Insurance Settlement Advice Needed

[p2oh]

In November I was bit by a pit bull at a friends apartment. The whole story was drama but now her homeowners insurance is involved and they have asked me to give them a settlement amount. I have no experience with anything like this and don’t know if I need a lawyer or not. They sent me a check for $1000 to cover medical expenses, but my medical expenses have been paid by my health insurance. So do I send the check to my medical insurance or back to her insurance and tell them to deal with my health insurance? This is such a mess! As far as a settlement goes I have no idea what to ask for. I mean I was out of work for a few days so that I can figure out but she told me to give her a figure for the scaring on my arm. I have no frame of reference for that stuff. Where would I even begin to find out something like that. Thanks for any help anyone can provide.

 

[KirstenB]

Gosh I don't know either. You hear that lawyers get 30% in that type of settlement, and it certainly sounds like you're trying to be very reasonable about the whole situation. Is there something like a Legal Aid Society who could help advise you? Will you need any future cosmetic surgery for the injury? If you think you might, then try to factor that in, plus any time off from work for that too. I have heard you're not supposed to cash their check until you're fully compensated for anything you can envision.

I was in a car accident years ago. The other driver was at fault. HIs insurance company called me to see if I was injured. I told them my neck was killing me (I was rear-ended), but I was only 23, so I thought I'd heal up okay. I think they sent me $1800.00 in case I needed Physical Therapy or anything.

Good luck, it must have been scary to be attacked by a pit bull, no less!!

 

[p2oh]

It was a very traumatic experience and I can't be around a dog without going into a panic attack, plus I have a nightmare at least once a week. I won't need plastic surgery, my only concern is I still have a little numbness on my hand and I keep thinking it will go away, it doesn't hurt or bother me, I just know it's there if that makes any sense. I am not trying to get over on anyone I want the whole thing over with. I just don't know why they asked me for a number, I thought it went the other way around.

 

[mickeyboat]

First - I think your medical insurance will probably want to be reimbursed for medical expenses they paud on your behalf. Don't spend that money!

Second - I guess how to handle the rest of your loss depends on your personality. Do you want to go for the throat and get all you can, or do you just want to be made as whole as possible and let it go?

If you want the dough - you need to hire an attorney. They will take a cut, but they can probably get you more than what you could get without them.

If not, compute what you lost for the time you took off, the trips to the doctor, and whatever out of pocket expenses you can come up with. Then do a little research, maybe through the workers compensation entity for your state, as to the "worth" of a scar on your arm. There are charts which show how much a leg is worth, how much molbility in your fingers is worth, how much a scar is worth. I am guessing the insurance company has ready access to this figure, but is hoping you will request less than that. Don't forget pain and suffering, which is also compensable.

Good luck.

Denae

 

[Cheshire Figment]

I would first suggest that you talk to an attorney but tell them you are just interested in advice and are willing to pay a hourly rate.

Do not sign any sort of representation agreement and do not allow the attorney to send any letters.

If you sign a representation agreement they will then get a percentage (between 30% and 40%) of any money collected after taking expenses off the top.

Figure out what your total out of pocket expenses (including payments to lawyer and what healt insurance company paid) and what additional expenses might be entailed to correct any possible problems. Then present that to your friend for presentation to the insurance company. Make them aware that you have talked to a lawyer for advice.

I would agree at least with part of what Mickeyboat said about determining the "worth" of the damage.

Normally the insurance company will be ore than willing to settle, knowing that if the lawyer gets formally involved then there would be the legal fees on both sides to be added.

I hope this makes sense.

 

[chris1gill]

Your claim is worth a whole lot more than 1000.00 IMHO... You said you are having problems with anxiety... well, that is a problem, as is the numbness you are discussing... so you need to take these things into consideration, along with whatever work and medical bills you have. If you take the check, your medical company will want reimbursement....

 

[disney kid at heart]

Do not cash their check as that will let the matter be closed and you have a lot of problems to take into consideration. Your health insurance will want to be reimbersed. You may need therapy due to the trauma. Think in the long run as to what medical problems may be incurred the future. That was a horrible thing you have gone thru. My prayers to you.

 

[va32h]

The first person to name a price is always at a disadvantage when bargaining. I have to agree that you should consult a lawyer and pay for his advice, not necessarily representation.

