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PIP settlement questions


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#1 littesheep

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Posted 20 March 2013 - 04:09 AM

Is anyone there able to help my complicated questions?

How to claim auto PIP settlement and medicare/medicaid insurance? I had an accident in Nov 2011. My passenger and I went to get treatment. It also involved with medical bills. My passenger signed the settlement and at the same time the medical bill was paid for by his settlement not from medicare/medicaid. This was all handled from my attorney. My question is: Is my passenger able to claim my PIP settlement? I talked to my PIP adjuster about this question. She said since my passenger had medicare/medicaid there would be a lien against his settlement. Since he already signed the settlement the medical bills have been paid for and he's not able to claim my PIP settlement. Is this true? I also talked to other attorneys and they told me he's still able to claim my PIP settlement. If he did get the settlement does he have to reimburse his PIP settlement to medicare/medicaid? Or can he get my PIP benefit instead of having to pay back since his medicare/medicaid did not pay for any of the medical bills from this accident?

I have a question about my own settlements. My PIP adjuster asked me to send all the medical bills and records. I asked her for an application claim form for PIP and she never sent me one. She also said that it wasn't required. Is this handled right? I found a claim form online and it looks like you have to sign it and date it. I don't know why she said it's not required... is that illegal? And also my auto insurance adjuster let third party handle my medical bills with a cap payment. It's really confusing. For one, my PIP settlement got reduced. Second, when I sent my medical records to them with a letter to say not to share with any third parties but they did. Only I know is that I bought a policy from my auto insurance and never understood that I had to deal with another health insurance that worked for them. But my medical bills are about $18,000. They only paid $9,000 which I should be paid $10,000 according to my PIP policy. They would not pay any doctor bills in full. She said the doctor had a contract with a third party which is another health insurance. They didn't pay in full but now the bills have to be paid when I signed the settlement. The bills would be the differences from my PIP and medical costs to me. This is a very confusing situation. Besides the medical bills, is there any other bills I can claim for PIP? A couple of weeks ago my attorney's paralegal even called me on the phone and said if I don't sign the release they will increase my medical bills because I have my PIP settlement. I have bad faith for this attorney and also his paralegal. They are always lying to me, saying I don't have a PIP policy and if I have it is too late to make a claim. So I made my PIP claim by myself. If I do trust my paralegal, I will lose the chance to get the PIP settlement. That's why I have posted a question on here because I have lost trust in my attorney. It sounds like he only cares about money for himself. He will not do any work and I've never even met him once. When I asked any paper work documents, they would not even mail it to me saying that I would have to drive down there to get them. They made a bunch of money from me and still would not even mail them to me. They treat me like their enemy. At the same time I have been dealing with my PIP adjuster. Who's the one I can trust? There is no one I can trust. I don't have any money to hire another attorney. My time is almost running out. I hope someone can give me a correct answer to solve this problem as soon as possible. I would really appreciate it. I am in Texas. Thanks.

#2 adjusterjack

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Posted 20 March 2013 - 01:34 PM

Is my passenger able to claim my PIP settlement?


Let's start with that question because it tells me that you might not understand how PIP works.

I have a sample of a Texas policy.

Your passenger doesn't get to claim YOUR PIP settlement. You and your passenger have separate claims under your PIP coverage.

PIP coverage is per person. Look at your policy. Whatever your PIP limit is, that limit is available separately to each occupant of your vehicle.

I talked to my PIP adjuster about this question. She said since my passenger had medicare/medicaid there would be a lien against his settlement. Is this true?


Yes.

Medicare does have a right of reimbursement from PIP under federal law:

http://www.themedica...party-benefits/

So does Texas Medicaid. Scroll down to D. Medicaid Liens at the following webpage:

http://www.texaslink...ubrogation.html

If your passenger has already had bills paid by Medicare and/or Medicaid, then either or both will eventually be seeking reimbursement under the PIP coverage.

I also talked to other attorneys and they told me he's still able to claim my PIP settlement. If he did get the settlement does he have to reimburse his PIP settlement to medicare/medicaid? Or can he get my PIP benefit instead of having to pay back since his medicare/medicaid did not pay for any of the medical bills from this accident?


You have to stop referring to his PIP claim as your settlement.

The attorneys are correct that he can still make a claim under the PIP coverage.

For example, Medicare might only pay 80% of his medical bills less his deductible.

PIP pays 100% with no deductible.

