Why Insurance Companies refuse to pay your medical bills

Probably the biggest reason most people decide to call a lawyer after being in an accident is the fact that the insurance company for the driver that caused the accident ALWAYS refuses to pay any medical bills or lost wages unless you are willing to settle the entire claim.

Obviously, this puts the injured person in an impossible situation. How can you possibly settle your claim when you don't even know how bad you're hurt, how long you will be off work, if you will need surgery, or how much it will cost? One of the most common questions we get from people who start off trying to handle a claim on their own is "Why does the insurance company refuse to pay my medical bills?" Especially when they know it was their driver's fault. The answer is sad ..... but simple.The insurance company knows that if you can not afford to go to the doctor, you will not be able to prove you were hurt in the accident and they will not have to pay you anything. Likewise, if they help you and your family by paying your lost wages while your off work, you are much more likely to be able to afford medical treatment. Again, the insurance company knows that if you have medical treatment, you can prove you are hurt, which means they will have to pay more money. They know that if you can not afford medical treatment ... or the light bill, then you will accept pennies on the dollar for your claim out of desperation.An experienced lawyer can almost always predict what an insurance company will do. Its really simple actually. The insurance company will always do whatever saves them the most money. Unfortunately, with the insurance company, fairness is seldom the deciding factor.So now that you know the bad news ... what do you do about it if you have been hurt in an accident that was someone else's fault? First, understand that the other drivers' insurance company is not your friend. The adjuster's goal is to 1) try and avoid paying anything, and 2) if they have to pay … to pay as little as possible, and 3) delay, delay, delay. Remember, the big insurance companies collect premiums in the billions and cover losses in the hundreds of millions (if not billions). The interest on that kind of money is phenomenal. Every day they can make you wait is more money for them.So, if you are hurt, do not wait on the other side's insurance company. Go to the doctor as soon as possible. KEEP GOING TO THE DOCTOR for as long as you still have problems. Each time you go back to the doctor, tell him or her exactly what symptoms you are having.  My advice to all of my clients about the best question to ask your doctor is this: "What next?" In other words, if you are still in pain, or still having problems, still can't get back to work after a couple of weeks, you need to be telling the doctor: "This isn't getting any better" and "What is our next step in treatment?".  "What are my options, or tests to determine what is wrong?" and, "Is there a specialist that I need to see for this condition?"STRONG WARNING HERE ..... Referrals to specialists are critical if you are suffering from an ongoing injury. However, if you are to this point on your own and have still not consulted an attorney, seriously consider calling someone now. The reason I say this is related to what I mentioned above, insurance companies look to medical documentation to establish whether you are hurt or not (really more of whether you can prove you are hurt or not).  Here's the problem, there are many qualified specialist out there.  Doctors normally work on what's called a reciprocal referral basis. In other words, Dr. Smith refers all his hurt back patients to the Dr. that sends him OBGyn patients.Here's the problem with that arrangement. Defense attorneys and insurance companies have 'hired gun' specialists in every area that they use as 'expert witnesses' in their big cases.  In every town of 40,000 people or larger, there will be at least one or two neurologists, and orthopedic surgeons that are c0mmonly used by defense lawyers and insurance companies to 'review medical records' and say the patient is not really hurt, or more commonly, not hurt when their drunk driver ran the red light and broad sided your car.The last thing you need when you have been in an accident, is to have your well-meaning family doctor refer you to the insurance companies hired gun!! Unfortunately, unless you are a trial lawyer who knows the doctors in your area, you have no way of knowing who to avoid. If you have been seriously injured and are at the stage where it is time to start seeing specialists, I would strongly urge you to talk to an experienced attorney that is familiar with the doctors you need to avoid.For answers on how an attorney can help you get medical treatment if you don't have health insurance, see my post titled "How your attorney can help you get medical treatment."Our firm represents injured people all over the state of Texas and partners with top law firms across the country. If you are located outside the state of Texas and need a referral to a top P.I. law firm in your area, we can gladly help you find someone close to you.

