Any insurance law experts out there?

[Cindy B]

I'm in a tough spot and don't know what to do regarding an accident with my son.

My son was riding his bike on 5/3/04, and a woman backing out of her driveway, did not see him and hit him.

Per the pediatricians telephone advice, we took him to the hospital. (He had large chest wall contusions, and the peidatrician wanted to check for internal bleeding and EKG as well).


Ok, went to the ER and all is said and done. He is fine now, but the first few days, tender.

When we went to the ER, it was considered an emergency so my health carrier Horizon under my contract is supposed to pay 100% for all costs, er treatment, xray, you name it.

I get this bill in the mail for over a $1000 for the EKG, nurse treatment, doctor treatment, etc.

Apparently the hospital is considering this an auto accident, and my car insurance needs to get involved. This is the state of New Jersey (big collective groan there)., and I have been told by the person who hit my childs insurance (All state) that they will not pay the claim even though she admitted fault. They have stated more than a few times that my car insurance needs to get involved.

Why question is why does my car insurance need to get involved? My son was on a bike, not on a car. A car hit him while he was riding. I personally don't want my car insurance to go up for riding a bike. I'm wondering if Allstate is just balking about paying the claim, or if it is correct. The manager at the Allstate office said due to the no fault in New Jersey, my car insurance would cover it, and then "fight" it out with Allstate. I don't want or need my claims to go up due to something someone else did.

To make the matter more interesting , Horizon did pay some of the claims (the radiology, and reading of radiology) but not the others. Horizon consideres this an "other accident" not an "auto accident", since it was bicycle vs car., not two automobiles, or auto vs. tree, etc...

Now I have submitted the reamaining bills to Horizon. But I am concerned at the response I got from Allstate. They told me no way, no how they would ever pay this claim, because my car insurance isn't involved.

How do I get someone to pay this $1000? Do I take the person that hit him to small claims court? Do I call my car insurance, and tell them to fight it out with Allstate? Do I let Horizon fight it out with Allstate? Should my car insurance rates go up because of someone else hitting my son? Or do I send the bill outright to the person and tell them to pay it? Or is it time for an attorney?

Any advice will appreciated.

 

[Briar Rose 7457]

I got lost halfway through your post, Cindy, but the short answer is: your car insurance needs to be involved. if I'm not mistaken New Jersey is a no fault state, so it doesn't matter that another party is "at fault".

essentially your no-fault coverage provides medical benefits even when your car insn't involved. the coverage extends to you and all memebers of your household.

insurance policies are written with excclusioins and coordination of benefits provisions. the purpose is to make sure you don't collect twice for the same injury, but it also serves as a way to allocate costs among insurers.

 

[Miss Jasmine]

I say don't try to handle this your self because you cannot trust insurance companies, even your own. Consult an attorney if you don't want to pay out the money yourself. Usually just one phone call from an attorney's office will straighten out the whole thing.

 

[Briar Rose 7457]

Miss jasmine, this is not an issue for an attorney. not at this stage, anyhow. (much as I'd like to see a fellow member of the bar get work.) Cindy's auto company is obligated to pay the $1000. she doesn't need an attorney unless her company refuses to pay -- and they won't, so long as Cindy puts them on notice in a timely fashion.

her health insurer is not obligated because they exclude auto claims. the driver's polciy very likely provides benefits but only if there's no other insurance.

when Cindy's auto insurer pays the claim they'll make a determinatiion as to whether they can pursue reimbursement from the driver's policy. but no fault laws usually limit the right to collect from another party or its insurer.

 

[Miss Jasmine]

Really, I live in a no fault state, and I worked for an attorney, and these matters came up frequently.

 

[Briar Rose 7457]

they only come up if the carriers deny claims. the time to consult an attorney would be if Cindy's auto carrier refuses to pay the claim, leaving her stuck with the bill. that hasn't happened.

 

[Miss Jasmine]

Well we'll see what happens. Insurance companies LOVE to deny claims, especailly ones like these.

So Cindy put your insurance carrier on notice and let us know what happens. I hope it all works out for you.

 

[dennis99ss]

Seems a bit backwards to me. Why would auto insurance cover a kid on a bike? Seems like a pretty clear liability case, but, I don't have a clue about no-fault. Why wouldn't the lady be liable? If she runs into a house with her car, is the homeowner supposed to pay for it? BTW, It does not suprise me that allstate takes this position. seems like it is their sop.

 

[aahmom1]

I think you should sue the person who hit your son in small claims, no way should you have to pay higher premiums because your son was injured. That makes no sense, whatsoever.

