- What happens when I’m done treating?
The car accident lawyer collects all the medical records and bills when the client is done treating. Then he will draft a demand package to submit to the BI adjuster. The car accident attorney has a conference with the client before the demand is submitted. The discuss will include the case value, client expectations, and negotiation strategies.
It typically takes thirty days for the BI adjuster to review the claim and make an offer.
- Do I need an expert?
It depends. The patient is left with some degree of permanent partial impairment anytime a patient undergoes surgery. That is the case whether it’s an arthroscopic surgery or ORIF. There are many orthopedic experts that charge a flat fee to perform an independent medical examination (IME). During the IME, the expert will follow an algorithm and provide a permanent partial impairment rating. This gives an objective measure of how the claimant will be impacted for the duration of their lives.
Sometimes the patient has a permanent injury where surgery is not indicated. For example, we often see spine injury cases which are not severe enough to warrant a complex spinal fusion surgery. Nonetheless the patient will require years of pain management treatment with cortisone injections and ablations. An expert can likewise provide a permanency rating under these circumstances.
• Can I still recover if I have a pre-existing condition?
Sometimes the patient will have an extensive history of pre-existing conditions. The car accident lawyer can anticipate that the adjuster is going to relate the treatment to the pre-existing condition instead of the crash. The car accident lawyer can cut off those arguments with an expert report. Hopefully, the expert report indicates that the pre-existing condition was aggravated by the crash.
- What is the negotiation process like?
The negotiation process truly depends on the individual adjuster you’re dealing with. Some adjusters have reputations of being easy to work with and some are very difficult to work with. A supervisor reviews minor impact soft tissue (MIST) cases who gives the file to a junior adjuster. The junior adjuster has strict parameters that they must negotiate in. The junior adjusters are often difficult to deal with because they have no discretion. They also want to make a good impression on their supervisor. If they can settle the case for less than they were authorized to offer, this is called a take-down.
• How do policy limits factor into a negotiation?
The negotiation process also depends on how much coverage is available. If there’s a $100,000 policy, it’s generally easy to obtain the policy limits if the injury is major. The reason is because the adjuster has a fiduciary duty to settle the case within the insured’s policy limits. The individual insured in on the hook for any verdict over $100,000.
The insurance adjuster might not be too worried about an excess verdict on cases where there’s a higher policy ($250,000 or $500,000). They have a bigger cushion. Once the claim starts getting up into the six figures, you will see the adjuster pull back. They’re trying to test the resolve of the attorney. Are they really prepared to litigate this case?
A smart insurance negotiator is going to look for that sweet spot. They’re going to make an offer that is low enough to save money, but substantial enough that the claimant has to think about the likelihood he’s going to get a better result in court.
- What is a health insurance lien?
BI adjuster should compensate the claimant for pain and suffering, medical expenses, lost wages, etc. Since the settlement is based on medical expenses, the health insurance company views it as double dipping. If the insurance is public (Medicare/Medicaid), there is an automatic lien. Private insurance companies must assert a lien.
Anytime a medical provider agrees to accept insurance, the health insurance company can adjust down the bill. The patient is not responsible for the difference (only co-pays and deductibles). The adjustment is approximately 30-40 cents on the dollar.
The BI adjuster is responsible for paying the gross (total) amount of the bill before the adjustment. The health insurance company will get reimbursed for the 30-40% they paid. Additionally, the attorney is generally able to reduce the lien by 33%.
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