Common Question Answers

Here are the answers to some very common questions.Q.    "What should I do if I am in an accident?"A.   Talk to an experienced trial attorney as soon as possible. You need specific advice for your individual situation if you have been involved in a serious accident.Q.   "What will it cost?A.   Our office provides free initial consultations. If we can’t help you, there is no charge. If you hire us, we work on a ‘contingency’ fee basis, which means we don’t get paid until you do. Mike Love & Associates, LLC advances all litigation expenses up front and you don’t have to pay anything unless we win a successful verdict or settlement on your behalf. Call us at (936) 632-2000.Q.   “Why do I need a lawyer?” or “Why do I need a personal injury trial lawyer?”A.   The short answer is: 1) to avoid pitfalls, 2) to identify issues that might not be obvious to a non-lawyer, and 3) to know that you have a trained professional on your side.To illustrate the point, consider that a trained personal injury attorney should know that as many as 29 separate insurance policies/coverages might apply in the following simple accident. In “Vehicle 1” are a 16 year old driver, and her two friends (both minors). The car belongs to the driver's grandmother. Assume our 16 year old driver pulls out from a stop sign (perhaps without looking as well as she should) and has a wreck with a speeding pickup truck.  [Vehicle 2] The pickup driver borrowed the truck from a friend and was making a delivery for the driver’s boss at the time of the accident.Its unlikely a 'non-personal injury" lawyer would see 29 potential insurance coverages under these short facts, but there are that many possibilities.Its grandmother’s car so her liability insurance covers the granddaughter as a permissive driver. However, if the 16 year old has her own car (and policy), her policy becomes ‘secondary’ and provides additional liability coverage. Because the driver is a minor, her parent’s auto insurance policies also apply. If her parents are divorced and have separate policies, they both provide additional insurance coverage for their daughter. (That makes four potential liability policies that may cover our driver so far)If grandmother also has PIP insurance (personal injury protection) and/or UIM (uninsured/underinsured insurance) coverage, it provides additional coverage to everyone in grandmother’s car, including the driver. The PIP coverage covers all occupants regardless of fault in the accident and the UIM would provide additional coverage if the liability coverage of the ‘at fault’ driver(s) was insufficient to cover the damages.Likewise, if our driver (or her parents) have PIP or UIM coverage, it would provide additional coverage for the occupants of our car. As for the underage passengers, if they or their parents have PIP or UIM coverage on their auto policies, those policies would provide additional coverage to each of those minors (although it would not provide coverage for anyone else in the car).Finally, there are many potential sources for insurance coverage that might cover the pick-up truck driver’s liability. Obviously, any insurance policy on the truck applies. However, if the driver has a policy on his own vehicle, it becomes ‘secondary’ additional coverage. Likewise, since he was performing a delivery for his employer, he should be covered under his employer’s auto policy. Most businesses also carry what is called a ‘general liability’ policy and ‘umbrella’ policies that provide additional insurance coverage over and above the auto liability policy which should be confirmed in the event of a serious accident.  This makes a total of 29 potential sources of insurance coverage for the occupants of vehicle number 1.If the facts warrant, a trained personal injury attorney would also examine whether or not the traffic signs were compliant with state law and design specifications. He or she might also investigate potential products liability claims if an injury was caused by a failure of the car’s safety features, seatbelts, air bags, etc.Q.   "Other than calling a lawyer, what are other ‘good ideas’ if I have been involved in an accident?"A.   Understand that with the shock of being in an accident, the rush of adrenaline, and simply with the way the human body works, it may take a few days to really know if you have been seriously injured. For example, many spinal injuries can take months to become symptomatic following a car accident. Therefore, it is important to take down basic information about the facts of the accident.  