to achieve that.

He not looking to get rich out of this just have his injury covered. The doctors if it don't progress better want to do an MRI to see if its does not progress properly. His own medical doctor due to it being the jaw said the text book time is more on soft tissue to jaw areas. thanks for the information I will have my brother look it over.

From what I can tell I think his best course of action right now is to just make sure everything is documented well that is occuring?

Edited by Chriss
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On this, the brother was not the driver, he was a passenger. Currently our insurance is paying for his medical bills. The agent claims its soft tissue injury. It isn't. The doctors say it isn't. I have had him to a medical and chiro. and my medical doctor isn't opposed to him going to chiro.

I can still have my medical doctor check him out again if you think that would be smart. But jaw injuries are not whiplash.

Thanks for all input.

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Well a jaw injury sure as heck is not a soft tissue injury. I guess that is a new one for me. A jaw popping out due to a rear end collision? Lost on that one, sorry. There is still an egg shell doctrine, but did he have some prior issues with his jaw?

Changing reps is normal. It just means the claim is not settling quick and they need to get it to another dept that handles more complex claims. It's the reason I said they might try to chase him to an atty, to keep this from happening and counting against them.

Of course there are other reasons like the rep no longer works their or just evening out all the claims per rep.

Just get/keep detailed notes and really the doctor notes and reports will speak for themselves. It's not like a lot of people are trying to scam insurance companies by making false jaw injury claims.

You might want to check with a legit atty on this one (one that does not sing on TV, climb mountains to prove they will go to any length, or dress in military gear and yell they will go to war with the insurance company for you). If you get into, even minor, permanent injury or visible injury, the claim goes to a totally different level.

P.S. Don't tell the insurance company your not looking to get rich and just want the injury taken care of. Everybody is looking to get rich on an insurance claim. :lol:

Trust me !! your idea of not trying to get rich and just wanting what your legally entitled to receive is going to be a ton different than the insurance company idea of what is "just fair."

Edited by Coltfan1972
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I knew coltfan1972 and I had more in common than just this board. I was a claims adjuster for years with Great American. And I will agree with everything that has been said so far.

Although, the jaw is a twist to a soft tissue claim, it brings up a viable claim of partial or permenant disability. It is in that type of disability you can obtain a higher settlement. As with any insurance claim they will try to low ball the final adjustment. That is what they are paid to do. With any potential claim, they do reserve the money they feel is within the maximum payout. I am sure the managers do a weekly status of this claim, that is why they are pressing you. Do not bend for their demands or bluffs. Make an informed decision based on the doctor's diagnosis.

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One thing to realize is, getting a settlement outside of policy limits is virtually impossible unless a death occured and there was severe negligence.

Nice to know there is a fellow, former working for the big bad insurance company, poster on here. :lol:

The above about policy limits is dead on. It would not hurt to see if your own policy has under insured coverage (not uninsured, under). If this takes a turn into a disability or visible damage and the other driver has min limits, you might need to be turning to that coverage.

It does not sound like an issue right now but legit med bills can add up quick and eat into most of the policy limits on a min limits policy.

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For this you need to hire any personal injury lawyer or car accident lawyer. They are completely expert in handling these kind of cases. To find a good car accident lawyer first of all ask your friends, they might suggest a good name. You can also go through the yellow pages or search online to get a good one.

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