Does anyone here work for an insurance company? Question.

[SandrainNC]

I need to ask a question and will be as brief as possible.

My son was hurt at daycare back in August. My husband and I took numerous personal days and I took a good many unpaid days to care for him (he broke his femur and was in traction for two weeks and a spica cast for 5). Anyway, we have asked that the daycare's liability insurance carrier reimburse us for my unpaid days and our personal days. They said yes, but then want us to sign this release that pretty much says we can never ever ask for anything from them again and that they are not admitting liability. Well, my attorney (I work for a law firm) saw it and said not to sign it. Then I talked to the insurance man again and he said until we sign the release, we cannot have our money because they are treating our reimbursement like a medical claim. Instead of hiring a nurse, we took care of him, so therefore the money is like a medical expense. Does this sound right to anybody?? If we would have hired a nurse, they wouldn't be able to wait to pay it out after we sign something because it would have been claimed at the time of the expense, and yet they refuse to give us the money until all of my son's medical is completely over with (he goes for another x-ray in May 2006) and until we sign that release (which even after his medical is over I don't feel comfortable signing because they are pretty much getting out of anything that could happen later because of his injury).

It makes me very angry because we could have easily sued the daycare because of this and we have chosen to only ask for money we lost and all of the medical expenses. We are being fair and it seems like they are not.

Any help would be appreciated!

Sandra

 

[mtdevine615]

It does make sense from the insurance compaines point of view. Don't sign anything, you will be giving up your right to any future settlement. You don't know (God for bid) if your son will have any problems in the future. I would however contact a lawyer and let them look into it. Sorry for your hardship.

 

[WIcruizer]

First, based on what we know, I'm not sure if the day care is even liable. I imagine you had to sign some sort of contract with them, and depending on the language they may be in a good position. Accidents happen, and it doesn't necessarily mean they were liable. Just as accidents can happen at home, on the atheltic field, etc.

So the insurance company has no problem paying a little $ to make it go away regardless of fault. That's what you need to decide. Accept the offer or sue them. That's really what your options are.

 

[barkley]

check with the lawyer-i think a settlement can be structured such that all of your out of pocket and medical expenses can be reimbursed (including lost wages) and a set amount for future unanticipated medical can be put in an escrow account that reverts to the insurance company if not utilized by a certain date in the future. i believe also, that in some cases the "pain and suffering" settlement can be delayed for final disposition until the child reaches the age of majority (i guess the idea is with some injuries the child may not realize the full impact for a few years).

we had an accident years ago that we felt was being inappropriatly handled by the insurance company, we did'nt sue but we paid a couple of hundred to consult with an attny. to review their proposed settlement, find out what was reasonable to expect, and ultimatly have him write a letter on our behalf presenting a counter offer.

 

[MELISAZACK]

kids dont' have to settle till they are 21 yrs of age -at least in PA but yes you dont' usually get your settlement until the final release papers are signed... IF you sign now you get what they offer but anything between now and 21 yrs of age that could go wrong or need to be done to your son would not be considered and you could not go after them again............

 

[SandrainNC]

Thanks mtdevine615! It does sort of make sense, but at the same time I just want to make sure they aren't taking us for a ride!

WICruzer - The daycare was very much at fault. My son slipped on water in the bathroom floor from an over flowed toilet. The toilet had been broken for a few weeks (and yes I know absolutely that it was broken) and the daycare knew about it being broken before his accident (I have proof of this as well).

I know accidents happen, but that was total negligence on their part, if not only for sanitary reasons. So that is why I say I could have sued them already. They were definitely at fault. Unlike if it were a playground fall or something like that. A lot of people would have sued them automatically and it is not my plan at all to gain wealth from my son being hurt. I still get upset thinking about it. He is only 4 years old and had to lay there for 7 weeks.

All we really want is not to lose any money out of pocket. The part that worries me is that even after this x-ray in May (the doctor said there is a chance that the broken leg can grow longer than the other leg in children between the ages of 2 - 10 when this sort of break happens so that is what he will be looking for) what if he has problems later on or heaven forbid, he has had between 20 and 30 x-rays because of this and that scares me to death! The insurance company has offered only what we have asked for. I guess if they insist on our signing such a document, then we will ask for more. And I guess we just have to wait until May or after depending on the x-ray outcome.