Police officers usually do a good job recording information, but they don’t always write down the names of every witness. Sometimes witnesses leave before the police get there, or leave before the police write down their names. You should always write down the name and phone number of all witnesses. It might be important later. If you have a camera, even if only on your cell phone, take pictures. Don’t bother trying to get detailed pictures of the damage to your car at the scene, that can be done later by your attorney, the body shop, or the insurance company. Take pictures from a distance that shows the position of the cars in relation to each other and other objects at the scene like a sign, driveway, or building. These signs or landmarks can later be used to create a scaled diagram of the accident if needed. Likewise, a picture showing impact debris of the other person’s car in your lane, is 100 times more important than a close up of your smashed bumper.Q.   "Is there anything special I should keep in mind when seeing my doctor?"A.   Yes. Make sure that you tell your doctor all symptoms you are experiencing. Make a list of your symptoms and any questions you may have to take to any appointments.Even though you feel it is “no big thing” now, any thing from dry mouth to headaches, dizziness, or hyperventilation may be a sign of something more serious. Anything that is out of the ordinary is a symptom and should be reported to assist your doctor in making an informed diagnosis.  For example, a tingling in your fingers, or weakness in your arm could be the sign of major disruption to the disks in your neck.Q.   "How long do I have to make a claim?"A.  Every state has what is called a “statute of limitations” for different types of claims which sets deadlines for filing suit. If you fail to file suit before the deadline you lose your right to be compensated for your damages. In Texas, the deadlines can range from a few months to many years. For example, in most personal injury cases, the statute of limitations is two years from the act that caused the damage. (Date of the car accident for example) However, if the claim is against a governmental entity (if you were hit by a city bus for example), you must give notice to the city or state within 6 months or you lose your claim. Most breach of contract claims have four years from when the contract was broken to bring a claim, but a bank can wait six years to sue you on a consumer loan.  [Perhaps banks have better lobbyists than accident victims.]You might have heard that a child’s claim doesn’t start to run until he or she turns eighteen. This is true.  However, the child's medical bills are the legal obligation of (and claim of) the parents which means the two year statute of limitations applies to the child's medical bills. Bottom line, the time you have to make a claim varies widely based on the type of claim and the state where the action or event occurred. This is one of the reasons you should speak to an attorney sooner rather than later.Q.   "What do I do when the insurance company for the other side calls me?"A.   Always be polite. However, it is almost always better to ask the insurance company to send you their contact information in a letter and to let them know that you are in the process of retaining an attorney to help you with your claim. Once you hire an attorney, all communications should go through your attorney.Q.   "When do I not need a lawyer?"A.   You might not need a lawyer if you were in a relatively minor accident, you are sure you were not injured, the insurance company for the at fault driver has accepted liability (fault) and already given you a rental car, and you either 1) know what your vehicle damage is worth or 2) you have taken your car to a repair shop that is dealing directly with the insurance company. If you have decided to handle your claim on your own, some general advice I can give is let the body shop handle the repair claim. They are used to dealing with the insurance company. If justified, add in a claim for the ‘diminished value” of your car. (A new car that has been wrecked and repaired is not worth as much as a new car that has not been wrecked.)  Therefore, the insurance company should pay the repair bill plus the difference between what your car was worth before the wreck and what your car is worth as a “repaired” vehicle. Finally, don’t sign a ‘release of all claims’, which also applies to potential personal injury claims, if they are only paying to repair your car.Q.  "Why does the other driver's insurance company refuse to pay my medical bills?"A.   