Expert: Claims Guy - 6/20/2011

Question
Dear Claims Guy,

I was rear-ended a couple years ago in WA.  My medical bills were paid through my PIP (total just under $8K).  I am currently in the process trying to settle w/ the other driver's insurance company.  Prior to sending my settlement offer, I received multiple unsolicited offers that I rejected.  The most recent offer for medical expense by the other driver’s insurance company was a little over $2K plus P&S that was just under $2K (my settlement offer was for $18K and I included supporting documentation such as Dr. statements, invoices, loss of sick leave, travel costs, etc.).  As a side note, the other driver’s insurance company paid less than $1K for the property damage.  

Questions:

1)  If I end up accepting a settlement offer that is less than what my PIP paid for my medical expenses, do I have to reimburse my insurance company w/ the remainder of my award (including my P&S award) to make up the difference?  In my case, there is such a discrepancy so far in the figures that I am worried I may end up with nothing in the end…

2)  Do you recommend I discuss the above issue w/ my insurance company to get an idea of what they will do?
  
3) The other driver’s insurance adjuster also refused to compensate for the loss of my earned sick leave from attending all my medical appointments (valued around $2K).  Any suggestions on how to fight back on this issue?

4)  At this point do you think legal representation is necessary to get the other insurance company to take me seriously?

Any advice would be much appreciated.  Please let me know if you need more information on my case.

Thank you in advance for your help!

Answer
1)  This varies by state.  Call your insurer and clarify with them.

2)  Yes

3)  This would be covered if the medical treatment was reasonable and necessary as a result of the accident.  It sounds like they are disputing this, probably because of the minor property damage.

4) It is very doubtful they will increase their offer by much if you get an attorney.  And the attorney fees will greatly outweigh the likely increase in any offer.  It appears they believe your medical treatment was largely unnecessary or unrelated to this accident.  When there is minor property damage, insurers often will doubt this, as will some judges and juries.  You need to decide if you want to sue the other driver and go to trial.  If the answer is yes, you will need an attorney.