What is a fair amount for insurance to pay medical expenses? 15 Answers as of March 29, 2012
I was hit by a car as a pedestrian in front of a store in July. My injuries were relatively minor (shaken up, scrapes and bruises from hitting the ground, pain, missed work ($460 lost wages). Medical expenses were $662 (urgent care, 2 RX copays, one visit to an orthopedic doctor, xrays). My car insurance company has finally paid me back part of my out of pocket expenses ($22.34). I have also paid $100 to the orthopedic office and the balance there is not yet paid ($379) but I have been told they will pay that bill and repay me. They told me they would get any expenses they paid from the other insurance company. However, the driver's insurance company told me today what they will pay me and it is up to me to pay my insurance company back or not. They said they do not have to pay them, as that is not the law in Arizona, and that I do not have to pay them back either, since I have $5000 in medical payments as part of my policy. And they said my rates will not go up if I do not pay my insurance company back. I cannot call and ask my company and see if this is true, as they have not yet reimbursed me the $100 or finished paying the medical expenses (the orthopedic office). I do not want to have to pay the medical expenses from my modest settlement. They offered me $2122.00, I told them I had a bit larger number in mind, she asked me how much (I had been looking at $2500-$3000) and told her $3000, she told me she could not do that, but offered me $2622. Is that a fair amount? And what are my legal obligations as far as my medical expenses?Free Case Evaluation by a Local Lawyer!
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Andrew T. Velonis, P.C. | Andrew Velonis
Your question is confusing. I only have a licence in New York, so I cannot comment on the law in Arizona. The fair amount to pay for medical expenses is the amount of the medical expenses. In New York, a pedestrian hit by a car is entitled to no-fault benefits. Once the paperwork is complete, the providers bill the insurance company directly and the insurance company pays the providers directly.
Answer Applies to: New York
Replied: 12/21/2011
Goodman & Goodman PA | Bruce Elliott Goodman
If your injury occurred in Arizona you will need to seek the advice of an Arizona attorney. However, no attorney can evaluate your claim without investigating the issues of liability, damages, and jurisdiction, and I can't imagine that they will do that if you are not retaining them to represent you.
Answer Applies to: Maryland
Replied: 12/21/2011
Law Office of Sam Levine, LLC | Sam L. Levine
In terms of damages for your medical bills related to your car accident, you should expect enough money to cover your medical bills, incidental expenses, lost wages & pain & suffering. The amount of damages is very subjective, but the insurance co. should negotiate in good faith & be fair & reasonable. If not, please consult with an attorney. Good luck!
Answer Applies to: Georgia
Replied: 12/20/2011
Paul Whitfield and Associates P.A. | Paul L. Whitfield
I don't know anything about Arizona law as it relates to subrogation liens (reimbursement of your carrier). You have a very small claim. The 2622 is perhaps all you will ever get. You owe the doctors and should pay them direct. They did not render service to an insurance company. They served you,. Pay them, get receipts. Send all receipts to your med pay carrier. They should send you a check for up to the amount of your coverage. You seem to be trying to get and stay ahead of insurance companies. Good luck on that. They are experts at staying ahead. That is why they and the banks have all the money in the world. If your carrier does not pay you promptly report it to the insurance commissioner of the state where the policy was written.
Answer Applies to: North Carolina
Replied: 12/20/2011
Law Office of Jared Altman | Jared Altman
Did this accident happen in Arizona. If so, then Arizona law may I apply and I am not familiar with that.
Answer Applies to: New York
Replied: 12/20/2011
The Law Office of Harry E. Hudson, Jr. | Harry E. Hudson, Jr.
You need to read your contract with your carrier. I do not believe the issue to be whether or not the driver's carrier has an obligation to pay the other carrier, usuallyyour carrier can sue the driver. Also, usually, the injured party owes its carrier for any damages the carrier pays. Not sure what Arizona has to do with this event. You owe the medical expenses if paid to you to the care providers or whoever paid for the care, other than the driver and / or his company. If this accident occurred here in CA or driver lives in CA, sue in small claims. I thnk case is worth more than three thousand. Insurance companies tend to hard ball. They have to pay if you have a judgment. They cannot send attorney into small claims court.
Answer Applies to: California
Replied: 12/20/2011
Counard & Heilmann Law Office | Michael Heilmann
In Michigan, Minor claims do not meet the threshold that is able to be sued upon. Therefore, if your injury is truly as minor as you claim, you should get three times your out of pocket expenses.
Answer Applies to: Michigan
Replied: 12/20/2011
R. D. Kelly Law Firm, P.L.L.C. | Robert Kelly
There isn't any formula to determine how much is owed for personal injuries. In the State of Washington, the at-fault party's insurance company does pay the injured person and the insurance company that paid the medical bills in the meantime has what is called a "subrogation" claim to get repaid if the injured party is fully compensated. In the case of Thiringer V. American Motors Ins., 91 Wn.2d 215, 588 P.2d 191 (1978), the Washington State Supreme Court said the following: "The general rule is that, while an insurer is entitled to be reimbursed to the extent that its insured recovers payment for the same loss from a tort-feasor responsible for the damage, it can recover only the excess which the insured has received from the wrongdoer, remaining after the insured is fully compensated for his loss." " This rule embodies a policy deemed socially desirable in this state, in that it fosters the adequate indemnification of innocent automobile accident victims." You can read Washington State cases on the MRSC website: http://www.mrsc.org/wa/courts/index_dtSearch.html You might be able to find an attorney to help you with that.