Probably the biggest reason most people decide to call a lawyer after being in an accident is the fact that the insurance company for the driver that caused the accident ALWAYS refuses to pay any medical bills or lost wages unless you are immediately willing to settle your entire claim upfront.Obviously, this puts the injured person in an impossible situation. How can you possibly settle your claim when you don't even know how bad you're hurt, how long you will be off work, if you will need surgery, or how much it will cost? One of the most common questions we get from people who start off trying to handle a claim on their own is "Why does the insurance company refuse to pay my medical bills?" Especially when they know it was their driver's fault. The answer is sad ..... but simple.The insurance company knows that if you can not afford to go to the doctor, you will not be able to prove you were hurt in the accident and they will not have to pay you anything. Likewise, if they help you and your family by paying your lost wages while your off work, you are much more likely to be able to afford medical treatment. Again, the insurance company knows that if you have medical treatment, you can prove you are hurt, which means they will have to pay more money. They know that if you can not afford medical treatment ... or the light bill, then you will accept pennies on the dollar for your claim out of desperation.An experienced lawyer can almost always predict what an insurance company will do. Its really simple actually. The insurance company will always do whatever saves them the most money. Unfortunately, with the insurance company, fairness is seldom the deciding factor.So now that you know the bad news ... what do you do about it if you have been hurt in an accident that was someone else's fault? First, understand that the other drivers' insurance company is not your friend. The adjuster's goal is to 1) try and avoid paying anything, and 2) if they have to pay … to pay as little as possible, and 3) delay, delay, delay. Remember, the big insurance companies collect premiums in the billions and cover losses in the hundreds of millions (if not billions). The interest on that kind of money is phenomenal. Every day they can make you wait is more money for them.So, if you are hurt, do not wait on the other side's insurance company. Go to the doctor as soon as possible. KEEP GOING TO THE DOCTOR for as long as you still have problems. Each time you go back to the doctor, tell him or her exactly what symptoms you are having. And, my advice to all of my clients about the best question to ask your doctor is this: "What next?" In other words, if you are still in pain, or still having problems, still can't get back to work after a couple of weeks, you need to be telling the doctor "This isn't getting any better" and "What is our next step in treatment?", "What are my options, or tests to determine what is wrong?" and, "Is there a specialist that I need to see for this condition?"STRONG WARNING HERE ..... Referrals to specialists are critical if you are suffering from an ongoing injury. However, if you are to this point on your own and have still not consulted an attorney, seriously consider calling someone now. The reason I say this is related to what I mentioned above, insurance companies look to medical documentation to establish whether you are hurt or not (really more of whether you can prove you are hurt or not).  Here's the problem, there are many qualified specialist out there. Doctors normally work on what's called a reciprocal referral basis. In other words, Dr. Smith refers all his hurt back patients to the Dr. that sends him OBGyn patients.Here's the problem with that arrangement, defense attorneys and insurance companies have 'hired gun' specialists in every area that they use as 'expert witnesses' in their big cases.  In every town of 40,000 people or larger, there will be at least one or two neurologists, and orthopedic surgeons that are c0mmonly used by defense lawyers and insurance companies to 'review medical records' and say the patient is not really hurt, or more commonly, not hurt when their drunk driver ran the red light and broad sided your car.The last thing you need when you have been in an accident, is to have your well-meaning family doctor refer you to the insurance companies hired gun!! Unfortunately, unless you are a trial lawyer who knows the doctors in your area, you have no way of knowing who to avoid. If you have been seriously injured and are at the stage where it is time to start seeing specialists, I would strongly urge you to talk to an experienced attorney that is familiar with the doctors you need to avoid.For answers on how an attorney can help you get medical treatment if you don't have health insurance, see my post titled "How your attorney can help you get medical treatment."Our firm represents injured people all over the state of Texas and partners with top law firms across the country. If you are outside the state of Texas and need a referral to a top P.I. law firm in your area, we can gladly help you find someone close to you.Mike LoveMike Love & Associates, LLCCourtHouse Plaza202 E. Lufkin Ave. Suite 201Lufkin Texas 75901(936) 632-2000TexasLawOffice.com

