Insurance Adjuster:

[CupCake]

For those who rememeber, I was involved in a car accident on Oct. 28th of 2005. My Mustang got totaled and I have been having back problems ever since.

I have never been in a car accident or gotten any tickets in my life before. The accident was not my fault and I am still having a hard time dealing with the driver's insurance company.

I am here today because I would like to get some opinions or ideas. I don't know if you guys will be able to help out.

After going to the Chiropractor for several months and not getting any relieve I was sent to get an MRI done. The MRI revealed that I had a bulging disc that is giving me problems still. When I talked to the insurance company they are trying to say that I had a preexisting condition that I didn't, or didn't know about. I have doctor's letter saying that my injury was a direct result from the accident and that I didn't have a preexisting condition that they could prove. But that doesn't seem to matter. They are still saying the injure was the result of a preexisting condition.

Does anybody know what would be the next step?

[Maroon 5.0 LX]

You should be talking to YOUR insurance company, not theirs.
Thats what you pay them for.

[Mr 5 0]

Hi CupCake:

The insurance company's initial flat-out rejection of your claim is practically standard procedure. You will likely have to sue the other drivers insurance company to obtain a reasonable settlement for your personal injury claim. This is also almost 'standard procedure' and what clutters up our civil courts and keeps tort attorneys in yachts and new BMW's.

My suggestion is that you contact a 'personal injury' attorney and explain the situation in a consultation (probably with one of his or her aides). Bring the physicians letter and the MRI report with you. You will probably need another physician to 'read' the MRI and determine whether your spinal disc injury really was 'pre-existing' or occured as a result of the accident. Expect to have to pay for his services, which won't be cheap. Unfortunately, this is how the system works. That doctor will also have agree to testify in court on his 'findings', which, if this ever actually happens, will also be an expense you'll have to pay. However, the fact that a reputable physician will testify that your injuries are not 'pre-existing' may be enough to convince the insurance company to settle with you out of court.

Most of these 'personal injury' attorneys are real bulldogs and know how to 'play' the insurance companies and work the courts. Be aware that they will take 1/3rd of any financial settlement they are able to obtain on your behalf but they won't chage you a fee upfront, other than copying expenses and so on. A few hundred dollars, at most. If any attorney asks for more, leave. He's a con-man trying to take advantage of you.

Yet another word of caution: if the other drivers insurance company won't 'settle' with you out-of-court, it could take 3 to 5 years before you ever go before a judge - and even then, the insurance company attorney will probably settle the day of your trial. This happened to my wife some years back. She was rear-ended and has had spinal/neck problems, 3 serious operations and other related complications ever since the accident. She settled out of court (after 5 years of waiting) for what now looks like a paltry amount of money, long since spent, considering her pain and suffering, since. However, realistically, you can only expect to collect up to the other driver's policy limits on his auto insurance that cover medical bills and personal injury, often no more than $100,000. if its even that high. Any personal injury attorneys office can explain all this to you, once you contact them. The local bar association can give you a list of reputable personal injury attorneys in your area.

I wish you well, CupCake.

[Rev]

Mr 5 0 is absolutely right on this. Get a personal injury attorney ASAP. Some doctors may even take an assignment from future collections as a fee for re-examining the the damage done to you from the wreck. Good luck in your persuit of the damage award that you deserve as payment for you injuries.

Rev

[rwhite65]

I also agree 100% with Mr. 5.0. Get an attorney.
Ryan

[DeltaMustang65]

Sorry to hear about your wife, Mr. 5.0. I hope she's doing better after those surgeries. Same for you too, Cupcake. I don't see you around much, but I vaguely remember you being in an accident. I'll say a prayer for both of you tonight.

[mustangII460]

Check your PM's

[Unit 5302]

I'm not sure how your state is setup. Minnesota is setup very well for situations such as these. In our "No Fault" state, you would submit your medical bills to your own insurance company. Your insurance company would pay the bills and subrogate for their expenses.

Unfortunately, it sounds like your state is setup different than Minnesota, and you will have to get a personal injury attorney. You may try contacting your state's insurance commissioner. Depending on how aggressive your states commissioner is, the insurance company may opt to pay your claim rather than lose their license to practice insurance in NC. In Minnesota, mentioning the Commissoner of Commerce and then following through can often grease the wheels quickly.