I am not sure about giving the money to the insurance company. If my insurance pays for something, I'm not required to reimburse them. I am sure they would like me to.

 

[mickeyboat]

I am not sure about giving the money to the insurance company. If my insurance pays for something, I'm not required to reimburse them. I am sure they would like me to.

Man, we are disagreeing all over the place on the boards today!

Most insurance contracts have clauses in them which requrie coordination of benefits, and third party liability and rights of repayment / subrogation / reimbursement.

Our says "If XXX Co. provides benefits to a member for an injury...for which a third party is or may be responsible, then XXX Co. retains the right to be repaid the full cost of all provided by XXX Co. that are for or related to the injury.... When XX Co. has provided benefits above and the Member or Member's Representative has recovered such costs from the third party, XX Co. is entitled to reimbursement frrom the Member for the full cost of benefits."

They are also entitled by the contract to put a lien on future judgements or benefits, and specifically identifies homewoner's insurance as a source of the duplicate benefits.

Denae

 

[oxfordcircus]

I would NOT use workers comp valuations. They are LOW. If I were a lawyer handling your case, I'd key in on the "neurological damage" - the numbness and tingling that still persists. The psychological effects are hard to prove unless you've gotten treated and medicated. Some lawyers will take out of pocket costs (lost wages plus medical expense in your case) and multiply it times 3 or 5 to give a settlement range. But I think that goes out the window when there's a permanent neurological injury. You might consider going to a lawyer whose face doesn't appear on a billboard, magnet or phonebook cover.

 

[missj1975]

I am not sure about giving the money to the insurance company. If my insurance pays for something, I'm not required to reimburse them. I am sure they would like me to.

Yeah, I agree. I think it is your insurance company's responsibility to go to the homeowner's insurance company to get reimbursed for any loss your health insurance incurred. On the other hand, you probably shouldn't cash the check yet until you find out more info on what compensation the homeowner's insurance is willing to give.

 

[p2oh]

I decided to send the check back and tell my insurance to contact her insurance to be reimbursed. The adjustere explained to me that there were two parts to the policy one medical and one liability. She said the medical had a $1000 cap and that is why she sent the check but that the liability is negotiable and to give her a figure. I guess I will have to go and talk to a lawyer as much as I don't want to.

 

[oxfordcircus]

Man, we are disagreeing all over the place on the boards today!

Most insurance contracts have clauses in them which requrie coordination of benefits, and third party liability and rights of repayment / subrogation / reimbursement.

Our says "If XXX Co. provides benefits to a member for an injury...for which a third party is or may be responsible, then XXX Co. retains the right to be repaid the full cost of all provided by XXX Co. that are for or related to the injury.... When XX Co. has provided benefits above and the Member or Member's Representative has recovered such costs from the third party, XX Co. is entitled to reimbursement frrom the Member for the full cost of benefits."

They are also entitled by the contract to put a lien on future judgements or benefits, and specifically identifies homewoner's insurance as a source of the duplicate benefits.

Denae

Totally. However, if the OP's health insurance is like mine, the OP was responsible for at least 20% of the costs, so the offer from the HO policy should not just go to the health insurance provider.

 

[mickeyboat]

Totally. However, if the OP's health insurance is like mine, the OP was responsible for at least 20% of the costs, so the offer from the HO policy should not just go to the health insurance provider.

Yeah, yeah, you are right!

Denae

 

[JR6ooo4]

my Dw was in a car accidentlast month and her neck was very soar. Her sister works at state farm snd told us that typical they offer 3 times the medical bills for pain and suffering. I assumed (hope) that is on top of paying the medical. She plans to submit 5 times.

they also want a one time payout. So if she thinks it may hurt in a year then she must wait the year to see if it does hurt.

It is very common to have a fear of dogs the rest of your life after being bitten. I am not sure how high that will rank on the charts mentioned earlier.


sorry to hear about the bite,

MIkeeee

 

[p2oh]

My insurance didn't pay everything, so maybe I should cash the check and send my health insurance what they paid out? I am so confused. Honestly, I took the girl the bill for what the insurance didn't pay and then she decided she wanted to file it against he homeowners. So they weren't even involved from the beginning. I know ten people in med school and no one in law school, go figure! How do you go about finding a reputable lawyer?

 

[va32h]

Man, we are disagreeing all over the place on the boards today!