Serious 18-Wheeler Wreck in Crockett Texas

I will be presenting a paper on prosecuting truck wreck cases for the Texas Trial Lawyers Association in October and for the State Bar of Texas again in November. As I was sitting down at my desk going over my outline, I saw a news story of another serious 18-Wheeler wreck which had just happened outside of Crockett Texas.Based on information available from news stories, TX Dot, and law enforcement, the accident appears to have been caused by the negligence of the truck driver who crashed, obviously at a very high rate of speed, into a line of cars that had stopped for a construction site. My heart goes out to the victims and their families.Unfortunately, this tragic accident raises many of the complex and critical issues of investigation and evidence preservation that are common in commercial motor vehicle accidents. The accident will be investigated by the accident reconstruction team of the Texas Department of Public Safety. The troopers investigating the scene should take detailed measurements and document the scene through the use of scaled diagrams and photographic evidence. This will be helpful in determining the cause of the accident. However, much more is needed to protect the rights of the victims in the case.In this case, driver inattention and/or impairment are almost certainly a major cause of the accident. This raises the question, why would a professional truck driver be so distracted that he would drive full speed into a line of parked cars. In my experience, this type accident usually occurs because of driver impairment (drugs and/or alcohol) or extreme fatigue (often caused by driving ‘on duty time’ in excess of the maximum legal limit). In this type of accident, it can be critical to move quickly in order to preserve all evidence of the underlying cause of the accident.FMCSA regulations require the trucking company to immediately perform a drug alcohol test of its driver in an accident involving a fatality, or in any injury accident where the driver was also given a citation. Unfortunately, many trucking companies neglect, or refuse, to drug test their drivers after an accident of this type unless an attorney is immediately retained and files pleadings with the court seeking to force the required tests. Likewise, most modern commercial trucks have on board computers referred to as ECM (electronic control modules) which can contain critical information regarding the operation of the truck such as speed, RPM, braking forces, and even the number of hours the engine was in operation prior to the accident. ECM data will be lost if the truck is not secured, and the ECM downloaded prior to the truck being put back into service or sold for parts.Finally, the driver’s “hours of service” logs where he or she is required to record all driving hours, on duty hours, and off duty time may contain critical evidence of the underlying cause of the accident. Despite the fact that federal and state law requires all driver logs to be kept for 180 days, these logs have a tendency to ‘disappear’ if they contain evidence of a driver working or driving in excess of the legal limit. A law firm experienced in prosecuting 18-wheeler cases will move immediately to secure and preserve all relevant evidence. Hopefully, the victims in the Crockett accident case will be represented by competent legal counsel to protect their rights.Mike LoveMikeLove@TexasLawOffice.comMike Love & Associates, LLCCourthouse Plaza202 E. Lufkin Ave. Suite 202Lufkin Texas 75901Attorneys representing injured victims in 18-Wheeler accidents seeking additional information to assist them in pursuing claims on behalf of their clients in 18-Wheeler or other commercial motor vehicle accidents can contact the law firm of Mike Love & Associates, LLC to request free copies of Mr. Love’s CLE papers on the subject of Trucking Litigation including: Trucking Litigation: New Strategies From Behind Enemy Lines, and Trucking Cases: An Inside Perspective Requests can be emailed to welledge@TexasLawOffice.com or call (936) 632-2000.

Tragic Truck Accident in Diboll Texas

Immediate Priorities:

• Drug Testing the Driver
• Downloading Crash Data From the Truck's Black Box
• Inspection of the Driver Logs
• Inspection of the Truck

East Texas recently received a tragic, sobering, reminder of just how devastating 18-Wheeler wrecks can be.  On January 4, 2011, Mary Chiz of Garrison and her fiancé, Travis, were severely injured when a big rig truck crashed into their SUV in Diboll, Texas.  Even more tragically, the couple lost their unborn baby boy, Wyatt, who was expected to be born within 2 weeks of the accident.  Details of the accident have been reported in several stories by the Lufkin Daily News.Based on news coverage and the scene photos, it appears that the Chiz vehicle had been stopped behind one truck at a traffic light when a second 18-Wheeler slammed into them at high speed.  The SUV was crushed by the impact and even the 18-Wheeler showed significant damage from the force of the crash.  Our hearts and prayers go out for the family in this tragic accident so close to home.Reading accounts of this accident and others that have been reported recently, brings to mind so many reasons why victims of these types of serious accidents desperately need skilled trucking accident attorneys to zealously, and aggressively, protect their rights.  As one might imagine, victims of these type accidents focus on the immediate crisis of injured loved ones.  In the immediate hours and days following this kind of tragedy, the victims don’t have the luxury of long term planning.  They must focus on emergency medical treatment, paying bills, and in the worst cases, making funeral arrangements.Unfortunately, in the hours and days following the wreck, the trucking company has very different priorities on which to focus.  The trucking company and their insurance company will be focused on ‘circling the wagons’ to limit their financial exposure and liability for damages caused by the accident.  These companies are very sophisticated when it comes to protecting themselves.  Critical evidence can be lost, or even destroyed, if an experienced attorney is not retained to protect the rights of the victims.