So if he sends all of his bills in for the PIP, the 80% paid by Medicare will go to Medicare and he will be paid the 20% difference plus his deductible or any other co-pays that he might have had to make.

That might also be true of Medicaid if Medicaid pays only a percentage of the bills.

So it's still a good idea for him to make the PIP claim. When all is said and done he is likely to get some money that's left over after Medicare and/or Medicaid gets reimbursed.

Is anyone there able to help my complicated questions?

I have a question about my own settlements. My PIP adjuster asked me to send all the medical bills and records. I asked her for an application claim form for PIP and she never sent me one. She also said that it wasn't required. Is this handled right?


Yes.

All you need to do is send copies of the bills to the adjuster. Or if you send the originals make sure you keep copies. Along with the bills make a cover page listing all the bills and amounts with a total at the bottom and keep a copy for your records.

Always, always, always keep copies of documents that you send to others or keep the originals and send copies.

I found a claim form online and it looks like you have to sign it and date it. I don't know why she said it's not required... is that illegal?


It's not illegal to not require a claim form but you can certainly use one that you find online if it helps you.

If you give me a link to the form I can give you a better opinion about it.

And also my auto insurance adjuster let third party handle my medical bills with a cap payment. It's really confusing. For one, my PIP settlement got reduced. Second, when I sent my medical records to them with a letter to say not to share with any third parties but they did. Only I know is that I bought a policy from my auto insurance and never understood that I had to deal with another health insurance that worked for them. But my medical bills are about $18,000. They only paid $9,000 which I should be paid $10,000 according to my PIP policy. They would not pay any doctor bills in full. She said the doctor had a contract with a third party which is another health insurance. They didn't pay in full but now the bills have to be paid when I signed the settlement. The bills would be the differences from my PIP and medical costs to me. This is a very confusing situation.


Confusing yes, but nothing wrong or illegal about how they are handling it. And you cannot tell an insurance company not to do something that has to be done to take care of the claim. You agreed to allow the insurance company to do many things, probably without reading the application or the policy carefully enough to understand what you were allowing the insurance company to do.

Besides the medical bills, is there any other bills I can claim for PIP?


Possibly.

Go look in your policy and read Part B - Personal Injury Protection Coverage. There is a list of things that your insurance company will pay for in addition to just medical blls.

A couple of weeks ago my attorney's paralegal even called me on the phone and said if I don't sign the release they will increase my medical bills because I have my PIP settlement. I have bad faith for this attorney and also his paralegal. They are always lying to me, saying I don't have a PIP policy and if I have it is too late to make a claim. So I made my PIP claim by myself. If I do trust my paralegal, I will lose the chance to get the PIP settlement. That's why I have posted a question on here because I have lost trust in my attorney. It sounds like he only cares about money for himself. He will not do any work and I've never even met him once. When I asked any paper work documents, they would not even mail it to me saying that I would have to drive down there to get them. They made a bunch of money from me and still would not even mail them to me. They treat me like their enemy. At the same time I have been dealing with my PIP adjuster. Who's the one I can trust?


First, trust yourself. Read your policy. Read the PIP section. Read it more than once if you have to. It's not that complicated.

Second, when it comes to the PIP coverage, trust the adjuster. From what I can see so far, the adjuster has been telling you the truth about the coverage and the claim process.

Third, as for your lawyer, sounds like he's a real jerk. Beyond that, if you tell me why you got a lawyer in the first place and what you expected him to do for you, I might have some helpful comments.

Warning: Legal issues are complicated. Explanations and comments here are simplified and might not fully explain the ramifications of your particular issue. I am not a lawyer. I do not give legal advice. I make comments based on my knowledge and experience. I guarantee nothing. If you act on my comments without the advice of an attorney, you do so at your own risk.


#3 littesheep

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Posted 22 March 2013 - 12:39 AM

Thanks for your reply. My car was rear ended by another vehicle and also involved in an injury so that's why I found an attorney to handle all of this situation for me. There was two passengers involved. One was hurt but the other was fine. I found this attorney through the phone book and then I called the number the person worked for the staff. They went to meet me at the chiropracter's office and signed a contract right there without the attorney being there. They are the ones who told me to go to this chiropracter. Beginning to end of the treatment it was a poor service. It seemed like they were trying to make an easy buck. The chiropracter also told me to go to the MRI. The passenger did all of this as well except he accepted steroid injections for his back pain.

