Auto Accident, My Fault, Seeking Monetary Compensation from my Own Insurance Company

Asked over 1 year ago - Glendale, CA

What is the name of your state (only U.S. law)? California

My question is whether I need to seek a PI attorney or whether I can do this myself?

Recently I was involved in an auto accident which was my fault. I suffered from neck injuries and would like to receive monetary compensation.

I was told that when seeking monetary compensation two steps needs to be completed. First, I need to find a medical provider (chiropractor) that is willing to negotiate the bill when paid. Second, once I complete treatment and receive an evaluation of my injuries along with the bill, I am supposed to submit the claim to the insurance company. When the insurance company settles the case, I negotiate the bill with the medical provider which is typically limited to 33% of the settlement check.

I am having

Additional information

I am having problem because the insurance company is requesting support that the bill was actually paid. My question is whether my results would be the same if the I seek out a PI attorney to handle the case. I am wondering if the results would have been different if I was not at fault.

Any advice would be helpful as well as any resources that I can look to such as books and technical manuals. Thanks.

Attorney answers (6)

  1. Robert Max Klein

    Pro

    Contributor Level 15

    14

    Lawyers agree

    Answered . California is not a no-fault state. That means when you are in an accident that is your fault, you are not entitled to receive compensation for your injuries. If you have Med pay coverage on your policy, you can use this coverage to pay for your medical treatment. This is not the same as getting monetary compensation for your injuries; it is merely having insurance coverage to pay for medical treatment.

  2. Manuel Alzamora Juarez

    Pro

    Contributor Level 20

    10

    Lawyers agree

    Answered . For instance , you could have swerved off the road to avoid hitting another vehicle,. or a deer or a pedestrian and you had the accident. You say it is your fault but a trained attorney would be able to look at the facts and make a valid claim for your injuries. Please get a free consultation with a PI lawyer. Best of luck.

    This answer is provided by Manuel A. Juarez, Esq., El Abogado de Accidentes de Autos de California: 510-206-4492.... more
  3. Paul J Molinaro

    Pro

    Contributor Level 17

    10

    Lawyers agree

    Answered . Something that often comes as a surprise to drivers is that their own insurance company is not their friend. Usually, the person who pays for a service expects that the old "customer is always right" rule will apply. That is not the case with insurance. They make money by taking in more money than they pay out. This is not a business model that is like selling widgets. Unless someone really knows how the insurance business works and how the laws governing insurance companies work, he or she should hire a lawyer to handle a claim that involves physical injury whether that claim is against his or her own insurance company or another.

    -Paul

    Paul J. Molinaro, M.D., J.D.
    Attorney at Law, Physician, Broker
    Fransen & Molinaro, LLP
    980 Montecito Drive, Suite 206
    Corona, CA 92879
    (951)520-9684
    www.fransenandmolinaro.com / www.888MDJDLAW.com

    "When you need a lawyer, call the Doctor... Call Paul J. Molinaro, M.D., J.D... Call (888)MDJDLAW."

    * This post and all others I make on Internet are for informational purposes only. None of the information or materials I post are legal advice. Nothing I post as comments, answers, or other communications should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing of this information does not constitute, an attorney-client relationship. While I try to be accurate, I do not guarantee accuracy.
    ** Fransen & Molinaro, LLP practices in the areas of personal injury, medical malpractice, and real estate law.

    Paul J. Molinaro, M.D., J.D. ... Attorney at Law, Physician, Broker... Fransen & Molinaro, LLP... 980 Montecito... more
  4. Jonathan Craig Reed

    Pro

    Contributor Level 16

    9

    Lawyers agree

    Answered . As others have pointed out in California if you are at fault for an auto accident and it is not covered by workmen's compensation or some other special "no-fault" provision, you don't get compensated for pain and suffering.

    While it is true that often a chiropractor will treat on a lien basis and ultimately agree to a three way split of the settlement that is an arrangement that involves a lawyer. Most chiropractors or other health care providers who treat on a lien basis want to see that you have an attorney because they view the attorney's willingness to take the case as a sort of screening process suggesting that you have a good case. They also know that the lawyer may face bar discipline of the lawyer fails to pay the chiropractor out of the settlement.

    If a person walks into a chiropractor's office with a favorable police report and the chiropractors treats the person on a lien basis and there is no attorney, I doubt the chiropractor would agree after a settlement to limit their fee to 1/3 of the settlement.

  5. Sean Michael Patrick

    Contributor Level 16

    7

    Lawyers agree

    Answered . You insurance company should pay reasonable expenses up to the policy limit. If they fail to, make you a low-ball offer, or do not promptly and fairly investigate your claim, you may have a Bad Faith cause of action against them. I would consult with an attorney in your area that knows Personal Injury and Insurance bad faith. Best of luck.

    I am licensed in California, therefore, my answers are based on general prinicpals of law or California law, which... more
  6. Mark John Caruso

    Pro

    Contributor Level 12

    3

    Lawyers agree

    Answered . So often I am asked this question..."What medical expenses can I get from the insurance company now that we know the collision wasn't my fault?" This is really an easy question to answer, because state law dictates what you are entitled to. However, just because you might be claiming a medical expense doesn't mean that you automatically get the money for those medical expenses. It is still up to you and your attorney to provide the insurance company with the facts and evidence to prove the damage.


    Under the law of the state of New Mexico and most other states, medical expenses must be reasonable, necessary and a direct result of the injuries sustained in the collision.


    The medical expenses must be reasonable in price compared to charges made by othere health care providers in the same community. This can be easily proven, and our firm has the annually published medical fees to help prove the reasonableness of the charges.


    The medical expenses must be necessary and needed because of the injury from the collision. No one would expect the insurance company to pay for a medical expense that you really didn't need. You are, however, required to mitigate your damage. That means that you are allowed to have diagnostic tests and examinations to determine whether you have an injury. If you have some pain that you didn't have before the collision, you are expected to take reasonable precaution to determine if you have an injury. If you ultimately determine that you don't have any injury, the insurance company will still pay for the cost of the examination and diagnostic x-rays and other tests.


    The medical expenses must be a direct result of the injuries sustained in the collision. You can't ask the insurance company to pay for anything that their driver didn't cause. However, they must also pay for the aggravation of a previous injury. As an example, let's say that your leg already had degenerative problems because of your age. It really didn't cause you any problems before the accident, but the twisting of the leg in the accident required you to now have physical therapy and ultimately a surgery. You aggravated the degenerative condition so now you must have the extra medical care. This would be a valid claim against the insurance company. The medical records provided by your doctor should clearly indicate that the medical care was needed as a result of the collision. If it doesn't state this on the records, then you should contact your doctor or his/her staff immediately to determine what he/she believes was the cause of the injury in the first place.


    Once you have finished all of your treatment, it is realitively easy to determine your total medical expenses. You need to use the retail price of the medical expenses, not the amount paid by your health insurance or the amount you paid as a deductible or co-pay. It is usually a simple addition of the charges.


    Sometimes doctors will state that you need to get extra money from the insurance company for future medical expenses. An example would be a doctor stating that you need one physical therapy visit per month for a total of 12 more months. You would need to calculate the cost of each visit and multiply times the number of visits the doctor says that you need and you then have an additional number for future medical care. Again, the same rules apply to future medical expenses that apply to the past medical expenses. The future medical expenses must be reasonable, necessary and a direct result of the collision.

    The AVVO response or other communication by Caruso Law Offices does not create an attorney-client relationship.... more
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