Drug Testing the Driver

Many people assume that the police will test the truck driver for drugs and alcohol after an accident like this.  Not so.  The police have no obligation to conduct drug and alcohol tests, and most often, only conduct tests if the driver demonstrates obvious intoxication symptoms.  However, the trucking company is required by federal law to immediately perform a drug and alcohol test on the driver after an accident of this nature.  Unfortunately, many trucking companies ignore the law because they simply don't want to risk the chance of finding drugs and alcohol in the driver’s system.  After a serious accident, the last thing a trucking company wants is documentation of the driver's drug or alcohol intoxication.  However, if the accident victim immediately retains an experienced trucking accident attorney, he or she can file emergency paperwork with the court to compel drug and alcohol testing of the driver.

Down-loading Crash Data From the Truck's 'Black Box'

Modern trucks have Black Box style recorders in the form of an ECM (Electronic Control Module, or EDR (Event Data Recorder).  These computer modules can record critical evidence in a crash.  One of the most important pieces of evidence to obtain from the computer is referred to as a 'Hard Stop' event.  Essentially, the computer takes a 'snap shot' of what is happening with the truck any time the driver slams on the brakes.  Engine RPM's, speed, transmission gear, etc. are all recorded.  This evidence becomes critical when the truck driver later claims to have been obeying the speed limit before the crash.  Unfortunately, the computer acts much in the same way as the old surveillance VCR recorders i.e., they continue to record over, and erase, old data. Most Black Boxes only record the last 1 to 3 'hard braking' events.  Therefore, if the truck is put back in service after the wreck and the driver happens to accidently ‘hit the brakes hard' while driving around his company’s parking lot, critical evidence establishing fault of the truck driver will be destroyed.  It can be very important for your attorney to immediately obtain a download of the truck’s computer as soon as possible following the accident.

Driver Logs

Truck drivers are also required by federal law to maintain a complete record of their time behind the wheel and their total working time.  For obvious public safety reasons, the law limits the number of hours a driver can drive.  These 'hours of service' rules are often flagrantly violated by some trucking companies with predictable and tragic results.  The most common accident involving a fatigued driver is a rear end collision.  Unfortunately, in the hours and days following accidents of this nature, many drivers (or their companies) will attempt to 'recreate' or 'cleanse' the driver logs to remove any evidence of the driver's illegal time behind the wheel.  An experienced trucking accident lawyer can prevent evidence tampering by immediately issuing supoenas for the driver logs.  Likewise, there are a number of ways that an experienced truck wreck attorney can identify and expose fabricated driver logs.  Our office recently presented a CLE paper demonstrating the best ways to identify and expose fabricated driver logs.  * Prosecuting or Defending a Trucking or Auto Accident Case 2010 hosted by the State Bar of Texas in San Antonio.

Inspection of the Truck

Many big truck accidents are a direct result of the failure to maintain the trucks and trailers driving up and down the road.  Again, federal law sets out minimum standards that trucking companies must comply with to ensure public safety.  Our firm has successfully prosecuted many big truck accidents which were directly caused by a failure to properly maintain the vehicles.  These accidents are often caused by faulty brakes, tires, steering components, or defective lighting on the trailers.  Our firm has even prosecuted cases where entire sets of wheels fell off the 18-Wheeler and crashed into another vehicle.  In defective maintenance cases, it is critical to obtain an immediate inspection of the defective equipment before evidence is lost or destroyed.If you, or a loved one, have been involved in a serious accident involving an 18-Wheeler or other commercial vehicle, these are just a few of the many reasons you should contact an experienced truck wreck attorney as soon as possible after the accident.  Our firm stands ready to assist upon a moment's notice.