I found it very difficult to believe this attorney and his paralegal through phone conversations. Mostly I heard from his paralegal. His paralegal sounded like she didn't know anything and didn't act professional and was very dishonest. I already talk to her once on the phone with the attorney, not really sure if it was him. I do not have any medical insurance, just the auto insurance with PIP coverage. I only got 90% from my PIP coverage. They only paid about 50% of my medical bills even though my attorney reduced some of my bills but it's still too high than my PIP will pay me. My doctor bill is $225 and my PIP only pay $90. My MRI bill is $700 and PIP only pay $435. My attorney would not accept the differences which he held my medical bills with the settlement. Once I sign the release they will take off my settlement to pay for the medical providers. They will not reduce any more money. I will be out of pocket for about $400.

I think this attorney is a jerk too. He did not do the things by order and he should have filed the claim for my PIP at first to pay these medical bills. Because he did not file my PIP claim, that's why this is complicated. Since I made a claim on my PIP they reimbursed me, but at the same time I have medical bills that are held up from the attorney with the settlement. In other words it's balance billing. That's why it increased problems between me and them. I have to deal with the attorney and health providers. They also threatened to increase my bills. Should I just go ahead and sign the release whatever it is? I do not think this is right if they could have filed my PIP to pay for it.

One question I have asked so many people is that my passenger has medicare and medicaid. My attorney didn't file a claim on his medicare/medicaid at all. When he signed the release all the medical bills been paid from his settlement not his "medicare/medicaid". Since the settlement is already signed, can he still file a seperate claim through my PIP? Does he still have to reimburse to medicare/medicaid? If you can answer these questions it will be really appreciated. I live in Texas. Thanks for your time.

#4 adjusterjack

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Posted 22 March 2013 - 07:37 AM

Hindsight is 20/20 but it seems that you made two mistakes. 1 - Hiring an attorney without personally interviewing him. 2 - Signing the fee agreement at the chiropractor's office.

I have no idea what you can do about the attorney now. You're probably stuck.

As for signing a release, that's up to you. You'll have to decide if your part of the settlement is something you can live with after the attorney, the medical providers, and your PIP carrier get theirs. Your PIP carrier also has the right of recovery from your settlement.

See your policy's General Provisions - Our Right to Recover Payment.

As for your passenger, if I'm reading this right, he did not have any of his medical bills paid by Medicare/Medicaid. If that's correct he has nothing to reimburse. If he did have bills paid by Medicare/Medicaid then Medicare/Medicaid will be reimbursed out of his settlement from the other driver.

While he CAN make a claim under your PIP, it's likely to be denied since he's already settled with the other insurance company. Had your PIP paid anything for him, your insurance company would have the right of recovery out of his settlement. Might be a good idea to let your own claim rep know about the passenger's settlement.

Warning: Legal issues are complicated. Explanations and comments here are simplified and might not fully explain the ramifications of your particular issue. I am not a lawyer. I do not give legal advice. I make comments based on my knowledge and experience. I guarantee nothing. If you act on my comments without the advice of an attorney, you do so at your own risk.


#5 littesheep

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Posted 23 March 2013 - 02:52 AM

Thanks for your reply but I'm a bit confused about the last paragraph. Why do I need to let the claim rep know about the passenger's settlement? Before my passenger signed the release, he had made a PIP claim on the phone with my adjuster. Later on for a while I did not hear from my adjuster. When I called again, they told me my adjuster has quit the job. Now there is a new adjuster. Then I asked the new adjuster if my passenger can claim PIP? She said if he had Medicare/Medicaid he's not able to claim PIP with my insurance because Medicare has a lien. I never told my adjuster that his medical bills were paid by his Medicare. She only asked if he had Medicare and made a decision to deny him. That's why he went ahead to sign a release because his PIP claim been denied. So I hope you understand that he got the PIP settlement denied before he signed the release. Don't you think my PIP adjuster is dishonest? Did she play a trick? Before and after he signed the release, my adjuster never accepted his claim. The reason she gave was because he had Medicare. I believe my adjuster told a lie and plus I have my attorney will not do anything for me except to collect money. Of course I do not think I can agree with my part of the settlement on those terms. Is there anything I can do before I sign the release? I'd appreciate it if you can explain more details on this. This is a complicated subject. I would like to know how to solve this problem with your help before it's too late to do anything about it. My case will be 2 years in Nov this year. Thanks again. You are really helpful.

