Expert: Claims Guy - 12/28/2010

Question
QUESTION: I was involved in an auto accident. I began having numbness and tingling in my hands and my doctor decided to wait about three weeks before scheduling an MRI to see if it would go away on its own.  It did not and I had the MRI.

I have turned in all of my receipts to the other defendant's insurance company.  They are now saying that it was not medically necessary and will not pay for it.  They also said they are not paying for it because it came back as normal.

My question is this can they do that; and also what about when my medical insurance wants reimbursement for this how can it be paid back if the insurance company does not pay.

This accident was a rear end where the defendant was cited for following too close.  

Thank you

ANSWER: They can do this, but you have the option of suing them.  Basically this boils down to a dispute and disagreement about medical necessity.  I suggest you let them know if they do not cover all your expenses, you will get a lawyer and file suit.  Do not yell or get angry, but advise them in a calm business-like maner.  They will then have a decision to make.

You can retain an attorney who will handle your case on commission, meaning he/she will earn a percentage of your award/settlement.  It won't cost you anything to hire the attorney.  Typical percentages range from 25-40%.  Check for an attorney referral from friends or family, or the local bar association.  Do not hire an attorney based on TV ads as those lawyers tend to be more about volume than quality legal work.  Also, make sure your attorney is familiar with auto accident claims - many lawyers are not and might mess this up.

---------- FOLLOW-UP ----------

QUESTION: Now she is saying that they will pay for half of it.  She is also stating that I only had two more additional weeks of treatment after the MRI.  I informed her that I had run out of visits and could not afford to pay for additional treatment.

The offer she made still does not cover all of the expenses and I am pretty sure that I have an ERISSA medical plan and they will ask for reimbrusement which will leave me owing my insurance company money.

I do not wish to hire an attorney at this time.  Is small claims the way to go?

Thank you for your promp response.

Answer
You can go to small claims court, but this type of case can be complicated and the insurer will have an attorney in court.  So you might be outmatched.  No guarantee you'll be happy with the outcome.  If i were you, I would meet with a couple lawyers and get some free advice, and maybe hire one of them.