Hayabusa Accident - Health Care Provider

[mvanlone]

As some of you may know back in May 6th of this year I was rearended by a driver that totaled out my Hayabusa and Tore my ACL of my left knee. At the time of accident all the way up to 2 1/2 months after the accident the other driver's insurance stated that they were not insured since the other driver failed to pay premium of their insurance. However, after the 2 1/2 months later the other person's insurance stated they will pay for the accident. So since I had full coverage of insurance that included uninsured motorist on it my insurance covered me right away. I have State Farm and they took great care of me. I believe than my insurance just submitted to the other insurance the costs to them later on.

Questions: My accident that took me to emergency room and later on surgery cost somewhere around $24,000.00 in bills. I am covered by 2 seperate insurance companies. One is from where I work and the other from my wife's insurance. So by the time both insurances were through, I owed nothing for doctor's bills. My motorcycle insurance (State Farm) after they seen the costs of doctor's bills and also me being out of work for 3 weeks, plus the pain and suffering that I was going through cut me a check for the cost of my insurance policy close to ($25,000.00) which I was disappointed in a way since I felt that was too small, but that was the maximum that I could get on my policy. I really considered this to be pain and suffering and lost wages and other miscelaneous fees that I would have to pay. Well 5 months later, I receive a letter from my work health insurance stating that they would "like" to recoop any money that I may receive in the future from accident to pay for the health care bills. Well, I guess they do not know that this accident has been settled between my motorcycle insurance company and I and I have used those funds to purchase me another Hayabusa and pay bills from the time I was out of work. I consider that money is "my pain and suffering money", can the health care insurance come after me for this money? I just want to see if anyone else on this forum has gone through something like this before and what happened. As far as I see this if the health care system approaches me on this, I am going to guide them to the other party that hit me and tell them to get it from them and if they can't get it from their insurance company than I feel that their were "underinsured" and they are still liable. I have read online where people had the injury that I had and were awarded over $100,000.00 for just pain and suffering alone.

Can anyone share any insight on this? I would appreciate any responses.

 

[VaBusa]

I hate insurance companies...an evil we all have to live with...

While I'm not in the insurance biz nor a lawyer, I'd say they're not entitled to settlement money that you received. You could take their letter very literally and say "well, from this point on (date of the letter) they want any funds you receive to recoup costs" and unless you're planning on trying to get more money, there won't be any...

If they press you, I'd talk to a lawyer. You ARE entitled to that settlement money to help curb the burden of missing work, pain and suffering and of course the option to replace the bike that was taken from you due to someone's negligence...

Did I mention just how much I hate insurance companies?

 

[dadofthree]

Good Luck bruder. How bout the Bike

 

[proud dad]

If your med bills was 24,000,an average lawyer could have gotten you 4x that amount.You should have got 100,000...1/3 goes to the lawyer....then the med bills are paid ...the rest is yours.Went through this crap a few year back when my wife was in an accident.YOU OWE NO ONE NOTHING.You could have got more.


The 100,000 would not have counted the cost of the bike.So it would be more.

 

[proud dad]

If they get nasty with ya.You'll have to get a lawyer.And let the lawyer spank them back and pay the lawyer's bill for harassing you.And maybe then some.If they play hard ball.Get the lawyer.

 

[mvanlone]

If your med bills was 24,000,an average lawyer could have gotten you 4x that amount.You should have got 100,000...1/3 goes to the lawyer....then the med bills are paid ...the rest is yours.Went through this crap a few year back when my wife was in an accident.YOU OWE NO ONE NOTHING.You could have got more.


The 100,000 would not have counted the cost of the bike.So it would be more.

Thanks for comment. I agree with you if at the time my policy was worth $100,000.00 I know that I could have gotten that amount, but the fact is my uninsured motorist part of the policy only paid $25,000.00. So that is why I could only get that amount. Trust me if my policy was $100,000.00 I am sure at the time that State Farm would had given me that amount. State Farm really treated me good and they gave me all that they could had given me. Once the other driver's insurance came back and stated that will assumme responsibility for the accident these people had the minimum state limit of $25,000.00. If they had more I would had went after it and gotten it. The driver that hit me, she was poor and the mini van was a rusted piece of $h1t of a vehicle. I am glad that at least I was able to buy another hayabusa and don't have a monthly payment on it.

