Claims Adjuster not willing to pay for my injury.. : (

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<p>as wondering if any of you could help me out a bit here…</p>

<p>I went on a college ski trip up in the northern California mountains and drove there myself…on the way back, my car was rear ended by another car.</p>

<p>I ended up a bit of a neck problem…couldn’t move my neck to the right (which was just absolutely convinenet for driving…:confused: )</p>

<p>I went to a doctor and he told me to do physical therapy…which was $30/pop copay 2x a week for 6 weeks…ALso, the doc told me to apply hot/cold packs twice a day for a few weeks.</p>

<p>Well, since with my financial aid for college I could barely afford extra clothes for fun, I didn’t do the physical therapy. I did, however, ask a friend who is going to physical therapy school and almost graduated what I should do and she told me that my injury was quite common and not that severe, and gave me some excersizes to do and told me that I shouldn’t be driving and that I should get rides or use public transportation</p>

<p>As a result, I only went to the doctor once time officially, and only spent money on that one visits and all my ice/hot packs.</p>

<p>I was also taking an art class ( I am going to school to be an art teacher/art therapist) and was paiting big murals.</p>

<p>I couldn’t paint the big murals due to my neck problem, so I withdrew from my class, thinking that I would take it next semester.</p>

<p>I ended up having to take that art class in the summer to meet a deadline, and as a result, could only work part time.–totally didin’t forsee that!</p>

<p>I also spend lots of money on subway/bus fare, which costs 2x as much as driving in my metropolitan city.</p>

<p>I filed a clain with Liberty mutal for the cost of the ice/hot packs and the loss of wages, subway/bus fare. and also a hundred or so for “pain and suffering”</p>

<p>Now, Liberty mutal is only willing to give me $500 for my “Alleged problems”–the insurance adjuster was VERy rude and implied that I was making everything up.</p>

<p>I faxed the insurance adjuster reciepts of my ice/hot packs, subway fare reciepts, and loss of wages and one doctor visit.</p>

<p>I estimate my loss to worth at least several thousand.</p>

<p>In retrospect, I should have just asked the Liberty Mutal Company to give me some money for my estimated physiotherapy costs, but they avoided telling me about that route.</p>

<p>Now, I know that insurance adjusters only given a range to work with, and that that $500 is probably the low end of that range.</p>

<p>My Adjuster refuses to pay for <em>loss of wages</em>, <em>subway fare</em> and the majority of my ice/hot packs, which were $14/a pack!</p>

<p>How do I get her to give a higher range?</p>

<p>I honestly believe that had I gone to physical therapy, I would have healed just the same amount of time…only i would have more to prove my case : (</p>

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<p>I am not an advocate of people bringing lawsuits against others but it sounds like you may have a legitimate claim. The only problem is that you do not have any real medical bills to prove injury. Had you been going to physical therapy you would have recouped those damages from the insurance company.</p>

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<p>I’ll preface this by saying that I’m not familiar with the way it works in California regarding this type of claim, whether it is recoverable from your own insurance company or if you claim against the third party’s insurer. Is Liberty Mutual your company or that of the person who was liable? Assuming the latter, have you been dealing with them from the start? Do you have medical coverage under your policy? In some jurisdictions, your medical expenses and sometimes even disability (lost wages) to a proscribed amount are recoverable under your own medical benefits package on your auto policy. Anything over and above the amount you receive for your lost wages (if it’s not 100%) would be claimed against the other company. Did you speak to your own insurer? </p>

<p>Being advised by your friend was a mistake, which I’m sure you realize now. Since you have little to actually prove your claim, it’s not a surprise that the adjuster is skeptical. If you estimate your claim to be worth thousands, then you’ll need detailed documentation proving your damages. With only one doctor visit, that isn’t likely. I sympathize with your situation and this is one more example of why the U.S. needs to get their healthcare delivery system fixed. </p>

<p>Check with your own insurer to see if they’ll cover your bills for the ice packs and your doctor’s visit. Proving lost wages when you’re working a part time summer job is difficult and likely why they’re refusing to consider that part of the claim. I’m still not clear on why you think the claim is worth thousands. There is always the option of retaining a lawyer but from what you’ve said here, I think even with a lawyer, you’re going to have a difficult time getting what you feel you should.</p>

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<p>I’m not an expert in any area at all, just a regular person reading your post. I can only say that it seems they should have paid for your physio, which you should have gone to but did not. The rest is how it all unraveled due to your choices. You don’t come across as responsible but instead making excuses with your hand out. </p>

<p>Ski trips aren’t cheap…nor is maintaining a car. No doubt if you could have found a way to skimp on non-necessities (and I’m not talking new clothes), or borrowed from family, and made your health a priority. </p>

