If you have both medical and auto insurance, you may be wondering which will pay for your medical costs. In Washington, the hospital will start by billing you personally or billing the medical insurance company whose information you provide. Later, after you make your auto insurance claim, you or your health insurer may be reimbursed by the other driver’s auto insurer. If you are among the few drivers who have medical payment coverage on your auto insurance policy, your own insurance company may reimburse you.

If you have no-fault insurance or Personal Injury Protection (called PIP coverage), your auto insurance company should pay. The hospital may bill you personally at first, especially if you could not provide them with insurance information when you arrived, but it should be simple to transfer the obligation to your insurer. You may still have a deductible under your PIP policy. If your bills are higher than the amount of PIP coverage you have, any medical insurance will take over after your auto insurance coverage is used up.

If there are problems, keep in mind that in Washington you (the patient) are ultimately responsible for your own medical bills, regardless of whether some insurance policy should cover it. That means you should take action quickly if the insurance company refuses to meet its obligations.

If your PIP policy has been exhausted, then in most cases your private health insurer should beging paying the medical bills.  Sometimes your private health insurer will need written confirmation from your PIP auto policy carrier that the limits have been exhausted.  If so, just call your PIP claims representative and ask him or her to send this letter immediately.  You should  also follow up with the PIP adjuster in writing so you have a record of your communications.

But what if you don’t have private health insurance or PIP coverage?  This is a difficult situation.  If this is the case, you may be obligated to pay your healthcare providers out of pocket.  Sometimes we here at the Davis Law Group can work out a suitable arrangement with your doctors to either wait for payment, or make small monthly payments.  It really depends on how reasonable and willing your healthcare provider is.

Early in my career (10+ years ago), I used to get extemely mad about this common myth.  I would often see that good, honest and trustworthy people who were somehow harmed by another person’s negligence, were then royally scr***d again by the insurance company when it came time to resolve the claim.  In fact, most of my clients tell me that they are extemely surprised how hard and nasty the insurance company will fight to defeat legitimate accident injury claims.  And when I say a legitimate claim, I’m talking about an accident that was clearly caused by someone else and where the injuries are fairly serious (surgery, broken bones, brain injury, etc.).

It is partly because of this common misperception among the public about accident claims that I chose to start the Seattle Accident Attorney blog and write about my experience as an attorney who represents people who have been seriously harmed by another.

Here is a perfect example of how unreasonable an insurance company can act.  It involves a case that I’m working on right now.  I represent a 55-year-old woman who was injured in a rear-end accident about 4 years ago.  To maintain confidentiality, I will call this woman “Jane.”  Jane is a very nice hard-working woman.  She’s been married for nearly 20 years and has two grown children.  This client is what I would call my “typical” client.  That is, Jane is an honest, hard-working citizen who was injured through no fault of her own.

Jane’s injuries started out as a typical “whiplash” injury.  The insurance industry likes to call this type of injury a “soft tissue” injury to suggest that the injury is extremely minor and insignificant because it only involves the “soft tissues.”  In my experience, the insurance companies fight “whiplash” injuries very hard.  They hire all kinds of medical experts to state that these injuries usually heal within 4 to 6 weeks, so any treatment or problems beyond this time frame is not related to the accident.

In any event, Jane’s whiplash injury progressively got worse over the years.  She received all kinds of different treatment to help resolve her pain and make a full recovery.  This included numerous family doctor consultations, physical therapy, massage therapy, xrays, injections, medications, MRI scans, and consultations with many different specialists about what was causing her symptoms.

It was not until more than one year following the accident that a cervical MRI was ordered.  The scan showed some “disc abnormalities.”  More physical therapy and medications were ordered.  Then another MRI was ordered a few years later when Jane’s symptoms were getting worse and the injury was severely impacting her daily activities.  This second MRI showed a “C4-5 disc angulation” or what may also be referred to as a “disc collapse” in the middle of her cervical spine.  Jane consulted with 3 different surgeons who all stated that she needed immediate surgery or risk paralysis.  The disc collapse also caused her cervical spine to curve in the opposite direction, which is called Kyphosis.  The doctors told Jane that she needed a complicated procedure where they fuse three vertebrae together and insert a cage and titanium plates to stabilize her spine so the abnormal curvature could be reversed and that her spinal cord would not be damaged.

All of Jane’s doctors (at least 8 different doctors), including her surgeon at Harborview Medical Center, have stated that the problem was initially caused by the auto accident years earlier.  The C4-5 disc collapsed started out minor and then as time progressed it got worse to the point that Jane’s spinal cord became precariously close to being permanently damaged.