My attorney already wants to charge them interest and he pretty much laughed at the document they want us to sign.

Thanks again!

Sandra

 

[SandrainNC]

Thanks Barkley! That is a good idea!

MELISAZACK - You mean we may not can even get our lost wages until he is 21??? That just doesn't seem right to me. But I guess them throwing it under medical is letting them get away with it. I missed around 109 hours that I wasn't paid for. That was a pretty big chunk!

Sandra

 

[MELISAZACK]

Well you usually don't recevie your settlement payment until you sign the release papers so yes if you don't sign until the statues of limitation run out for your state
then you may not see any of the settlement until then....in Pa the kids are able to hold off on statues until their 21st bday so parents don't have to sign releases for them in injury cases until that time - wereas for an adult I believe the statute is only 2
yrs from accident 4 yrs from last date of treatment.

 

[SandrainNC]

Ok. Thanks Melisazack. I guess the problem I have with it is that it doesn't seem like what we are asking for is settlement. It is reimbursement for our wages lost, which they would have paid to a nurse right then and there. That is the part that just doesn't sound right to me. We lost money because the daycare was negligent and it seems they should have to give that back now. Which is why I came to the boards - to see if this sounded correct.

What a pain this is. I am so grateful that my husband's job allowed him to work from home 3 days a week or I would have been home 6 to 7 weeks without pay by myself. We would have been in trouble. Someone who needs the money (not that we are rich, but we aren't about to lose anything because of it) would have just signed that paper to keep from losing their car or house or something so I hate that they can do that to people.

Anyway, thanks to everybody for your responses!

Sandra

 

[jfulcer]

The insurance company has offered only what we have asked for. I guess if they insist on our signing such a document, then we will ask for more.

So you told them how much you wanted them to pay, they said they would pay it, and you're unhappy? I'm not sure what the problem is.

The "we won't pay anything more on this" clause is a pretty standard one for insurance companies when you are negotiating a settlement - which is what you ARE doing.

I can also see the insurance company holding off any payments other than direct medical expenses until you signed a document - I think this is pretty much standard too.

I am assuming you are just upset you are not getting your 'out' wages now instead of past May 2006 like you mentioned. If the insurance company kept paying you your lost wages (and I'm NOT saying you would ever do this) how many time would they then have to pay your wages? During that 'theraputic' trip to Orlando? etc? You can see how it CAN get out of hand for someone that COULD be unscrupulous - and they are out there. I am NOT saying you would do this, I am saying someone may (and most likely has in the past).

The insurance company is just trying to limit their liability (which I can understand to a point). I just hate siding with the insurance company on this.

 

[MELISAZACK]

as mention above - your expense is not that of a lincensed medical provider so those type cost are paid through your settlement not as an expense for
medical treatment - only dr, hosp, therapist, rx, durable med equipment would
be considered in that field anything issue or treated by a licensed dr/nurse
everything else is out of pocket and that is what a settlement coverers.
So sorry to say that "yes" it was a inconvience to you and a loss of income but not a medical expense.....so it would have to wait till then...sorry

 

[Hillbeans]

SandarainNC - I just wanted to say reading your post and your "I don't want to make money off of my son's injuries" was a breath of fresh air.

I was disgusted yesterday that the first thing some of the relatives of the coal mineers said after they were told their family members had died was "I'm going to sue x,y and z".

Anyway, I think it's being VERY reasonable that you be reimbursed for time you and DH missed work with the setting up of an escrow account with funds in it for current and future medical bills as a result of this accident with the understanding that anything extra in the end would go back to them.

I have a 4 yo boy and couldn't even imagine going through this whole ordeal. Hugs to you guys and your little boy to feel better soon.

 

[SandrainNC]

So you told them how much you wanted them to pay, they said they would pay it, and you're unhappy? I'm not sure what the problem is.