<p>I also don’t know how you added it up. Cost of subway/fare sure…but twice as much? And what about first deducting what you would have saved on gas, maintenance, parking?</p>

<p>Art class in summer? No medical excuse to enable you to do it the following year? How so? Was it the insurance company’s responsibility to figure out how you would earn money in the summer when taking those classes? Maybe several weeks of physio and you could have stayed in the class. Or gone the following semester. Or or or…</p>

<p>Seems not very convincing.</p>

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<p>No, it doesn’t seem like a reasonable claim. I wouldn’t grant it if I were Liberty Mutual, either.</p>

<p>$500 sounds like a nice offer.</p>

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<p>I’m not an insurance expert either…but clearly this happened LAST year…at least for you to have taken a course during the summer. Where I am, claims for insurance need to be made IMMEDIATELY and injuries verified IMMEDIATELY, not a year later. It sounds like you are making this claim MUCH later than you should have. How could the insurance company verify your injuries when you really didn’t take the time to do that yourself? By not following through on the medical advice you did immediately receive, I can imagine there is a perception that nothing really was wrong…until you had a bill to pay for summer school. That is NOT ths insurance company’s problem at this point in time.</p>

<p>Lesson learned…when injured, go to the doctor iimmediately, do the necessary medical followup immediately and get documentation for all. Doing all of this a year later sounds like it’s just not going to work.</p>

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<p>I think thumper is right on the timing of all this. Not sure if it applies to other states, but a friend received similar injuries due to a car wreck last year (his car was totalled though). At my insistence, he immediately sought medical attention and consulted an attorney, who filed notices of claim for injuries with the other party’s insurance company as well as his own…he was leaning toward the “home cure” method taken by the OP as we have many mutual friends who are medical professionals and his health ins is just plain awful. But the docs/PT’s all billed the insurance company for his co-pays, MRIs, etc. (which ran into the thousands) and he was given a settlement for transportation, lost wages (a pain to document since he’s self-employed, but very necessary), out of pocket expenses for prescriptions, and other miscellaneous costs. Now he’s just fighting for a fair settlement on his rare old sportscar :frowning: </p>

<p>Moral of the story…sometimes it’s better not to take the DIY approach even if it seems cheaper/easier at the time. When in doubt, call your attorney for advice first!</p>

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<p>Btw, I think your friend took a big leap into dispensing medical advice without a license! Idk what ethical boundaries govern PT’s but I would not be taking advice from an unlicensed, inexperienced student if it were my neck!</p>

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<p>My recollection is that you have 2 years to file suit in California for personal injury. Contact an attorney. Perhaps the first route is to have a “demand letter” written on your behalf, though you may have to pay the attorney for their services - this may get you an acceptable offer. If litigation is desired, most attorneys take PI cases on a contingency fee basis (you don’t pay unless and until you get a settlement or award); if you can’t find one willing to work on that basis, it’s unlikely that your damages are sufficient to entice them. Another route is small claims court, which caps damages - in California, it’s either $5000 or $7500 - I don’t recall and it’s something that’s easy for you to find out through a quick search.</p>

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<p>Many personal injury lawyers will do a brief free consultation and give you a realistic idea of what claim amount you’d be likely to get. My daughter did that and then managed her own claim (she was hit by a car while cycling). She got 4x the original offer (which was substantial).</p>

<p>The fact that they’ve made an offer at all says that they know they’re at fault. Now it’s just a matter of how much they’ll give you. Consult a lawyer.</p>

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<p>Folks, since we all have to pay for auto insurance, and therefore we all have to pay for fradulent insurance claims, I’d be really careful about trying to help this young lady out. Should she (and thousands of others like her) be successful, we’ll all end up paying higher insurance rates.</p>

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Fraudulent? :confused:</p>

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<p>Yup, we all get to pay for (through insurance rates) the cost of all claims, both those legit and fradulent.</p>

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<p>OP, ya messed up. Let this experience teach you : If it didn’t happen in a medical record, it just didn’t happen. Adjustor Rule 101</p>

<p>Just ask yourself this question…when it comes time for bonuses at the Insurance Company, who gets rewarded? The adjustor who pays out the least…or the most? I think you’ll know the answer. </p>

<p>And babyontheway, I hope you are never the victim of another’s negligence. I wouldn’t want you to wrestle with your beliefs. lol.</p>

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<p>Insurance is there to pay legitimate claims, or else they are just stealing our premiums. Aren’t they? ;)</p>

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<p>There’s nothing wrong with turning in legimete claims to insurance. Like damage to the vehicle, legit medical treatment for bodily injury, lost wages due to bodily injury. </p>

<p>But sometimes people try to milk the insurance company for every penny they can, and sometimes try to scam the insurance company by turning in false or fradulent claims. Sometimes they go to prison for insurance fraud. We’ve all seen it.</p>