Jane’s medical bills are approximately $230,000, which includes the surgery and facility bill of $190,000.  Fortunately, the other driver was an insurance agent for State Farm and had $2.1 Million in auto coverage through her employer.  Now, you would probably think that State Farm would do the right thing and offer a reasonable amount of compensation to take care of Jane’s past and future medical bills plus include some amount to compensate her for having a painful permanent and dangerous spine injury.  Not.

Instead State Farm went fishing into Jane’s prior medical history.  Jane, in her early 50’s, obviously had some prior injuries and doctor visits over the years.  State Farm found out that Jane injured her neck at work while lifting boxes about 3 years before the accident.  Even though Jane’s doctors determined that the injury was a “minor strain” that fully resolved within 6-8 mos., State Farm found this injury highly significant. 

State Farm also discovered that Jane injured her low back at work moving furniture about a year before the accident.  Even though Jane’s doctor stated under oath that this low back injury had nothing to do with her neck, State Farm found it significant that Jane’s massage therapist following this injury stated that she had “neck tightness” along with low back pain.  Jane’s last massage therapy for her low back injury ended more than 6 mos. before the auto accident.  But State Farm didn’t care.  It hired a well-known defense medical expert (he’s admitted to earning more than $3 Million over the past 15+ years working for insurance companies and against injured victims) to state that Jane’s auto accident injury was mild, should have resolved within 8 weeks, and that her current problem and resulting surgery was all entirely due to Jane’s pre-existing cervical spine condition.  It did not matter to State Farm that this expert was the only expert out of 8+ reputable doctors who held these opinions.

Jane and I participated in mediation last week with State Farm in an effort to resolve the case short of a jury trial.  You would think that State Farm might offer an amount that most would think was close to being reasonable?  Nope.  State Farm’s final offer was $50,000.  Not even enought to cover 25% of Jane’s medical bills to date.  Add to this fact that Jane has now incurred over $20,000 in litigation costs (doesn’t include attorney fees), and you can see that Jane’s only real option is to go to trial.

The insurance industry wants the public to believe that most trials involving injuries are necessary because the victims and their lawyers unreasonably demand millions of dollars to settle.  I just don’t see that in my line of work.  In fact, it is usually the other way around.  The insurance company offers such an unreasonably low settlement that the victim is left with only one real option: try the case in court and let a jury decide.  Jane’s case is a perfect example of this.

Why was this client of mine upset?  Well, there was no dispute that the defendant caused the accident, a fairly significant rear-end accident.  And there was largely no disputed that my client sustained a severe injury to her neck, where now two surgeons are recommending surgery to re-stabilize the disc herniation and deformity that is now present on her MRI scan.

Yet, the insurance company for the other driver continued to cling to the argument that this was only a minor soft tissue injury that should have healed within 3 to 4 months.  Understandably, my client was livid that the carrier was pursuing this line of defense.  What also infuriated my client was that the insurance company was trying to argue that she had a pre-existing neck condition so the auto accident in question was not the cause of her ongoing problems and the more than $40,000 in past medical charges so far. 

The at-fault carrier was relying on a single notation in my client’s medical records.  A chart entry made 3 years before the accident by my client’s family doctor where my client complained of neck pain and some hand numbness after suffering a minor strain picking up boxes at work.  It did not matter that my client stated this injury healed fully and that she had no neck pain complaints for 2 years before the accident.  My client simply could not believe that the insurance company was taking this route since it seemed so preposterous to her.  In my client’s view, this defense also inferred that my client was lying about her prior injury.  And this infuriated her even more.

To support its defense, the insurance company hired a well-known neurologist who examined my client, reviewed her records and proclaimed that yes indeed she had a pre-existing condition and it was this condition that was causing her current problems.  This defense neurologist also stated quite convincingly in his deposition that the neck injury my client received in the auto accident should have cleared up within 4 months because most people heal within this time fram.  So if my client was still having problems beyond 4 mos. following the crash, it was her pre-existing condition and not the accident that was causing it.

So I found myself again explaining to a client that this defense asserted by the at-fault insurance company was so common in my practice that I have taken the liberty of drafting a stock letter that explains basically what I’m saying here.  The insurance company will use ANYTHING in your prior history to minimize or defeat your claim.  It will hire any doctor (and believe you me, there are a number of well-credentialed doctors who will gladly help) to help it convince a jury that the accident victim’s symptoms or problems are not the result of THIS accident, but a prior one, or a prior condition, or a …..  You get the point. 

But when it’s your case, and you’re the one who has gone into debt and lost a significant time from work, and your pain is unremitting and constant, and it won’t go away…. it’s hard NOT to take the insurance company’s tactics personally.  I would be angry too.  Very, very angry.