 

[Briar Rose 7457]

Originally posted by Miss Jasmine
Well we'll see what happens. Insurance companies LOVE to deny claims, especailly ones like these.

So Cindy put your insurance carrier on notice and let us know what happens. I hope it all works out for you.

guess you never heard the words "bad faith".

carriers only deny claims when they have reason to, or they are exposing themselves to extracontractual damages. not to mention the possibility of a complaint to the Insurance Commissioner. the insurance company I work for right now has extensive training programs on how to avoid unfair claims settlement practices (NJ has extensive regulations in this area, by the way) and how to avoid a bad faith suit.

why pay an attorney to find out what you already know, i.e., that you have to file a claim with your insurer? file the claim, and if you get a denial -- which is unlikely -- then you will need to consider consultation with an attorney. hire an attorney now and you're only creating extra steps for yourself.

 

[Briar Rose 7457]

dennis and aahmom, new jersey is a no fault state, and what happened here qualifies as an auto accident. as such, suit is barred as a matter of law. she cannot sue, the judge will (quite properly) throw the case out of court.

 

[Briar Rose 7457]

here's some reading on the subject of no-fault insurance:No fault benefits it's counter-intuitive, but that's the way it works.

 

[Miss Jasmine]

Songbird, I don't want to be hashing this out with you on two different boards. Yes I know about bad faith. Perhaps you should be spending this time working on your clients cases rather than going after me. After all you are the attorney and attorneys are ALWAYS right.

 

[AirForceRocks]

dennis and aahmom, new jersey is a no fault state, and what happened here qualifies as an auto accident. as such, suit is barred as a matter of law. she cannot sue, the judge will (quite properly) throw the case out of court.

Not necessarily - apparently, it would depend on which option the driver chose when purchasing insurance.

Three states have a "choice" no-fault law. In New Jersey, Pennsylvania and Kentucky, motorists may reject the lawsuit threshold and retain the right to sue for any auto-related injury.

http://auto.insurance.com/insurance_options/auto/auto_basics_no_fault_ins.asp

 

[believe]

How would this be handled if Cindy B didn't have car insurance? Kentucky is a no fault state also, so I am curious....I do know that when my niece was hit by a vehicle my sister did not need to involve her car insurance...of course my niece did have broken bones and have to go through surgery.

 

[MICKEY88]

I guess my attorneys more observant than the rest of us. Iforwarded this to her and she asked if the post is for real since the date says the accident occured 5/3/04....11 months from now.....the simple solution would be to keep him inside next may 3rd and avoid the accident.......sorry had to lighten the situation it seemed to be getting hostile

 

[Steve H.]

Originally posted by MICKEY88
I guess my attorneys more observant than the rest of us. Iforwarded this to her and she asked if the post is for real since the date says the accident occured 5/3/04....11 months from now.....the simple solution would be to keep him inside next may 3rd and avoid the accident.......sorry had to lighten the situation it seemed to be getting hostile

I was wondering if I was the only one who noticed that!

 

[Disney Doll]

Hey Miss J, lighten up!!! I don't see briar rose attacking you personally, she's just relaying information about what she knows.

Worked for a health insurance co. a few years back. Any accident that involves a car ultimately gets paid by someone's auto insurance. What happened a lot in my state(Connecticut) is that the person who wasn't at fault insurance would pay, and then go after the person who was at fault insurance for reimbursement. That way the medical bills get paid without a long wait on the end of the hospital etc. It used to be called Coordination of Benefits...I don't know if it still is.

Our family attorney is also a friend, so if I were in this situation, I would probably give him a "heads up" that this is going on, in case, down the road, I needed to enlist his services.

 

[DebbieB]

Do you have an insurance agent? You should talk to them. I work for an insurance company in underwriting. Since your claim is only $1,000, no-fault personal injury protection should pay for it. It covers the named insured and all members of their household. I don't know what the maximum med pay limit is in NJ, but I'm sure it's over that. When a claim goes over the limit, then liability insurance comes into play, as well as claims for "pain and suffering" (that's where the lawyers come in).

 

[Miss Jasmine]

Originally posted by Disney Doll
Hey Miss J, lighten up!!! I don't see briar rose attacking you personally, she's just relaying information about what she knows.

Well you didn't see the whole thing becuase some of this discussion took place on another board. Believe me I am not the one who needs to lighten up.

Advice is advice, you can choose to ignore it. That's why it's only advice and not law.

What I thought was funny is that I said she should consult with an attorney and that is what Briar Rose is (or at least says she is), so ummm isn't that what she ended up doing anyway?