You are here:

Auto Insurance Claims/Car Insurance Rejects Paying Medical

Advertisement


Question
QUESTION: Hi Justin,

I was in a car accident 20 Jan 12; rear ended. The driver and Farmers Insurance took full responsibility for the accident. The repairs to my car were just over $6,000, and Farmers indicated they would cover my medical bills. Farmers have already paid in full for the car repairs. I went to the doctor four times between Feb 2012 and Apr 2012, and I this week I provided my medical bills. They rejected paying for three of the visits, the time I took off of work for the doctor visits, and did not make any offer for pain and suffering. I was 52 at the time of the accident, and the impact to my car was very forceful / destructive.

The reason they used for not paying for the three doctor bills and my time off is because of the gaps between doctor visits. Right after my car accident I made the first doctor appointment, in which the first available appointment was on 10 Feb 2012 (3 week gap), the second doctor visit was on 09 Mar 2012 (4 week gap) due to him being out of town on business, the third doctor’s visit was on 23 Mar (2 week gap) and the last was on 06 Apr (2 week gap). The total cost for the doctor is $395.00.

At the time of the accident Farmers told me they would fully cover my doctor visits, and for me to contact them after I had completed taking care of any medical needs. I did exactly as I was told…, at no time did Farmers indicate any restrictions in managing doctor visits. I’m an honest person, and did exactly what was asking of me by both Farmers and my doctor.

I have no problem taking them to small claims court. But I would like to get some legal insight to what is going on and how I should address this. My time off of work is about $1,000, I would be asking for $2,000 for pain and suffering…

Sincerely,
Paul D

ANSWER: Paul,

 I don't have enough information to give you a good answer because I do not know the extent of your injury.  What did the doctor say?

 Generally, if you have a soft tissue injury, a doctor cannot assist you, it will be physical therapy and pain meds, muscle relaxers.  The best question to ask yourself, is would you have sought the exact same treatment if you had known for sure Farmers was not going to pay?

 If you would have, then you generally will have a case that in my opinion is worth a fight.  If you simply misunderstood what would be paid for and attempted to get some medical care just to document it, then you may have a problem.  I simply can't tell because I don't know what kind of injury you sustained, and the type  of injury and what you do for a living will make an impact on the pain and suffering, if any.  

 It seems like you may need the assistance of an attorney since you are dealing with Farmers.  They are not known for being generous in their injury settlements.  
 

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

QUESTION: Thank you for your response.

As a result of the accident I had pain and numbness in my leg and arm. This is why I went to the doctor. On the first doc visit he injected me with something to address what I was experiencing. The follow up visits were to monitor my condition for improvement. It wasn't until the last visit that the pain and numbness from the accident subsidized.

In response to your statement "If you simply misunderstood what would be paid for and attempted to get some medical care just to document it,.."; from what I wrote above this is not the case.

When I first talked to Farmers I responded to their questions, via the phone, that I had incurred pain and numbness and was going to seek treatment for it.

From your statement "The best question to ask yourself, is would you have sought the exact same treatment" ... from what I wrote above I needed too so YES!

Please respond to how the information I have just added supports me having a claim.

Sincerely
Paul D

Answer
Okay, so pain and numbness?  What was the diagnosis?  Did you have a torn ligament, pinched nerve, strained muscle?  It is highly unusual to get an injection for a sprain or strain.  I'm sure the problem is the lack of information about your injury.  At this point what you're telling me is subjective.  You haven't proven that you have sustained any injury at all.

Also, going for a followup is normally because you are not progressing properly, but if you are healing up, why did you go to the doctor?  I think that the argument Farmers is likely to use is that your treatment was not medically necessary.  You will have to get your doctor to assist you by thoroughly explaining him/herself.  It does seem like you got unusual treatment for an unusual injury associated with an auto accident.  The doctor is going to have to say that you sustained the injury due to the accident and explain exactly what the injury was and why you got the treatment and followups you got.

I hope this helps!  

Auto Insurance Claims

All Answers


Answers by Expert:


Ask Experts

Volunteer


Justin Petty

Expertise

Challenge me! I promise that I will provide you with the most honest answer I can muster, and I will base it on nearly 20 years of complex claims experience. My strength is shooting it straight and seeing through BS. I do not bluff and I can tell when somebody is. I've handled claims in almost every State in the U.S. and adjusted claims and consulted attorneys and CEO's on recovery and special claims tactics for over a decade. I am the founder and President of Petty Details, LLC. We provide the highest quality claim services to insurance companies, attorneys and individuals all exactly in the same way, by paying attention to the details and doing the right thing.

Experience

Nearly 20 years of combined claim company management, litigation, all lines adjusting, claim auditing, damage assessment, subrogation, small claims, tort recovery, collection, skip-tracing, tactical investigations, and contribution claim recovery experience across the United States of America.

Organizations
NASP (National Association of Subrogation Professionals) AllExperts.com (Auto Insurance Expert) Diminished Value Appraisers Group (LinkedIn)

Publications
10 years experience in writing and developing technical claims correspondence for litigation and unique scenarios at insurance companies and as a consultant to attorneys assisting with legal briefs and research. 42 published articles relating to auto insurance and claims. Self Published e-books entitled "How Much is My Injury Worth" and "Diminished Value - How Do I Get Paid?".

Education/Credentials
School of hard knocks, 3 years college, NO DEGREE, years of real world experience running a claims service company and adjusting claims for carriers. Speaks English and Spanish, Limited Portuguese & Italian.

Awards and Honors
Platinum Author (EzineArticles.com) All Lines Adjuster (TX, 1998 - 2008) TX Public Adjuster (2009 - 2011)

Past/Present Clients
State Farm Insurance, Endeavor GA, MileMeter Ins., American Recreational Markets, Gainsco Ins. Co., Safeway Ins., Home State County Mutual Insurance, Old American County Mutual Insurance, FCCI, Farm Bureau, Liberty Mutual, and Pronto General Agency, LTD just to name a few! On top of insurance companies and attorneys, I have personally helped thousands of accident victims with the difficult and stressful process of navigating their claim to a successful resolution.

©2016 About.com. All rights reserved.