Transcript
Pam: Welcome back. This is Fighting for What’s Right, with personal injury attorney Barry Doyle. Barry, in your book, Myths and Mistakes which is available at the resource center on our website, FightingForWhatsRight.com, you list out the common myths about accidents and accident cases. There were a few that kind of caught my attention. I’d like to get your take on them.
Barry: Sure.
Pam: First, is there a standard settlement for any type of injury?
Barry: One of the common ideas that people have is that there’s a standard amount of money that’s going to be paid out in a settlement for any particular type of injury. For example, if I broke my ankle I should get so much money. And the truth is that there really is a ton that goes into evaluating a case for settlement. It’s a pretty complex question, but really the basic equation is liability plus the damages. In other words, the liability part amounts to how strong is the evidence of negligence on the part of the defendant? How wrong was the conduct? Then the second part is the damages. In other words, how badly hurt you were. How much do you have in medical expenses? How much do you have in wage loss? We actually have a full report in the resource center of the website called How Much Is My Case Worth? where there’s really an extended discussion about that.
The bottom line is that one of the most important skills that a lawyer brings to the table following an accident is being able to evaluate a case for settlement. This is much more art than science, and there really aren’t standard settlements for any particular type of accident or injury.
Pam: So what about the thought that my bills will get paid no matter what?
Barry: There’s actually two camps to this. There’s one camp that is really concerned that their bills will never ever get paid, and then there’s the camp that sort of assumes that yes, my bills will get paid no matter what. And that second camp, the camp that really believes that their bills are going to get paid no matter what, is probably the more concerning camp of the two because those are people who are assuming that things are going to come out much better than they are.
The fact of the matter is that there’s no guarantee that your bill are going to get paid at all much less get paid in a timely kind of fashion, and one of the things that insurance companies are allowed to do and frequently do is contest whether the care that you got was reasonable and related to the accident, whether the injuries that you’re claiming happened as a result of the accident were actually caused at least in part by the accident. Those are issues that are frequently in dispute and the idea that your bills are going to get paid no matter what is an idea that has just no basis in reality. Another thing people think is, all I have to worry about is my out of pocket expenses because I have health insurance.
Even when people have health insurance, being involved in an accident can really represent a significant source of financial stress for them, because you end up taking a big hit with copays and deductibles and that kind of thing. By definition an accident is something that nobody ever plans for, so getting stuck with copays and deductibles is something that people are really concerned about when they’re trying to figure out how they want to try to settle the case when they’re handling it for themselves. The main thing that they’re really concerned about is their own out of pocket expense. In other words, the copays and the deductibles.
Now, what happens in reality is a lot more complex than that because when you have health insurance, every health insurance policy is going to have a provision in it which provides in essence that if you’re hurt in an accident and you collect money from somebody else, we’re entitled to be reimbursed the money that we pay out for accident related care. The technical term for that is it’s subrogation, and basically what it does ultimately is it puts the financial burden for the accident back on the person who’s really responsible for it.
When there’s a subrogation clause in your health insurance policy, and there almost always is, you’re responsible for reimbursing your health insurance the money that they paid out on your behalf for accident related care, so you’ve got to consider not just what you’re out of pocket, but what you also have to take into account for your health insurer, and most people don’t know that. Liability insurers know that and it’s one of those things that they’re very careful to address when it comes time to issue a check. A lot of times they’ll issue a check they’ll be made payable to you and Aetna or Blue Cross or Blue Shield or whoever your health insurer may be.
Now, the problem’s even more acute when you’re dealing with a government health program such as Public Aid or Medicare, because there’s an actual legal requirement that those government programs be reimbursed for accident related care and insurance companies are actually responsible for making sure that that repayment is made.
So you need to think about much more than your co-pays, your deductibles, or just what you’re out of pocket, but you need to keep in mind these reimbursement obligations too. Most people don’t know about them and certainly don’t take them into account when they are discussing the topic of settlement with an insurance company.
