Auto Insurance Claims/auto accident

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Expert: - 1/3/2010


Question
My son is on my auto insurance. He had an auto accident on Oct 10th of LAST YEAR He had a Syncope(fainting spell behind the wheel which made him blackout and crash). He is not getting any medical bills payed and i DO NOT KNOW WHY.  INFO ON THIS MATTER WOULD BE GREATLY APPRECIATED tHANK YOU

Answer
There are three types of medical coverages that are associated with auto insurance:

(1) first party coverages which could be called  Med Pay or PIP.  These pay for medical bills and lost wages for people in your car, caused by the accident, no matter who was at fault.

(2) third party bodily injury coverage.  This pays for injuries to other people that the driver of your caused due to his/her negligence.

(3) uninsured motorist coverage.  This pays for injuries to people in your car caused by the driver of an uninsured vehicle due t his/her negligence.

In this case, the only  coverages that might apply would be first party coverages.  In some states it is called Med Pay and in some it is called PIP.  But this is not required coverage in every state.  You should look at the insurance declarations page which is issued with your policy.  It will say if you have these coverages.  If you do have it, the coverage should pay for medical bills and maybe lost wages that were caused by the accident.  However, it will not cover anything unrelated to the accident, like medical care for the condition that caused the fainting spell.

If after reviewing all this you think the insurer made a mistake, you should call and complain to the claim supervisor.

Auto Insurance Claims

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Claims Guy

Expertise

I am currently an Auto Claims Manager for a large insurance company. I have 18 years experience in the industry, having worked as a Claims Adjuster, Injury Settlement Negotiator, Claims Manager, SIU/Fraud Investigator, and Compliance Officer......I can answer questions related to any aspect of Automobile insurance claims and coverages. I can provide an inside look at how insurers operate. I always treat my customers fairly and want to help make sure you are treated fairly. However, please keep in mind that being treated fairly according to the law does not guarantee that you will get what you want. I can also answer some questions regarding Homeowner's and other types of insurance claims. I have handled all types of auto insurance claims and coverages. I am NOT an automotive repair expert but can give advice re how insurers handle complex repair issues. Please keep in mind that every state has its own set of laws pertaining to rules of the road, liability, and insurance. No one is an expert on every state. I am most familiar with laws in Maryland, DC, West Virginia, and Virginia, but will attempt to answer questions for other states. I am not an attorney an cannot provide legal advice. My advice will be my opinion based on my experience.

Experience

I am currently an Auto Claims Manager for a large insurance company. I have 18 years experience in the industry, having worked as a Claims Adjuster, Injury Settlement Negotiator, Claims Manager, SIU/Fraud Investigator, and Compliance Officer. I am not an attorney an cannot provide legal advice. My advice will be my opinion based on my experience.

Organizations
CPCU Society. Adjusters license in multiple states. International Association of Specal Investigators

Education/Credentials
I have a B.S. in Finance and have completed the AIC and CPCU designations.

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