It took me some time and effort to calm my client down.  I had to explain that her case was not unusual and that the only thing we must do is continue preparing for trial.  That is the only thing that is in our control.  I told the client that I will do everything I can to defeat the carrier’s arguments, but there is significant cost and risk involved.  Of course, I will do everything I can to try and settle the case for a fair sum, but often times that is not possible.  Especially, if the carrier takes a very aggressive approach to defending the case (which is happening to my client’s case here).  But that is our system of justice.  Even the insurance company has a right to have this case decided by a jury.  And a big part of my job is to make sure that insurance company ultimately regrets that decision.

To answer these questions, I usually talk about how accident victims are wholly unprepared for the insurance company claims process.  In fact, I’ve described it as “entering into a war zone.”  This is because the insurance company, and its high-paid lawyers and doctors, go to extraordinary lengths to defend, delay and deny legitimate personal injury claims.  When I say legitimate, I’m talking about claims where there is no dispute that another person caused injury to another person according to the treating healthcare providers.  In automobile injury cases, it may be a rear-end accident where the person suffers ongoing neck and back pain. Yet, many times the insurance company takes the position that no injury occurred, or if one did, it should have resolved within a few months.

The phrase “war zone” is what I use to describe how everything a personal injury victim does and say will be heavily scrutinized by the insurance company and its lawyers.  The truth does not matter.  Let me say that again because it is incredibly important and surprising to many: THE TRUTH DOES NOT MATTER. 

All that matters to the insurance company is if there is any fact or circumstance where an argument can be made to defeat or substantially minimize the claim.  Even innocent statements by the victim to his or her doctor can be attacked by the insurance company and exploited or taken out of context to support the carrier’s defense.  Initial statements at the scene like “I’m OK,” or “I feel fine” are often used by the insurance company doctors to suggest that the injured person is lying about an injury or exaggerating symptoms purely for financial gain.  Statements to the doctor that the accident “was minor,” or “not that bad” or “just a fender bender” are often used to the carrier’s advantage.

What is a personal injury victim to do?  Well, for starters, you need to become aware of how adversarial the process is.  This doesn’t mean you will get into fights or arguments with the adjustor.  In fact, usually the other person’s insurance company representative appears incredibly helpful, nice, accommodating, and friendly.  Most people don’t realize how adversarial the process is until many months or even years later when it comes time to try and settle the claim.

You need to realize that the type of treatment you receive, the frequency of treatment, and statements you make to your healthcare providers can all be used against you.  You’d be surprised at some of the positions taken by insurance company doctors in an effort to help deny the severity or existence of the injury so the carrier can pay less money out to settle the claim.  For instance, often times the insurance company physician will rely on old injuries or back pain 10 years ago to suggest that the current symptoms or problems are due to a pre-existing condition and not the accident that is the subject of the lawsuit.

Does every personal injury claim need a lawyer?  Absolutely not.  In fact, that is one reason why I wrote my book.  So those people who decide not to hire a lawyer will at least have some information to help them during the claims process.  Most reputable personal injury lawyers will tell you whether a claim is too small to justify the expense of a lawyer.  I usually say this to a handful of people every month and advise them to settle the case on their own because they are likely to receive more money in their pocket than if they were to use a lawyer.

Yet when the injuries appear serious, or when the medical treatment charges rack up, then more is at stake for the personal injury victim.  I tell injured victims that when more is at stake, you may be better off hiring a lawyer to represent you.  If more is at stake and you decide to represent yourself, you take the chance that you will make a mistake during the claims process which could cost you a lot of money and headache.  When the injuries are serious and potentially permanent or long-lasting, then I’ve found that most people don’t want to take chances.  They usually want to make sure that they achieve the best possible result in their claim, whether that means a good settlement or a good jury verdict.  In those cases I recommend that a person hire an experienced, trustworthy and reputable personal injury for guidance.

I can tell you that roll-over collisions can cause the most severe and debilitating injuries.  I’ve handled dozens of these types of accidents.  The injuries are usually severe and long-lasting given the collision forces generated in the crash.  Roll-over accidents are notorious for causing spine injuries, to include fractured spine or vertebrae, disc injuries, facet joint problems, and strain/sprain injuries.

Hopefully the Seattle Police Department will take care of this by carefully investigating the cause of the collision.

Interestingly, the article suggests that the number of uninsured motorists is closely tied to the unemployment rate.  That shouldn’t be surprising since most people who lose their job will try to save money by cutting out certain expenses that they believe is expendable.  Auto insurance appears to be one of those unnecessary expenses, which may be true if the alternative is not paying your rent and/or buying enough food.

I previously wrote in the March 2008 volume of the Davis Law Group Newsletter that people should buy as much uninsured motorist (UM) as they can afford.  Now that the recession is here, I’m including a partial reprint of that article:

Uninsured motorist or Underinsured Motorist (UM/UIM) coverage is extremely important.  I have handled a lot of cases in my office involving accidents that were caused by an uninsured motorist or by someone who has the minimum amount of coverage that is legally required-just $25,000.  Yet it is the uninsured or underinsured motorist who is responsible for causing a much higher percentage of the accidents that occur on our roadways each year. 

