Basis for pain and suffering?

[Dragonbits]

I'm curious - did you receive any required consent from your UIM carrier prior to settling the case with the at-fault party?

I myself didn't receive any consent from the UIM carrier. It went from the UIM carrier direct to the at-fault carrier.

What happened was that after agreeing to a settlement and signing a release, I asked what was holding up the ACH deposit of the $25K? The at fault party told me they were waiting on a letter from the UIM carrier before releasing the funds. This was about May 4th.

This seems plausible only because both the at fault carrier and the UIM carrier both contracted us on April 29th, and the UIM carrier was the one that called us on my cell phone 45 min later. The UIM carrier offered to place all four of us (myself, my wife who was with me, the at fault and UIM carrier in a three way call to facilitate the settlement since it was, as they said, only 11 min until the adjuster stated she was leaving for the day. April 29th being the 2 year mark.

My guess is if this wasn't done at the last minute, and since I usually ask questions about things I am curious about, I would have never known about the communication between the insurance carriers.

All of which makes me curious about the demand letter I had sent to the at-fault carrier, did they share this letter /' my demand amount with the UIM carrier? Is seems likely the amount at least was discussed since the UIM carrier assured me that my $100K UIM coverage could be used since the $25K didn't cover my demand. Of course, the UIM adjuster was very careful to explain he would have to make an independent analysis, subtract whatever had been paid already to come up with a net amount.

 

[Zigner]

The POINT I am trying to make is that many (most?) UIM policies have a provision that requires their consent before you enter in to a settlement with another party.

 

[Dragonbits]

The POINT I am trying to make is that many (most?) UIM policies have a provision that requires their consent before you enter in to a settlement with another party.

Ok, but you were asking questions about what I did, not making a general statement. It was obvious by reading what I wrote that the UIM insurer was involved in every step. The consent you are referring to goes from the UIM insurer directly to the at-fault insurer and doesn't involves us directly.

The UIM insurance worked to set up the settlement with the at fault insurance. The UIM adjuster even suggested, that although he couldn't give me legal advice, he would settle with the at fault party as they were already at their policy limits, and that the UIM insurance would then take over.

But before we could get a check from the at-fault party, the UIM insurer had to send a release of their subornation rights to the at-fault insurer. The UIM adjuster explained why they needed to give consent to the at fault party before they could send us a check.

Reason?

The UIM insurance has subornation rights with regards to any settlement we get from the at fault party for any medical payments our insurance had already made, such as ER treatment, which we are covered up to $2,000 Our insurer had already paid $1900 for that purpose.

Our UIM insurer wavied their aubornation rights, if they had not, they the at-fault insurer would have sent us $25K - $1.9K..

At this point, even if the total claim was determined to be less than $25K (by the UIM insurer), the UIM insurer has already waived their subornation rights so they would have no recourse to recover that money.

 

[Zigner]

The consent you are referring to goes from the UIM insurer directly to the at-fault insurer and doesn't involves us directly.

That is not true.
The consent I'm referring to is the consent that the UIM carrier gives to YOU to settle the case but still seek payment from your UIM carrier. That has nothing to do with the other party.

But, as you say, your carrier seems to be working with you. If they didn't consent to your settlement, then I just hope they don't figure it out at some point.

 

[Dragonbits]

That is not true.
The consent I'm referring to is the consent that the UIM carrier gives to YOU to settle the case but still seek payment from your UIM carrier. That has nothing to do with the other party.

But, as you say, your carrier seems to be working with you. If they didn't consent to your settlement, then I just hope they don't figure it out at some point.

So would that be verbal consent, or a letter?

FIgure it out? I think even a child could win that fight, it would be tough row to hoe to argue my carrier didn't give consent since they have sent an official letter to the at-fault carrier waiving their subornation rights to a settlement.

Here is a real question for you or anyone?

We sent a demand letter to the at-fault carrier, are they (at-fault) likely to share that letter or the amount of the demand with the UIM carrier? Any legal reason they wouldn't be able to share that information?

 

[justalayman]

Ok, but you were asking questions about what I did, not making a general statement. It was obvious by reading what I wrote that the UIM insurer was involved in every step. The consent you are referring to goes from the UIM insurer directly to the at-fault insurer and doesn't involves us directly.

The UIM insurance worked to set up the settlement with the at fault insurance. The UIM adjuster even suggested, that although he couldn't give me legal advice, he would settle with the at fault party as they were already at their policy limits, and that the UIM insurance would then take over.

But before we could get a check from the at-fault party, the UIM insurer had to send a release of their subornation rights to the at-fault insurer. The UIM adjuster explained why they needed to give consent to the at fault party before they could send us a check.

Reason?

The UIM insurance has subornation rights with regards to any settlement we get from the at fault party for any medical payments our insurance had already made, such as ER treatment, which we are covered up to $2,000 Our insurer had already paid $1900 for that purpose.

Our UIM insurer wavied their aubornation rights, if they had not, they the at-fault insurer would have sent us $25K - $1.9K..

At this point, even if the total claim was determined to be less than $25K (by the UIM insurer), the UIM insurer has already waived their subornation rights so they would have no recourse to recover that money.

So, you’re suggesting your insurance provider engages in illegal activity?