I am just unhappy with what that paper says that they want me to sign. Claiming they aren't admitting to liability (it was the school's fault darn it) and we and none of our relatives, including my son, can never ever claim anything again. Which we hope we would never have to do of course. But who knows what problems he could have in the future. I have never broken a bone, so I have no idea.

I can also see the insurance company holding off any payments other than direct medical expenses until you signed a document - I think this is pretty much standard too.

That is what I was trying to find out - if this is standard, which I guess it is.

I am assuming you are just upset you are not getting your 'out' wages now instead of past May 2006 like you mentioned. If the insurance company kept paying you your lost wages (and I'm NOT saying you would ever do this) how many time would they then have to pay your wages? During that 'theraputic' trip to Orlando? etc? You can see how it CAN get out of hand for someone that COULD be unscrupulous - and they are out there. I am NOT saying you would do this, I am saying someone may (and most likely has in the past).

Actually, my attorney (I know I keep calling him that, but he is actually my boss) told me to ask them to rewrite the release to say "lost wages through" and then the date this past November when my son returned to daycare and we returned to our normal working schedules, so we weren't trying to have a never ending date for the lost wages. Just when he was out of school and had to be at home and we had to care for him. You are right though, someone would try to count that trip as therapy. But we were trying to put a date on it.

Thanks again MELISAZACK. I am glad other people know about how these things work, because it really confuses me.

Thanks Hillbeans! I hadn't heard that about the relatives of the people in the mine, but I am not surprised. Everybody has gone sue happy. I am going to keep the escrow in mind when we have to start talking about it again.

I appreciate everyone's input! Now at least I know that they aren't trying to pull something over on us.

Sandra

 

[WIcruizer]

WICruzer - The daycare was very much at fault. My son slipped on water in the bathroom floor from an over flowed toilet. The toilet had been broken for a few weeks (and yes I know absolutely that it was broken) and the daycare knew about it being broken before his accident (I have proof of this as well).

Thanks for that info. Please understand, I wasn't implying the day care was NOT liable, your original post just didn't go through these details. Now that we know the day care certianly was liable, you are in as tronger position.

I suggest this. Put a document in front of them with the exact provisions you want, for the exact dollars you want. If they don't accept your terms, sue them. And when you do, include a couple million for pain and suffering. Sometimes that's what it takes (unfortuntely) to get what you are entitled to receive. Then they know you're serious. Eventually they'll settle on your terms, and make sure your legal fees are paid for as well. They will not be stupid enough to take it to trial where they know they'll lose.

 

[SandrainNC]

Thanks WICruizer! I know I didn't put the details in the original message because I was trying to make it as short as possible. I hope we can settle in a nice way. We did take pictures of my son in traction and his cast just in case we needed them later though. They would have to be crazy to take it to trial. I'm not even worried about them doing that. I just hate controversy and was very worried they were trying to take advantage of us. I'm relieved to hear that at least it is pretty common what they are doing. I guess we will wait until May and see what the doctor says and go from there.

Thanks!

Sandra

 

[kelleigh1]

I've worked in insurance and now work in legal. That doesn't mean I know all the answers. But it does make it easier to see both sides. The insurance company doesn't want to be in the position where they could potentially be paying to you for years. But it also sounds to me that they owe for lost wages and any and all medical care for your son. I can understand why they want to pay you now and wash their hands of it, but the other side of that coin is that you don't know what residual problems your son could have and if you sign their release, you could be stuck paying for additional medical for which they would normally be responsible.

I agree with your attorney/boss. Don't sign it. Have an attorney write a counter-release and then go from their. (We recently settled a case where the release was rewritten at least 4 times.)

 

[SandrainNC]

Thanks Kelleigh1! Thanks for your input from both sides! I'm just not going to worry about it anymore until May I guess. I just wanted to make sure there wasn't something I should be doing differently now if they were being dishonest with me. But since it seems they are not, we will just wait and I will have my attorney write a counter release then.

Now, I am just going to concentrate on the fact that we are going to WDW in 16 days. Yahoo!!!!

Thank you everybody for helping me!

Sandra

 

[kelleigh1]

We're going in 10 days!! So you'll be arriving at the end of our trip. Have a great time!