What's Taking So Long...Continued

What's Taking So Long...Continued...

Close-up car accidentIf you have followed my blog so far concerning my automobile crash (we personal injury lawyers abhor "accident," preferring terms like "collision" or "crash" that connote negligence), you know that it occurred in early March. You read that initial post, then the update in April, and the last note was in June, which addressed why everything was taking so long.

Well, it's still taking a long time!

In fact, the only thing to report is that I am just recently released from seeing my chiropractor related to this incident, to return on an "as needed" basis. The treatment lasted a bit over six months, which sounds like a long time. Unfortunately, I'm sorry to report that my symptoms are not completely gone. Despite diligently obtaining treatment and doing everything my doctors told me to do, I still have some residual pain, stiffness, and a slight loss of normal range of motion in my neck.

Most of you are probably waiting for some report of finality, conclusion, closure, or at least progress that is somehow understandable and demonstrable. So am I.

So why is it taking so long and what is happening to make this drag on seemingly forever?

As I completed treatment with all of my doctors but my chiropractor, I requested and obtained all of my medical records, reports, and bills. I made sure that all of those bills were submitted to my automobile insurance carrier for payment through my medical payments coverage.

Med pay versus health insurance--what's the difference?

Why submit bills through "med pay" instead of health insurance? If I put it through the health insurance, the insurer can refuse to pay if these bills are related to an auto crash or work-related injury. Essentially, the insurance contract allows the insurer to recoup what they pay out if you collect money from the party at fault. But it also allows them to refuse to pay these bills. It's right in the contract that comes with your coverage (you never bargained for it or read it, but it's there).

If I put them through my auto insurance medical payments provision, the bills submitted will be paid up to the limit in my policy. Most policies feature a $5,000.00 med pay limit. Of course, as with health insurance, I am contractually obligated to repay this money to my auto carrier if I recover from the party causing the crash.

Med pay provides me the assurance my bills will be paid, whereas health insurance may refuse to pay for them. Also, medical payments will pay the providers the full amount, not leaving a balance for me to pay, whereas health insurance discounts what it pays providers, leaving me to pay the rest.

Also, since health insurance companies usually reduce the amount of the bills submitted and not pay the entire bill, this leaves a balance for me to pay out of my own pocket.

If I had no insurance at all, either auto or health, I'd be stuck having to beg medical providers to place a lien on the file, waiting in line to get paid once the case settles. I would still owe the money anyway, but often providers do not bother to collect if there are no assets or insurance available. Also, savvy lawyers negotiate to reduce liens to much lesser amounts.

Thus, a person with insurance may be in worse position than one who DOESN'T have insurance.

Bills and Records-The Next Step

The next step after submitting bills for payment is to obtain medical records and bills from the providers. You would think this should be relatively easy. However, it can be quite a hassle.

For example, to obtain the emergency room records and bills, I had to submit requests to at least five (5) different places and entities! There is the emergency room records custodian, the emergency room billing agency, the emergency room physicians billing service, the radiology department, as well as their separate billing service. It is not one stop shopping! Nevertheless, I have everything so far except for the chiropractor, since I was released only weeks ago.

Lest you think the chiropractor just hits the copy machine and sends me everything in a flash, it is a bit more labor intensive.

In most personal injury cases, there is at least one "key/main" treating medical provider who prepares a narrative report, briefly summarizing the mechanism of the injuries, the treatment, and the prognosis. If the case were to go to litigation, he might also have his or her deposition taken and/or even provide live testimony in court. In a case of this nature, I am hopeful a narrative report should sufficiently explain to the insurance company what happened, what I was treated for, and why all that treatment was related to the accident and medically necessary. Otherwise, all there is for an insurance adjuster to read is exam notes, which are often not very detailed.

This all brings me back to why everything is stuck in sand.

My doctor has to create a narrative report that takes into account a great deal of medical history, test findings, treatment, and prognosis. It takes quite awhile to prepare this, especially because this particular chiropractor has training in the mechanisms of auto crashes and the injuries that result. Thus, it will involve some physics and other brain numbing information. The main reason for this is that it (hopefully) shoots down many of the insurance company's anticipated arguments (treatment was too long, treatment wasn't necessary, accident didn't cause all of the injuries, these types of injuries resolve themselves over time without any treatment...to name just a few of the "old standbys/usual suspects."

Once I have that, I will put my lawyer hat back on and go through my records, put them in chronological order, grouped by provider, create a spreadsheet listing treatment dates, billed amounts, and other information. I will send all that to the adjuster with photographs of my visible injuries, damaged eyeglasses, the intersection and autos involved, and other documentation.

The evaluation and negotiation process is slower than ever. Insurers use time as an asset in two ways; it allows them to hold and earn interest on their money and it "starves" the claimant, often forcing people to take less money sooner rather than wait and take the risk and incur the expense of litigation. Most carriers have a hierarchical approach to review, often-involving supervisors, claims committees, and medical review experts, prior to a dime being offered.

We all know that if you want to get something done quickly and efficiently, the minute the words "review" or "committee" are inserted into the conversation, there is no way the process will ever be quick or efficient.

If "nothing" seems to be happening, it is hard to feel connected to your case.

This seems needlessly frustrating to many people. I was fortunate in that I had great auto insurance AND I had health insurance AND the other driver had insurance. Imagine what it would be like if I had no way to pay my bills while I was waiting to finish treatment and resolve my claim and was hounded by bill collectors regularly! For me, time is not an issue because I know my bills are paid already. The only issue for me is receiving fair compensation. If you are not familiar with this process, I cannot imagine how isolating and daunting it could be to wait months and months with seemingly "nothing" happening.

This is one reason I try to stay in contact with my clients regularly (and this blog is just one method), even if "nothing" is happening. I attempt to reassure them and explain at least a little of the process, easing their anxiety.

Claims are not as fast-moving or linear as we would hope. There are many things happening at once, with treatment, bill submission, obtaining medical records and bills, along with continuing to work, play, and devote time to other pursuits. There often is no explosive "gotcha" moment. In fact, they are quite monotonous, and filled with dead moments of "no action."

Soon, I will have everything together and can begin working toward a resolution of the claim.

As far as my recovery, the "new normal" for me is that I cannot turn my head to the left as far as I used to, my shoulders get stiffer sooner, especially when I type, my right hand and wrist are aggravated more by typing or smart phone usage, and my lower back is stiffer than before. No doubt, I am still a very active person, and I plan to remain so. This will have a small, subtle effect on the rest of my life. I certainly drive even more cautiously, especially when approaching intersections. All in all, except for the (new) car payment, it could have been so much worse.

I hope to report a resolution to you in the future--please be patient!

Categories: General