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Auto Insurance Claims/Personal Injury Claim Negotiation

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Question
Hello,
I was involved in a rear end collision.The at fault driver was a 17 year old who admitted to police that he was distracted while changing the radio station (i suspect he was actually checking his cell phone). He was found 100% at fault and was cited by police on the scene. Damages to vehicle cost approximately $1,100. I suffered headaches and neck/back pain from whiplash and sought out a doctor within 10 days of accident. I was referred to undergo physical therapy to treat the injuries. Treatment and supplies costs approximately $1,200. Treatment was performed bi weekly for 5 weeks during lunch hours while still working. Though I am a salaried employee, I estimate that I had lost earning capacity of $900 based on my wages for productivity time lost while performing treatment activities.

Due to my work schedule, I performed initial therapy at physical therapy office & followed home therapy regimen (exercise/rehab routine, mobile electro stimulant machine, heat and ice treatment) provided by PT office. I also received bi-weekly massage & acupuncture from local massage therapist who performed at gym/wellness center and sometimes at my home using mobile massage table. Medical records and invoices were provided by doctor and PT office. Massage therapist was only able to provide carbon receipts.

I have decided to try to settle the personal injury claim without lawyer on my own as it seemed like a straight forward case. The at-fault drivers insurance company however, refuses to compensate for the massage therapy expenses incurred because they were only documented on carbon receipts and not on medical forms. Is it acceptable for them to do this? They are also refusing to pay for the lost earning capacity since they are denying all treatment time and expenses from the massage therapist receipts, and because I did not have to take leave of absence from work or report the injury to my boss or HR since I am a salaried employee.  I suspect that it may be a negotiating tactic, but the insurance company has remained steadfast for the past 2 weeks on this and has only offered me $750 to settle the claim, when I know the claim is actually worth $5000 to $7000 if litigated. What documentation is legally required to support the expenses? If the insurance company continues to deny this, can I return to seek treatment at a provider that uses medical forms? My physician has recommended that I  perform an MRI and X-ray, and potential further therapy as I still have pain in my neck and back. Does the at-fault insurance company have to compensate for these costs? What leverage can I use to negotiate a better offer from the at-fault insurance company?  

Thanks in advance for all of your help with this.

Answer
There is no legal requirement that bills be provided in a specific manner.  However, health care providers typically use a standard billing format and use CPT and ICD9 codes.  Massage therapists are not health care providers, and their credibility is lacking in comparison to a licensed physical therapist.  This is a matter of credibility.  It comes down to what they believe is appropriate and what they predict a judge/jury would believe is appropriate.  You say you know the claim is worth $5-7k if litigated.  I suspect the insurer does not agree with this assessment.  If they did, they would offer more.  No one can guarantee a trial outcome - it is very subjective.  But insurance claim reps base their assessment on their experience with similar cases.  Part of the problem is the damage to your vehicle is relatively minor when compared to other accidents, so it is less likely a judge or jury would buy the need for all this treatment.  If you feel strongly about this, you probably should hire an attorney and go to trial.  

You might try speaking to th adjuster's manager.  You could explain your next step is to hire an attorney and file a lawsuit if they do not offer a specific amount by a specific date.  Don't be argumentative.  Be professional but firm.

Auto Insurance Claims

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Claims Guy

Expertise

I am currently an Auto Claims Manager for a large insurance company. I have 20 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 20 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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