#6 adjusterjack

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Posted 23 March 2013 - 08:11 AM

Thanks for your reply but I'm a bit confused about the last paragraph. Why do I need to let the claim rep know about the passenger's settlement? Before my passenger signed the release, he had made a PIP claim on the phone with my adjuster. Later on for a while I did not hear from my adjuster. When I called again, they told me my adjuster has quit the job. Now there is a new adjuster. Then I asked the new adjuster if my passenger can claim PIP? She said if he had Medicare/Medicaid he's not able to claim PIP with my insurance because Medicare has a lien. I never told my adjuster that his medical bills were paid by his Medicare. She only asked if he had Medicare and made a decision to deny him. That's why he went ahead to sign a release because his PIP claim been denied. So I hope you understand that he got the PIP settlement denied before he signed the release.


OK. Got it now. That wasn't clear to me from your previous writings. The reason I suggested telling your adjuster about the passenger's Medicare settlement was in case he made a claim on the PIP without revealing the settlement.

But since he already made the claim on the PIP and got denied because he had Medicare, there is nothing more you need to do about the passenger.

Don't you think my PIP adjuster is dishonest? Did she play a trick? Before and after he signed the release, my adjuster never accepted his claim. The reason she gave was because he had Medicare. I believe my adjuster told a lie


No, your adjuster was not dishonest, didn't play a trick, didn't lie. With all due respect I think you are just overwhelmed by the insurance process and don't quite understand what's going on. Nothing wrong with that. Happens to everybody. That's why you come here to ask questions.

I have my attorney will not do anything for me except to collect money.


Your attorney's job is to collect money from the party that caused the accident. That takes time.

Of course I do not think I can agree with my part of the settlement on those terms. Is there anything I can do before I sign the release? I'd appreciate it if you can explain more details on this. This is a complicated subject. I would like to know how to solve this problem with your help before it's too late to do anything about it. My case will be 2 years in Nov this year. Thanks again. You are really helpful.


If you are not happy with the settlement offered by the other driver's insurance company you can refuse it and have your attorney file a lawsuit against the other driver in the hopes of getting a court to award a higher amount of money.

Keep in mind though that your attorney gets approximately 1/3 of your settlement if he doesn't have to file a lawsuit and he likely gets more (sometimes as much as 40%) if a lawsuit is necessary.

Read your fee agreement.

He'll have until November to file a lawsuit. Once filed, it could take another year or more for the litigation to be completed.

If you get (or have gotten) a settlement offer, feel free to post the figures for me to comment on.

Warning: Legal issues are complicated. Explanations and comments here are simplified and might not fully explain the ramifications of your particular issue. I am not a lawyer. I do not give legal advice. I make comments based on my knowledge and experience. I guarantee nothing. If you act on my comments without the advice of an attorney, you do so at your own risk.


#7 littesheep

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Posted 24 March 2013 - 11:51 PM

My question haven't been answered clearly. That's why keep asking questions until I completely understand. At the same time I don't know if you completely understand my questions. Since the accident happened to until today my attorney have never filed a claim to my pasenger's Medicare so all of his medical bills from this car accident was never paid by Medicare. My attorney held all the medical bills with the settlement until he signed the release. All the medical bills were paid from his settlement not his Medicare. In other words he could have gotten more of a settlement without having to pay the medical bills by the settlement. Since he paid the bills out of pocket, I would think my PIP adjuster should reimburse him from what he paid for the medical bills by his settlement.

 

I had talked to a couple of other attorneys from Austin, TX since my passenger signed the release. I asked them if he can still make a seperate claim from my PIP coverage? These two attorneys said he's still able to make a claim after the auto accident settlement was released. Am I correct? Are you from Tx? The policies are different in each states. Some have to reimburse and some don't. I asked you because this is very complicated. So I hope I am not confusing you for what I had typed. Thanks for all the help.



#8 adjusterjack

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Posted 25 March 2013 - 09:03 AM

My question haven't been answered clearly. That's why keep asking questions until I completely understand.At the same time I don't know if you completely understand my questions

No problem.

 

I admit, it has been confusing. At one point it seemed like he did make a Medicare claim.

My attorney held all the medical bills with the settlement until he signed the release. All the medical bills were paid from his settlement not his Medicare.

Got it.

 

 

 In other words he could have gotten more of a settlement without having to pay the medical bills by the settlement.

No.

 

If anything had been paid by Medicare, Medicare would have a lien on the settlement and would have been reimbursed. Your passenger may have decided not to file a claim with Medicare if he could afford to front the money for the bills and wait for the settlement.

