My health insurance paid my bills in an auto insurnace. The other party's auto insurance is ready to settle but is willing pay the adjusted rate' that my health insurance paid for and not the full invoiced rate bill
The total for my medial bill is $4000 they offering me $2,800 for pain and suffering and $480 for lost wages. even though my medial bills where $4000 they told me i am only entitle to $1800 for medical bills adjusted bill
My question is is that a fair offer?
and am i entitle to the full invoice amount here in North Carolina since i was paying all my health insurance premiums and its not a state or government provided insurance?
Whether you are entitled to the full charge depends upon the date of the accident. In the name of "tort reform," the N.C. legislature made changes last summer that allow insurance companies to receive the benefit of your health insurance. The so-called "billed v. paid" legislation applies to accidents that occurred after October 1, 2011. Therefore, if your accident occurred before that date, you are entitled to the full charge. If it occurred afterwards, you are entitled to all amounts actually paid or required to be paid to satisfy the bill. I also agree with the previous comments that you should, at a minimum, discuss your case with a personal injury attorney. Most personal injury offices provide free consultations.
T. Shawn Howard, attorney
Maginnis Law, PLLC
19 West Hargett Street, Suite 906
Raleigh, NC 27601
The adjuster may be correct depending on when your accident happened last year. If it happened after October 1, 2011, then you are no longer entitled to the entire invoiced bill, but rather the amount paid and/or needed to satisfy the bill. For example, let's say your hospital bill is $5,000.00. But, you have health insurance that you pay for with your hard earned money, that paid $2,000.00 on that bill. You owe a $500.00 co-pay. The other $2,500.00 was a contractual adjustment and was written off under your health plan by the provider. Under those circumstances, you can recover only $2,500.00, representing the amount actually paid to satisfy the bill and the amount still needed to satisfy the bill. This new law was pushed through the legislature last year as part of our Tort "Reform" package and was sold as a necessary measure for job creation and to control medical costs. You can judge for yourself whether that has worked out or not. As far as your claim, you may wish to contact an experienced personal injury attorney to better understand your rights and whether the offer is reasonable given the facts of your case as it it relates to the other aspects of your claim. As far as your question regarding fairness of the "bill v. paid" situation, I recommend you keep that in mind come November.
You should never, ever, ever try to settle a personal injury claim with an insurance company WITHOUT legal counsel. You will never receive fair treatment without counsel. You need a personal injury attorney to review your records and offer you a reasoned assessment of you case.
Assuming you have enough time to get counsel, do it ASAP.
Low ball settlements are fairly standard when people 'do-it-yourself' in a personal injury case. No. Based on the few facts listed here, the offer is not to be taken seriously. If you are, in fact, serious about your case, you should retain an experienced personal injury attorney.
SEE LINK BELOW FOR MORE ON THIS TOPIC:
Why are insurance companies making such low settlements? There are probably a couple of reasons for their change in behavior. The first possible explanation is the current economic conditions. Insurance companies are trying to hold onto as much money as they can, for as long as possible. In car accident cases, it seems that some of the big insurers are almost forcing claimants to hire lawyers if they want to get paid fair settlements. This tactic will most likely hurt these insurers in the long run, because car accident attorneys are generally able to get claimants higher settlements than people who do not have legal representation.
The other reason that insurance companies may be changing their tactics could have to do with the massive turnover rate within the industry. Due to the economy, many insurance companies have been laying off experienced adjusters, or forcing them into early retirement. The less experienced adjusters often try to prove themselves by forcing unreasonable settlements on claimants.