<p>As an insurance adjuster, I’m sure you saw numerous cases of people padding their claims. And I’m sure you saw many cases of insurance fraud.</p>

<p>I have no idea if this case if fraud or not, but I do think it is fishy enough that I’m not willing to help the OP out because it sounds fishy.</p>

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<p>You tell me. Is lost summer wages because of a summer art class that was dropped the previous quarter a legitimete claim? Let’s assume the disabled student services was not contacted to make reasonable accomodation to accomodate the temporary physical disability.</p>

<p>I have no problem with legitimate claims. I just don’t think all of what she wants is a legitimate claim.</p>

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<p>Honestly the insurance company isn’t going to budge on this one. You can’t just turn up well after the fact of an incident and say (paraphrasing):</p>

<p>“well there was all this other stuff that happened later too, here are the receipts can I be paid please… oh, and can I have some additional money for pain and suffering too.”</p>

<p>It simply doesn’t work like that. </p>

<p>You say your neck started to hurt later because of the car accident… Unless you have paperwork from the accident report documenting that your injury was from the accident then it essentially didn’t happen. Were you examined in a hospital immediately after the accident to document the injury and document that it was caused by the accident (and not say from your skiing)? It sounds like you only had one ex post facto doctor’s visit and then a bunch of random expenses that you occurred on your own. </p>

<p>In these cases all you’re likely to get is some “go away money”… that’s what the $500 is. It’s a good offer. You should take it and move on. </p>

<p>I know it seems harsh and unfair, but there’s just far too much fraud out there for insurance companies to be more soft about such things.</p>

<p>P.S. $14 for an ice pack !?!?!? Frozen peas make a great ice pack and cost next to nothing.</p>

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<p>OK, I think I need to address this.</p>

<p>As some of you know, my wife was pregnant until about two months ago. During her pregnancy, on the day of her baby shower, she was a victim in a freeway accident. She has no idea how it happened, but she was minding her own business driving down the freeway when a car went perpendicualr in front of her and she slammed into it. Cut and dried, other drivers fault. Totaled our car.</p>

<p>Both mom and baby are fine, thankfully, but she went in for several hours observation to make sure everything was fine. </p>

<p>The insurance company cut us a check for the cost of the car. We were on our own for rental car (we carpooled, although it was very difficult), and my time I spent looking for another vehicle was not compensated. </p>

<p>Did we put in for “pain and suffering” damages? Of course not. While the event was very stressful, I figured that the “pain and suffering” that we experienced was part of the risk of driving. It was not lasting anxiety and did not require therapy or other treatment. </p>

<p>Shortly after, my wife went on mandatory bedrest for the rest of her pregnancy. Did she put in for lost wages due to bedrest? No, because it was pretty obvious to each of us that the bedrest was unrelated to the car accident. It would have been convenient to collect a large sum of cash because of it, but that wouldn’t be right or fair.</p>

<p>So, yes, my wife was recently the victim of anothers negligence. Please don’t assume that my harshness to a person fishy insurance claim means that I think all insurance claims are bad. Insurance is there for a reason, and legitimate claims should be filed and paid. It’s also something that is subject to abuse, and we all have to pay the cost of insurance abuse through higher rates.</p>

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<p>BOTW, I’m so glad to hear your wife and child are okay! I think this kid’s story is probably true because the pain/range of motion description is accurate, but it probably won’t matter either way because she didn’t go through the proper channels to get the documentation she would need to successfully execute a claim (at least for actual expenses related to the injury). She sounds inexperienced with insurance matters, ill-advised, and was obviously focused on other things…hopefully she won’t have recurring neck problems and it will be a relatively low-cost lesson learned. </p>

<p>Having lived with neck problems for 40+ years as the result of a childhood injury, I would not take the $500 quite so fast. She should probably consult an attorney, even at this late date, just to see if anything could/should be done in case a chronic condition ensues. My parents were unaware of possible long-term effects and were only reimbursed for medical care and dental work that were obviously required at the time…the damage to my neck and permanent teeth wasn’t apparent for several more years and the claim was closed by then. We paid tens of thousands in related dental and medical expenses for treatment until NYS banned “pre-existing condition” clauses for health insurance plans. I still pay for chiropractic care, which my insurance will not cover at all, and PT visits above the allowance, but I would live in agony without them.</p>

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<p>It will be difficult to prove anything at this point. Your friend should not have given you much of any advice. If they were a student, their opinion means NOTHING. You needed to see a professional as directed by the physician. Then you could have been reimbursed for it.</p>

<p>If insurance was so easy to convince to pay for what is essentially self-treatment, then what would be the point of PT clinics? Those professionals would serve no purpose.</p>