 

[Shibumi]

Get a lawyer.

If Johnny Cochran wasn't smoking a turd in Hell, I'd call him.

 

[proud dad]

If your med bills was 24,000,an average lawyer could have gotten you 4x that amount.You should have got 100,000...1/3 goes to the lawyer....then the med bills are paid ...the rest is yours.Went through this crap a few year back when my wife was in an accident.YOU OWE NO ONE NOTHING.You could have got more.


The 100,000 would not have counted the cost of the bike.So it would be more.

Thanks for comment. I agree with you if at the time my policy was worth $100,000.00 I know that I could have gotten that amount, but the fact is my uninsured motorist part of the policy only paid $25,000.00. So that is why I could only get that amount. Trust me if my policy was $100,000.00 I am sure at the time that State Farm would had given me that amount. State Farm really treated me good and they gave me all that they could had given me. Once the other driver's insurance came back and stated that will assumme responsibility for the accident these people had the minimum state limit of $25,000.00. If they had more I would had went after it and gotten it. The driver that hit me, she was poor and the mini van was a rusted piece of $h1t of a vehicle. I am glad that at least I was able to buy another hayabusa and don't have a monthly payment on it.

I spaced that part about no insurance.Yea you got the max,that's all you'll get from State Farm,they did their job.You still owe no one nothing.The only real thing they could do is go after the girl.But ya can't get blood out of a turnip.Get a lawyer if it get's nasty. A fee of say $500 [ just a guess] for a phone call from a lawyer is alot better than you having to fork out thousands.One call could end it,if needed.

 

[AzBooSa]

Get a suit! This sounds like a Wal-Mart kinda deal I hear about a year ago happening to one it's employees. If it were I, I would have lawyered up from the beginning. Even if she has no money now, you could at least get a judgment against her for future income.

 

[Mr Bogus]

I started working with patient insurance billing about 2 years ago and handle billing for an Immunologist on a daily basis. Here is my understanding of how medical insurance works..

Insurance on your behalf (policy's you or your wife have) are only going to cover actual damages (medical expenses) where applicable. (unless you had uninsured, collision coverage from State Farm)

If you have dual (or in your case 3 policy's) coverage, primary pays and secondary pays the left over (barring any copay, deductible, co-ins costs). The tertiary policy (#3) would pay any unpaid (including deductibles, copays, or co-ins)and this all applies only to the "medical" half of your accident.

Property damages are a different animal..(I only deal with medical insurance)

If 2 or more insurance companies paid on the same claims, primary has the bulk of the responsibility. Most primary insurance companies pay around 80% until max out of pocket costs are met (usually around 2G out of your pocket) they then go to 100% up to the policy limit.

If you have a secondary insurance, they typically pick up the 20% (after any deductibles are met)Under no circumstances do insurance company's pay more than 100% of actual costs. Any overpayment (as per contracts with providers) must be refunded to the Ins. company. (these refunds are a real PITA)

Now if you go back to the paperwork you signed (for medical treatment), there was a section that was titled "reassignment of benefits" that essentially states that any payments you receive are not yours. They must be forwarded to the care provider. The provider then must refund to the insurance company any overpayment's. The insurance company will find out about this extra payment...

If the checks you received were in fact for medical benefits (there would be an EOB) then any overpayment's must be returned.

The insurance company screwed up sending you any check at all for medical expenses. (we deal with this pretty regularly in the office I do insurance work for). We send a letter stating that they have in fact reassigned benefits and that the check they received was in fact not theirs. From there, it goes to legal if the patient does not return the funds. (have not lost a single case on this). The medical provider is then responsible for returning any overpayment to the correct insurance company.

As pointed out above, a lawyer is a good idea (for the physical property damages portion of the accident) The medical part is pretty cut and dried as far as how it is handled.

State Farm does not usually pay so easily btw.. You need to look at the payment letter and see what they payed as (EOB)

Good luck and glad you are here to post this headache