Auto Insurance Adjusters acting like Medical Insurance Adjusters

atx · #1 01-26-2005, 07:37 PM

What is the name of your state? Texas

Are auto insurance adjusters allowed to cut your medical bills by more than half? I was under the assumption that only medical insurance adjusters could use usual and customary fees.

Surely the auto insurance company doesn't expect me to pay the additional $7,000.00 that was cut?

Especially since their insured was 100% at fault.

Thanx

tammy8 · #2 01-26-2005, 07:56 PM

REASONABLE costs are covered. Give more details as to why your med bills seem to be almost 15K.

atx · #3 01-26-2005, 09:49 PM

The accident took place last April. I was at a stop light when the driver hit me from the rear at 45 miles per hour. I have been in treament since then. I was diagnosed as having Cervicobrachial Syndrome (which is actually a more severe form of whiplash and the damage that was caused to my cervical is permanent).

Currently my medical expenses are $10,000. My doctor has stated I need at least 50 more treatments which comes to a total of an additional $5,000.00.

I did some research on the web and found a law firm that is suing several insurance companies for reducing or denying medical claims. So it is against the law.

[url]www.freedweiss.com/insurance.htm[/url]

teflon_jones · #4 01-27-2005, 06:28 AM

50 more treatments!?!?!? I'm not very familiar with your condition, so can you explain what's involved in these treatments? I've been through physical therapy for various serious injuries a number of times in my life, and it never took 50 treatments for any of them. Off the top of my head it sounds excessive.

Lynx 36 · #5 01-27-2005, 08:43 AM

Quote: "Are auto insurance adjusters allowed to cut your medical bills by more than half? I was under the assumption that only medical insurance adjusters could use usual and customary fees."

Auto insurance companies do have people cross-trained in both areas.

Quote: "
Currently my medical expenses are $10,000. My doctor has stated I need at least 50 more treatments which comes to a total of an additional"

Is this a chiropractor or a REAL doctor? Chiros are not doctors, they have no P.h.d. You better make sure you see a neurologist if you expect the insurance company to pay 100% of your meds. If not expect the insurance company to send the meds offf to be reviewed. Then what will come back is a written report pointing out all the over-treatment and you could end up being on the hook. If all you have are bills from a chiro w/ no doctor visits or recommendations you will more than likely be paying a lot of these yourself. I've handled many injury claims and 50 more treatments on top of what you've already had is way too excessive f/ whiplash.

Quote: "I was diagnosed as having Cervicobrachial Syndrome (which is actually a more severe form of whiplash and the damage that was caused to my cervical is permanent)."

Was this diagnosed by a neurologist or a chiro? Big difference here. The chiro will tell you anything to keep you coming back over and over again. This is how the quacks make their money.

Quote: "I did some research on the web and found a law firm that is suing several insurance companies for reducing or denying medical claims. So it is against the law.'

No, just b/c you sue doesn't mean you will win.

I would cut your meds in half too. This is obvious overtreatment and possible insurance fraud as well. I may send this to the NICB f/ an investigation.

atx · #6 01-27-2005, 05:37 PM

50 more treatments!?!?!?
Yep, 50 more treatments. The treatments include physical and manual therapy, neuromuscular, myofascial trigger point treatment because of the dysfunction of my neck and a few other treatments.

[Is this a chiropractor or a REAL doctor?

Yes, this is a real neuro doctor with x-rays and all.

[Auto insurance companies do have people cross-trained in both areas.?

This particular adjuster does not have training in both areas. I double-checked with the Texas Dept of Insurance regarding what type of adjuster license she has. Now if she wants to send it off for a peer review that's fine. I was an insurance auditor on behave of the nurses and phycisians that conducted the peer reviews and have access to what procedures fees are usual and customary. What she is trying to reduce or deny is much lower than usual and customary. This particular insurance company uses a software that reduces med claims below usual and customary. That's one of the reasons that are in a lawsuit.

Medical treatments excessive or not, bottom line is I'm not paying for anything because their insured caused the accident. I do have my attorney standing by along with a local news station who loves to expose companies doing such action. If they don't pay what I think they should, then I will just go to the insured. Who is some young little kid who is on his parents policy. So the money will come one way or the other.

Thank you all for your comments.

teflon_jones · #7 01-28-2005, 09:37 AM

Quote:

Originally Posted by atx

Medical treatments excessive or not, bottom line is I'm not paying for anything because their insured caused the accident.

Ok, so what you're saying is that it's ok to take money that you don't need for anything related to the accident. Knowingly seeking money for treatments that you don't need is fraud. I really don't understand this at all unless you're in cohoots with the doctor because all you're getting out of these excessive treatments is more time at the doctor's office. You're not getting any monetary gain...

Lynx 36 · #8 01-28-2005, 09:42 AM

Quote: "Medical treatments excessive or not, bottom line is I'm not paying for anything because their insured caused the accident."

Wanna bet!? If treatments are deemed excessive you will not be reimburesed f/ treatment that is not necessary. It doesn't matter who you sue. It will only expose the fraud here, so go sue.

Quote: "I do have my attorney standing by along with a local news station who loves to expose companies doing such action."

What action? Not paying on a fraudulent claim? Sorry, atty's and TV stations don't scare insurance companies. Maybe the T.V station will expose the obvious insurance fraud here. If I was the adjustor I would call them myself.

Quote: " If they don't pay what I think they should, then I will just go to the insured. Who is some young little kid who is on his parents policy. So the money will come one way or the other."

You not the sharpest tool in the shed are you? So if they don't pay what YOU think they should you think you can sue them and get the money? Do you think it will be that easy? You obviously don't know how these things work at all. The insurance company will send a half dozen lawyers down on you to try and prove their case and they will defend their insured should you sue them. You're about to get a reality check, real fast here. But what do I know, I only do it f/ a living. You're just the typical dumbass I deal w/ everyday who thinks they just broke the bank cause they were injured. Like you and them, you learn eventually that is not the case and you don't end up getting everything you think you are going to get.

Again, if I was handling this claim I would nail your ass f/ fraud you try this crap on me sister!