Most insurance contracts have clauses in them which requrie coordination of benefits, and third party liability and rights of repayment / subrogation / reimbursement.

Our says "If XXX Co. provides benefits to a member for an injury...for which a third party is or may be responsible, then XXX Co. retains the right to be repaid the full cost of all provided by XXX Co. that are for or related to the injury.... When XX Co. has provided benefits above and the Member or Member's Representative has recovered such costs from the third party, XX Co. is entitled to reimbursement frrom the Member for the full cost of benefits."

They are also entitled by the contract to put a lien on future judgements or benefits, and specifically identifies homewoner's insurance as a source of the duplicate benefits.

Denae

I think I understand what you are saying, and I admit that I am totally ignorant insurance guidelines, etc.

I was just thinking of an incident last year where I cut my thumb - my insurance paid for the ER visit and stitches and sent me a form for 3rd party liability since it was a work-related accident. After I filled out the form, whatever was settled was between my insurance company and their insurance company though - TriCare didn't come to me and ask for reimbursement.

 

[mickeyboat]

I think I understand what you are saying, and I admit that I am totally ignorant insurance guidelines, etc.

I was just thinking of an incident last year where I cut my thumb - my insurance paid for the ER visit and stitches and sent me a form for 3rd party liability since it was a work-related accident. After I filled out the form, whatever was settled was between my insurance company and their insurance company though - TriCare didn't come to me and ask for reimbursement.

That's right, but it was because no one sent you a check. This is different.

I think if it was me, I would probably not do anything until I have spoken with an attorney. I am not sure how I would go about finding one if I knew no one who could give me recommendations. How about your state's Bar Association?

Denae

 

[oxfordcircus]

My insurance didn't pay everything, so maybe I should cash the check and send my health insurance what they paid out? I am so confused. Honestly, I took the girl the bill for what the insurance didn't pay and then she decided she wanted to file it against he homeowners. So they weren't even involved from the beginning.

I would hold the check until everything gets sorted out. If the check has the words "full accord and satisfaction" anywhere on it, you're getting screwed. Don't cash it, but don't send it back either. You are entitled to get 100% of your medical expenses covered. Assume your expenses were $1,000 and your insurance covered $800. Your friend's coverage should pay $200 to you and the rest to your health insurance co. A problem arises if your total medical expenses exceed $1000. If there's a cap on med-pay, then that's all the HO carrier will pay from that part of the policy. That's when you have to go agains the liability portion to recover the rest of the medicals PLUS your pain and suffering and all that other jazz you hear about in tort reform debates.

I know ten people in med school and no one in law school.

Count your blessings, name them one by one.

How do you go about finding a reputable lawyer?

Good question. Plaintiff's lawyer who advertise have the reputation for letting non-attorneys handle their case load, so they have the reputation for settling for low values. Referrals are the best way to find a good lawyer. Ask friends. Ask your med school buddies (just kidding...they probably already hate lawyers!). Your case doesn't sound huge, so you may have trouble finding a good lawyer to take an interest. If you could find a prominent plaintiff's firm, they should take your case and allow a young associate to handle it under the close supervision of a more experienced attorney. And then there's always the option of handling it yourself.

 

[cybrkitn]

It was a very traumatic experience and I can't be around a dog without going into a panic attack, plus I have a nightmare at least once a week. I won't need plastic surgery, my only concern is I still have a little numbness on my hand and I keep thinking it will go away, it doesn't hurt or bother me, I just know it's there if that makes any sense. I am not trying to get over on anyone I want the whole thing over with. I just don't know why they asked me for a number, I thought it went the other way around.

I had to take a double take at your intial post and this one! The same thing happened to my DH when we lived in a two family apartment. DH went to his broken down car in the backyard to empty it out so he could get rid of it. The downstairs tenant had their pit bull chained outside even though they were not home. Well, it broke free of it and lunged at DH. Needless to say, he also has numbness on the pads of his fingers that will never heal. He was also having nightmares from his traumatic experience and neither of us could see a pit bull without panicking for a couple of years.

We were advised by one of our landlords (who was also a family friend) to go through their homeowners insurance. DH had to get a lawyer for it and he wound up with a settlement. But we wondered the same thing regarding the medical bills b/c we also have medical insurance through his job. I don't remember what happened with that. I'll see if I can ask him about that tonight.