Answer Applies to: Washington
Replied: 12/19/2011
Attorney & Counselor at Law | John Hugger
I do not know or do Arizona law. Where was the accident? If in Colorado I would get all the meds from your insurance company and normally they will take the other company to arbitration if they can not amicably resolve it. Also, what companies are involved? If you settle you will not get any more $ and will need to pay all of your medical providers. Consult with an attorney ASAP!!!
Answer Applies to: Colorado
Replied: 3/29/2012
Ford, Howard & Cornett, P.C. | Bradley Cornett
You mention Arizona in your question, but your question was submitted as a question about Alabama law. The law can differ significantly from state to state. If your accident occurred in Arizona, I suggest that you re-submit your question and indicate Arizona rather than Alabama. That way, you will get responses from attorneys who practice law in Arizona rather than Alabama. With that said, whether or not you have to re-pay your automobile insurance carrier for medical expenses paid on your behalf will likely depend on the language of your insurance policy. Look for the term "subrogation" in your insurance policy especially in the section about Medical Payments coverage. A few insurance companies do not subrogate (require re-payment) for medical payments made under the MedPay portion of an automobile policy but most insurance companies do. You should discuss the matter directly with your insurance company. If you are insured by a reputable company, they will tell you the truth whether or not they have paid yet. You many need to speak with someone in the subrogation department (instead of a claim adjustor). If you are not comfortable speaking with your insurance company about your subrogation questions, you should consult with an experienced attorney who handles insurance matters. You likely only have a right to MedPay (medical expenses) from your own insurance carrier. However, you can recover all compensatory damages (such as medical expenses, lost wages and pain and suffering) from the liable individual (or his/her insurance carrier).
Answer Applies to: Alabama
Replied: 12/20/2011
Lapin Law Offices | Jeffrey Lapin
I can only answer some of your questions. Your "Question" and the "Question Detail" are not very similar so it is hard to answer your actual "Question." To try and answer your actual "Question" the "fair amount" is what the medical provider is willing to accept from the "insurance" company as full payment less any co-pays or deductibles. For example, a medical provider may charge $100.00 for some service. The insurance company and medical provider may have a contract in which the insurance company only has to pay $80.00 to the medical provider. An insurance company may not have a contract but still may be able to get the medical provider to accept less. I am not licensed in Arizona so I cannot answer any questions about the law there as it relates to paying back your insurance company. However, assuming your insurance policy is governed by Nebraska, you likely have a contractual duty to repay your insurance company. Your insurance policy probably has provisions regarding "reimbursement" and "subrogation", which are legally different, but basically have the same meaning, which is, that if you recover from a third party (including an insurance company), you have to repay your insurance company. However, you would have to check your policy to see what effect, if any, if what the other insurance company is saying about Arizona law (not having to repay your insurance company) is true. This would depend, in part, on the specific language of your policy. I cannot answer the question whether "$2622" is a fair amount to settle your case for. I would need to know a lot more about your injuries and damages. Lastly, as to your "legal obligations as far as my medical expenses" you have a legal obligation to pay your medical providers. They provided you a service and are entitled to be paid. They do not have to wait until your settle your case to receive their money. They might be willing to wait but they do not have to. This response is not a substitute for professional legal advice and does not create an attorney-client relationship, nor is it a solicitation to offer legal advice. If you ignore this warning and convey confidential information in a private message or comment, there is no duty to keep that information confidential or forego representation adverse to your interests. You should seek the advice of a licensed attorney in the appropriate jurisdiction before taking any action that may affect your rights. If you believe you have a claim against someone, you should consult an attorney immediately, otherwise there is a risk that the time allotted to bring your claim may expire.
Answer Applies to: Nebraska
Replied: 12/19/2011
David F. Stoddard | David F. Stoddard
You are responsible to the doctors for your medical expenses. The portion of the insurance money that is for medical bills is to reimburse you for your medical expenses. It looks like your lost wages and medical bills combined is about 1,122 and you have no permanent injury. When you have no permanent injury, anything exceeding your medical bills is usually good. I would say it is fair.
Answer Applies to: South Carolina
Replied: 12/19/2011
EJ Leizerman & Associates | Michael Leizerman
Be very careful. You should have an attorney read your insurance policy. Many have rights of reimbursement or subrogation of any medical payments for any amounts you collect from other insurance companies. If you have collected medpay and do not pay back, you could be subject to a lawsuit from your insurance company.
Answer Applies to: Ohio
Replied: 12/19/2011
Carter Boyle LLC | Nelson Boyle
Be careful you do not sign a release that says you will hold harmless or indemnify the responsible party or their insurance company from anyone seeking to recover for any reason. This language can mean that you will reimburse the med pay insurance and you will then have to do so. Lawsuit damages come in 3 general categories: Things that can be fixed, things that can be replaced but cannot be fixed, money to make up for things that cannot be fixed or replaced. It sounds like they are giving you no amount for inconvenience, pain, suffering, loss of ability to do things while you were injured, emotional distress, future lost work, or mileage. They should these things that cannot be replaced or fixed have a money value.
Answer Applies to: Colorado
Replied: 12/19/2011
The Carlile Law Firm, LLP | D. Scott Carlile
As a non-client I cannot advise you whether or not your settlement offer is fair compensation. I can tell you that you have a legal obligation to repay your medical expenses and any emergency care providers - hospital, ER docs, EMS, etc. have a lien against any settlement.
Answer Applies to: Texas
Replied: 12/19/2011