The law only requires that a driver have at least $25,000 in liability insurance.  Yet, most of us know that a $25,000 policy does not go very far, particularly with the high cost of medicine today.   That’s why you should purchase as much UM/UIM coverage that you can afford.

Here’s a true story to illustrate just how important UM/UIM coverage is.  About a year ago, a woman called me about an accident she had several months earlier (I’ll call her Janet).  Janet was rear-ended by another motorist who was uninsured.  The other driver was 25 years old, job-less, and had neglected to buy any insurance on his 1990 Honda.  The collision was fairly significant, causing more than $8,000 damage to Janet’s Ford Taurus.  Janet received a significant neck injury that ultimately required surgery to repair the herniated disc in her cervical spine.  She had complications following surgery and another procedure was performed.  When she contacted me, Janet’s medical bills were more than $80,000.  And they were continuing to accrue because she was still getting treatment and medication for her ongoing symptoms.  Fortunately Janet had health insurance through her employer.  But her health insurance carrier only paid about 70% of her bills.  What was more unfortunate however, was

that five (5) years earlier Janet decided to reject UM/UIM coverage so she could save an extra $100 per year.  That decision proved tragic.  

Janet’s decision to reject UM/UIM meant that she really had no recourse against the other driver.  Oh sure, she could have sued him.  But litigating and going to trial is very expensive.  Even if she secured a judgment against this young man, he was essentially judgment-proof.  He had no assets and a low paying job.  She never would have been able to collect anything from that young man.  If Janet had adequate UM/UIM coverage under her own auto policy, she could have secured compensation from her own carrier.  But Janet had rejected UM/UIM coverage years ago to save money and she never thought to renew it after her financial position improved.  Instead, she had to pay thousands of dollars for her own medical treatment. 

In the end, Janet had to pay more than $20,000 out of her own pocket for an accident she didn’t cause.  An unjust result to say the least.

When surgery is not recommended for many months or years following the accident, this gives the insurance company some room to argue that the surgery is unrelated to the accident in question.  How is this possible?  Well, there are a number of doctors, including surgeons, who routinely evaluate injured victims at the request of insurance companies.  Some of these doctors make a lot of money doing this.  I know of one Seattle neurologist who has made more than $2.5 Million testifying as an insruance company medical expert over the last 15 years.

Often times the doctor hired by the insurance company will look for anything in the patient’s medical history where it can be argued that the need for surgery was due to a pre-existing medical condition, like an old injury, a past back surgery, or some other event.  One time a defense doctor tried to blame my injured client’s surgery on an incident where she bent over to pick up her laundry which caused a severe aggravation of her already existing back pain.  It did not matter that my client had ongoing and severe back pain since the date of the accident two months earlier.

Often times the insurance company doctor will try to blame a car accident victim’s back pain complaints on a pre-existing “degenerative” condition, despite the fact that the person never had back pain complaints before the auto accident.  What is a degenerative spine condition?  It is mostly a normal occurrence that is somewhat dependent on the aging process.  As we age, our spines deteriorate to a certain extent.  The discs dry out and lose their shock-absorbing qualities.  The spinal joints become enlarged and/or develop osteophytes with normal wear and tear.  Most of us encounter these changes without experiencing any symptoms of pain and discomfort.  Some of us may experience symptoms but they usually go away with time.  But this “degenerative” condition allows the insurance company doctor to argue, sometimes quite convincingly, that the person’s ongoing or chronic symptoms are due to this pre-existing condition and not the car accident.

When a person experiences chronic neck or back problems following a car accident (defined as pain lasting longer than 3 months), it is usually a good idea to hire counsel to represent your interests.  Not every chronic back pain case leads to surgery, but many do.  I have represented several dozen car accident victims who developed chronic neck or back pain and then underwent surgery one or two years later.  In these cases, it is extremely important that you have an attorney who knows the medicine and can effectively cross-examine the insurance company doctor to reveal holes in that doctor’s opinions. 

It has taken me several years of reviewing medical journals, talking to doctors, attending medical seminars, and taking numerous depositions of insurance company doctors to learn the medicine of spine trauma and the treatment that is usually prescribed and recommended for these types of injuries.  Because of this, I know when an insurance company doctor is being “intellectually dishonest” when it comes to examining and offering opinions about my injured client.  Because spine medicine is incredibly complex, often with no clear consensus among practitioners about the exact diagnosis, it is easy for the insurance company doctor to offer “opinions” that stretch the truth and perhaps contradict the conventional wisdom of those doctors who actually specialize in spine medicine.