 

 

Since he paid the bills out of pocket, I would think my PIP adjuster should reimburse him from what he paid for the medical bills by his settlement.

Also no.

 

First of all, it's your passenger's choice whether to claim on your PIP. Obviously he hasn't because he paid his own bills. It's not up to you or your insurance company to decide that. Had he made a claim on the PIP your insurance company would have a lien on his settlement and would be reimbursed out of it.

 

 

I had talked to a couple of other attorneys from Austin, TX since my passenger signed the release. I asked them if he can still make a seperate claim from my PIP coverage? These two attorneys said he's still able to make a claim after the auto accident settlement was released. Am I correct?

That's correct. He CAN make a claim. If he wants to he can submit his bills to your PIP adjuster and be paid. Then your PIP company will be reimbursed out of his settlement.

 

I think what you are missing is that, when it comes to medical bills, you don't get to collect on them more than once.

 

 

Are you from Tx? The policies are different in each states. Some have to reimburse and some don't. I asked you because this is very complicated

I'm not from TX, but, as I mentioned earlier, I do have a sample Texas policy to refer to and multi-state reference material at my fingertips.

 

I think I pointed out earlier that your Texas policy has a provision requiring reimbursement.

 

I hope I have been successful in explaining things to you. If not, please continue to ask questions. I have the advantage of a college degree in insurance and 35 years in the insurance industry. I understand that insurance is often difficult for the consumer.

 

 .


Warning: Legal issues are complicated. Explanations and comments here are simplified and might not fully explain the ramifications of your particular issue. I am not a lawyer. I do not give legal advice. I make comments based on my knowledge and experience. I guarantee nothing. If you act on my comments without the advice of an attorney, you do so at your own risk.


#9 bgduncan

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Posted 10 December 2013 - 01:58 PM

Okay here is the deal.  Most likely the reason she is telling you that you don't have to sign it, is because in some states.... I know Texas for sure the insurance company is REQUIRED to carry $2500.00 PIP on you regardless.  They ofcourse don't tell you that.  They try to upsale you on the PIP.  Of course you can chose to carry more PIP but you DO NOT HAVE TO.  If the insurance company tells you that you have to opt out, they are lying.  By law in Texas and some other states it is mandatory.  Insurance companies and lawyers like to keep this on the hush hush.... so if you are EVER in a car accident, immediately go thru your insurance to get your PIP.  You don't need a lawyer to do this as they will try to take 1/3 to 2/3.  I went with Jim Adler, worst experience of my life.  They wanted to keep 2/3 of my PIP money even though I didn't sign anything saying they could do that.  I told them show me the contract and you can have it.  They said it wasn't in their contract... it was their "policy".  Policy my foot, a policy is not a law.  As a matter of fact most thing that people think are laws are really just policies.  The only real laws are those that are required in our Constitution, so MAKE SURE YOU KNOW THEM.  YOUR BILL OF RIGHTS IS ALL YOU HAVE and the courts are slowly chipping away at it......  Okay so I am rambling.  Don't OPT OUT of the PIP.  They can't go up on your rate if they are required to pay it.  I am not sure what state you are in but Texas demands they already have to carry it for you.  Research everything, trust no one where money is involved.  Insurance companies and Lawyers are the absolute WORST.  Document everything.  If you go to your lawyers office tape them on your phone, because the lie lie lie. What you need to do is go to voice memos on your phone a speaker should come up.... press the red button and then hit the top bottom of the phone that saves the battery.  That way it looks like your phone is off, but you are really recording.  I am dead serious, if I had not done this, I would not have gotten the settlement that I did.  Also it is NOT written in stone that you have to pay the attorney 33% of the GROSS amount.  That means they take theirs first and leave you with the crumbs even though they will tell you upfront that everyone gets 1/3.  1/3 to you, the doctor and the attorney.  Then the bills come back and they sing a different story.  They can and WILL reduce their fees if you are adamant, and if they don't you know they are crooks so run like hell and find another attorney.  I can't overstate the importance of documentation.  Save every email, voicemail and if they are acting shady record what they are saying.  People NEED to be accountable these days.  If we got NSA and every other organization spying on all of us all the time, I say what is good for the goose is good for the gander.  If we allow them to do it they are just going to take more and more advantage until you have to sign in just so you can use the restroom.  America is becoming one greedy NAZI police state, our founders would be appalled. They insurance companies will NOT tell you they are required to carry the PIP so where is the transparency?  So for the short version DON'T SIGN A DAMN THING!






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