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winstonpur · Mar 20, 2008, 01:01 PM

I was hit by a car while riding my bike and have health insurance... This Question is not about who I pay or paying back anyone... It is about what the adjuster has to consider when calculating the offer.

I am about to settle my claim and am wondering-- in considering my settlement do adjusters have to consider all of the whole $25,000 that was billed to the insurance company or just the $12,000 that they paid and the rest was written off?

If I did not have health insurance they would have to pay all the $25,000.

I do not have a lawyer... my health insurance company put my med bills into subrogation instantly...

I just want to know for the adjuster, does he have to consider the full $25,000(+13,000 difference) in billed medical bills, than just the actuall $12,000 paid by my health insurance company in computing my settlement?

I live in Colorado
Thanks

JudyKayTee · Mar 20, 2008, 01:19 PM

Originally Posted by winstonpur

I was hit by a car while riding my bike and have health insurance.... I am about to settle my claim and am wondering-- in considering my settlement do adjusters have to consider all of the whole $25,000 that was billed to the insurance company or just the $12,000 that they paid and the rest was written off? If I did not have health insurance they would have to pay all the $25,000.

Your Attorney should have negotiated this with the health insurance company before agreeing to a settlement - if your health insurance gets wind of the settlement they can attempt to collect the written off portion from you.

If you are doing this without an Attorney make certain the adjuster puts IN WRITING what the agreement with the health care providers is. When you say "in considering your settlement ..." what do you mean?

I'm surprised that the health care providers didn't lien against any future/possible settlement.

What State are you in?

winstonpur · Mar 20, 2008, 02:46 PM

Originally Posted by winstonpur

I was hit by a car while riding my bike and have health insurance.... I am about to settle my claim and am wondering-- in considering my settlement do adjusters have to consider all of the whole $25,000 that was billed to the insurance company or just the $12,000 that they paid and the rest was written off? If I did not have health insurance they would have to pay all the $25,000.

I do not have a lawyer... my health insurance company put my med bills into subrogation instantly...

I just want to know for the adjuster, does he have to consider the full $25,000(+13,000 difference) in billed medical bills and the actuall paid by the insurance company was $12,000 in computing my settlement?

I live in Colorado

Fr_Chuck · Mar 20, 2008, 03:22 PM

If and when you reach a settlement with the car insurance you are suppose to be required to pay back any health insurance money that they paid out.

Under most insurance policies ( in the US) have a clause where they are not required to pay if another insurance or person is liable to pay.
So actually you are lucky they even paid to start with.

So once you settle, your health insurance can reqiure you to repay them.

winstonpur · Mar 20, 2008, 03:34 PM

This Question is not about who I pay or paying back anyone... It is about what the adjuster has to consider when calculating the offer.
Thanks!

Fr_Chuck · Mar 20, 2008, 05:28 PM

The adjuster does not have to consider anything, unless you tell them what you want. The adjuster will try to not pay you for the hospital bills, since most people don't know they will owe it back to the insurance company. It is the adjusters job to pay you as little as they can.

Since it appears you don't have an attorney, expect to get a lot less than they should be paying. You have to give the adjuster a list of what you want to settle, not see what they will offer

ScottGem · Mar 20, 2008, 05:38 PM

Ok, first, if you don't have an attorney you are being foolish. If you were hit then you get paid and whatever settlement you get would have covered the attorney's fees.

As to what the claims adjuster for the insurer has to consider, they are going to want to pay out as little as possible so they are only going to consider what your out of pocket expenses where. And the fact that your healt coverage put you under subrogation means anything you receive with respect to the accident goes to pay what they paid out first. Without an attorney I bet you don't see a dime. The car insurer will reimburse the health insurer and that's it.

JudyKayTee · Mar 20, 2008, 06:07 PM

Originally Posted by winstonpur

This Question is not about who I pay or paying back anyone....It is about what the adjuster has to consider when calculating the offer.
Thanks!

The insurance adjuster does not HAVE to consider anything when he/she makes the offer. The insurance adjuster is paid by the company that insures the person who hit you - the insurance adjuster is not your friend.

The fact that you even ask the question of what the adjuster "has to consider" indicates that you do not understand the process.

Every insurance adjuster who posts is going to be here screaming BUT every penny that the insurance company does NOT give you they get to keep - for raises, for bonuses. I repeat - the insurance adjuster is NOT your friend. It is his/her job to pay you off as inexpensively as possible. They are also not regulated, licensed, no particular qualifications, no particular education - they can tell you the moon is green is that will get you to settle... and there's nothing you can do about it if they lie.

Your ATtorney works for you and the more he collects for you, the more he gets paid. Statistics - and I would have to pull them - show that the settlements negotiated by Attorneys are much, much higher than those "negotiated" by private parties.

I've heard the "we pay 3 times your medical expenses, that's the standard in the business" line; I've heard the same thing with 2 times and 4 times.

The insurance adjuster doesn't want you to consult with an Attorney because if you do you will have some idea of the value of your case (the value of your injuries) as well as your rights and you won't take what they offer. I've heard of - and I'm in NYS - insurance adjusters showing up with cash, waving it under people's noses and - dazzled by the money - people signing releases right on the spot, signing away their rights. And the insurance adjuster is not your Attorney and has no duty to inform you of your rights and/or the pitfalls of the settlement - and will the medical providers pursue you for the entire amount or not falls into that category.

You are making a mistake but after you have been negotiating with the insurance company, they have your statement, it is probably too late to change things.