Following a loss, you can expect the other party’s insurance carrier to reach out to you. Even during the investigation phase, it’s not unheard of for the third party carrier to extend a contingent offer for your bodily injury claim. The exploratory conversation generally entails your version of the loss, a description of your injuries, treatment, and lost wages, as well as a brief calculation on the adjuster’s part.
When liability has been resolved, they will likely extend an offer during this initial conversation as a way to set your expectations. Accepting this settlement is not full and final, but signing/cashing the check and/or any release will be binding.
As indicated previously, a bodily injury claim generally entails three components: 1)medical bills, 2) lost wages, and 3) pain and suffering, otherwise know as general damages.
Even if you carry health insurance, your medical bills are included in the calculation of your bodily injury claim. How much you see of those bills in the bottom line greatly depends on your health insurance and its administrator. For example, if you carry Medicaid, Medicare, or Tricare, the government (either federal or state), will put the third party carrier on notice of a lien. A lien is essentially a hold on your settlement funds, that declares to all involved parties that the insurance carrier has paid your medical bills and has rights of recovery. Some private health insurance carriers employ third party administrators to pursue liens against the third party insurance carrier. During conversations with the liability insurance carrier, they may skim over this liability and if your affairs are not in order when it is time for final settlement, you may find yourself responsible for these liens. This is when it’s important to have someone on your side, to traverse the insurance landmine and make sure you recover fairly when it is time for the disbursement of funds settled upon in your bodily injury claim.
As a third party claimant, when you pursue a bodily injury claim against a liability carrier they will not pre-authorize treatment. Instead, they will likely tell you that they will consider reasonable and customary charges and treatment. For that reason, you could also be left with balances on bills considered to be excessive in cost or duration. So, just by virtue of having incurred these bills as a result of their policyholder’s negligence, does not mean that the liability carrier will automatically include all of your medical bills. Instead, they will review these items and “cut” bills, often utilizing terminology that is confusing to the layperson. Again, this is when having an advocate to negotiate on your behalf can mean additional money in your pocket.
In short, medical bills are considered in a bodily injury claim. It is beneficial, however, to have a personal injury attorney to review and assist you with your claim to have a liaison available to traverse the industry lingo and argue the hefty cuts to these bills or discuss settlement outside of any potential liens generated by these medical bills. Ultimately, the adjuster is trained to close a file quickly and within the company parameters. Your LA personal injury lawyer has your best interest in mind and works only within those guidelines set during consultations.