[CupCake]

Man, I sure wish things were like that here in NC. But insurance laws are crappy. My insurance company is not covering for anything. I have tried contacting them and there is no help there. It is amazing we pay them so much money for nothing.

I have contacted a lawyer and they are researching the information that I gave them so I don't know how long that is going to take. We will see.

When I talked to the insurance adjuster and said something about the state comissioner, she pretty much laughed at me and said nothing was going to grt done if I called them. That basically they will get a complaint of somebody that is not happy and that is it. I don't know if that is true or not. I guess we will see about that too.

Thanks to all of you guys for replying. Just let me know any information that you might have or find out. I will keep you posted. )

[Mr 5 0]

Originally Posted by CupCake

Man, I sure wish things were like that here in NC. But insurance laws are crappy. My insurance company is not covering for anything. I have tried contacting them and there is no help there. It is amazing we pay them so much money for nothing.

I no longer work for an insurance company but I did, once, and I want to point out that your comment is based on a mistaken premise that many folks seem to share.

While in force, your auto insurance policy covers you for any financial liability you might incur in an accident that you are responsible for. The level of that coverage depends on the choices you made when selecting the policy limits. In many cases, depending on what coverages you decided to take - and pay for - your car will be covered if it is damaged or wrecked beyond repair in a collision that you caused. This frees you from having to pay off a car loan on a car you can't drive. Your auto policy can also cover your vehicle for damages such as vandalism, equipment theft (usually stereos) and even other things that would otherwise cost you a lot of money to repair or replace. It's called comprehensive coverage and it's relatively cheap to buy. You can even get towing coverage on your auto insurance policy. Often for less than the cost of one tow.

My point is that the auto insurance you pay for each year or every six months, depending on your renewal terms, is not 'for nothing'. While the policy is in force, you are financially protected (24/7) to the extent your policy states, depending on what you elected for your liability coverage limits. That is what you pay for. Protection.

Now, some states (like mine) also provide policies that allow you to file a damage claim on your policy's collision coverage, have your car repaired or replaced as needed and your insurance company sues the other (at-fault) driver's insurance for their reimbursement. It's basically 'invisible' to you and saves you waiting for months (or longer) for another driver's insurance company to pay you for your loss.

While most auto insurance policies have so-called 'medical' coverage, which is supposed to pay - up to the policy limits, usually $10,000. - for medical treatments someone like you may incur due to the actions of another driver that caused a crash, apparently that is not the case in your situation as you stated that your initial claim was flatly rejected.

I have contacted a lawyer and they are researching the information that I gave them so I don't know how long that is going to take. We will see.

These things move slowly, so you have to be patient. Realize that once the insurance company is notified that you have engaged an attorney, no claim adjuster can speak to you, only someone from the insurance company legal department, usually a lawyer, who will usually prefer to speak to your attorney, not you. Thats been my experience and I would think it applies in any state. You'll soon find out.

When I talked to the insurance adjuster and said something about the state comissioner, she pretty much laughed at me and said nothing was going to grt done if I called them. That basically they will get a complaint of somebody that is not happy and that is it. I don't know if that is true or not. I guess we will see about that too.

She was trying to intimidate you and keep you from contacting the Commissioners office, or else why would she try to dissuade you? Ignore her and file your complaint - in writing - not by telephone or even e-mail. Letters get more attention. Give all the pertinent facts (policy numbers, dates, etc) and don't let it get too long. You will get results, despite what some insurance company adjuster tells you. A big part of their job is to find reasons to not pay anything on a claim from a victim of one of their policyholders. That would be you.

Thanks to all of you guys for replying. Just let me know any information that you might have or find out. I will keep you posted. )

Hope we've been able to help, even at long-distance. Keep your spirits up!

[CupCake]

Thank you for sharing all of that information about the Insurance Company. I know I am protected all of the time and that if something was to happen and it was my fault, my insurance company will take care of everything.

I guess I am just annoyed because it has been a year after the accident and sometimes it just feels like nothing is getting done. But as you said I have to be patient.

I came to the same conclusion about the Insurance Comissioner. Another thing that I know is that there is a lot of people taking advantage of insurance companies and they have to be suspicious of everybody but that is crappy for all of us that are trying to get what we are entitled to.