I believe the word you are intending to use would be subrogation. Subornation is something very different.

 

[Dragonbits]

So, you’re suggesting your insurance provider engages in illegal activity?

I believe the word you are intending to use would be subrogation. Subornation is something very different.

, I could blame spell checker but I would be lying. Sorry about that.

 

[Zigner]

I'm glad you've got this all figure out, DB.

Why are you here again?

 

[Dragonbits]

I'm glad you've got this all figure out, DB.

Why are you here again?

I am learning as I go along. (Like trying to adjust the font size.)

I was trying to determine how to calculate the value of the claim. Especially as regards pain and suffering.

Medical costs is one big element of the value of a claim. Not by any means the only element.

One of the things that puzzled me, a hospital will bill health insurance $30,000, but the health insurance will only pay their
negotiated rate. That negotiated rate varies depending on the health insurance, in my experience health insurance might pay anywhere from $15,000 down to $3,000 for that medical claim., Blue cross will have one rate, Medicare another, Medicaid another, etc, etc.

I assume we would have to pay back the actual cost that the health insurance incurred, but In the above example I wanted to claim the hospital billed $30,000 for that operation. I am sure the adjuster knows that the health insurance didn't actually pay out that amount, but making the total medical costs a higher amount typically results in a higher settlement. And since the negotiated rate varies so much, the billed rate seems like the only constant between various claims. Though of course billed rate varies quite a bit also depending on a lot of things.

So initially I was asking, what should I say was the medical expense, $30K or what the heath insurance actually paid?

Any out of pocket medical costs are easy to figure out.

There will be other questions, such as when the health insurance company comes to demand their subrogation, or their cut of a settlement, can I the deduct the prorated value of my time and expense from the total?

I think people on the forum made a good point about not being able to behave as an attorney. But it seems to me that if my wife gave me an enduring power of attorney, that would make me attorney in fact. For which I would not actually need to be a lawyer. Just to prevent a possible problem.

I am learning as I go along, it's all new to me, the only insurance claim I have handled was for a house fire and collision damage on a car. In the house fire example, I did deduct a reasonable hourly rate for replacing the floor myself.

 

[justalayman]

I think people on the forum made a good point about not being able to behave as an attorney. But it seems to me that if my wife gave me an enduring power of attorney, that would make me attorney in fact. For which I would not actually need to be a lawyer. Just to prevent a possible problem.

NO
a poa does not allow you to act as an attorney, ever. It allows you to act on behalf of the principal in situations the law allows.. it doesn’t allow you to give legal advice nor does it allow you to represent your wife. Acting in the stead of your wife is not the same thing as representing your wife in court.

To your damages:
Your damages are what the incident cost you. That means your damages regarding medical issues would be what the final bill was, not what was billed prior to any discount being applied.

You don’t get to collect more than what it cost you. That would be an enrichment and is not allowed


Your time has no value in your wife’s case.

 

[Dragonbits]

NO
a poa does not allow you to act as an attorney, ever. It allows you to act on behalf of the principal in situations the law allows.. it doesn’t allow you to give legal advice nor does it allow you to represent your wife. Acting in the stead of your wife is not the same thing as representing your wife in court.

To your damages:
Your damages are what the incident cost you. That means your damages regarding medical issues would be what the final bill was, not what was billed prior to any discount being applied.

You don’t get to collect more than what it cost you. That would be an enrichment and is not allowed


Your time has no value in your wife’s case.

Just to clarify, I wasn't trying to collect on the billed amount, that would be beyond stupid.

But pain and suffering is crudely based on a multiplier of the medical costs. I realize it isn't just a simple formula, but it's still a factor. One can have a huge amount of pain, but if your medical costs amounted to $500, good luck on convincing anyone your pain is worth very much.

One the other hand, if your medical bills amounted to $400,000, it implies you must have had significant pain and suffering.

I do see databases online that you can look at various injuries and their settlements, it would be very interesting to look at, but accessing those databases is kind of expensive .

 

[Dragonbits]

NO

a poa does not allow you to act as an attorney, ever. It allows you to act on behalf of the principal in situations the law allows.. it doesn’t allow you to give legal advice nor does it allow you to represent your wife. Acting in the stead of your wife is not the same thing as representing your wife in court. ​

Acting in the stead of your wife is not the same thing as representing your wife in court.

Bummer, there goes my chance to meet Ruth Bader Ginsburg.

I would sooner pull my own tooth than try and represent even myself in anything outside of small claims court / traffic court.

A good man always knows his limitations.

 

[Dragonbits]

The Statute of Limitations on Subrogation in Illinois?

Regarding subrogation, is there a statute of limitations (SOL) on how long my health insurance company has to ask for repayment from me after a settlement based on monies I receive from the other party's auto insurance company? There are no liens from health companies, but I want to avoid spending money that I may be asked to re-pay later.

It seems to me that there must be a statute of limitations, however, it can’t be as simple as an individual simply waiting till the very end of the 2-year SOL to collect a settlement then saying the health care company is time barred. But sometimes the law is a strange animal, so maybe it works that way.

Anyone know the details behind time limits for subrogation in Illinois, and should I have posted this to this tread or created a whole new one to ask this question?