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UMBI Claim. Low Offer after waiting 9 months.

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fejee

Member
What is the name of your state? CA

Accident happened in 7/03 with the hit and run driver at fault. The injured person made a UMBI claim with Mercury Ins. Her car damage was $18k. She signed a medical authorization in 8/03, sent by her carrier and listed all her treating doctors.

In 1/04 she finished treatment and mailed her med recs to the adj. She was also seen at Kaiser by an ortho, 7-8 times after the loss and told this to the adj. The adj also knew she was claiming lost of earnings so he ordered her employment recs via her signed authorization. The employment recs shows her doctor put her on disability for 3 months and her lost earnings were $15,000. She works for a major airline, handling baggage at time of arrival and departure.

Her med bills are $8000,lost earnings are $15k. Her pol limits are $30k,she demanded the limits in 1/04. She never recd any offer till 2 weeks ago.The new adj offered $3k. The adj's offer letter said her injuries (neck, back and shoulders) should not have limited her from doing her usual duties as a baggage handler. Each baggage weighs about 100-120 lbs. She asked her employer if she could work part-time after completing two months of treatment. The employer said no, as her dr put her on a 3 month disability and she was not fully recovered. Her new adj told her they never ordered her recs from Kaiser and did not say why?

Does this sound like her insurance company delayed paying her claim and acted unfairly by this low offer? The carrier had all her records, except Kaiser, and waited 9 months to evaluate her claim. Did Mercury act in bad faith by giving such a low offer? An offer based on their review of only the partial meds, since no Kaiser recs were ordered. What would be considered a fair offer in this scenerio. Thank you for your valuable assistance people. How would do the Dept of Insurance view this case as?
 


fejee

Member
QUOTE:
"are you representing yourself?"
***************************************************
My sincere apology for not responding to your question, Stephen. No, I am not rep myself. The case I mentioned involves my niece who asked for my assistance in resolving her claim against her Insurance Company.

What really seems improper on the carrier's part is that they never bothered to obtain the med recs from Kaiser where the injured person was seen by an ortho on at least 5-6 ocassions. The offer of $3000 considers no lost earnings because carrier feels injuries from not severe so as to preclude their insd in carrying out her usual duties as a reservation person.

The carrier's offer letter tells their insd(my niece), she waited a month before seeking treatment. This is not true. The prior adjuster was told that the insd did see the Kaiser Dr,a few days after the loss and the Dr.had recommended PT. The insd did attend two sessions of an exercise program at Kaiser and when it did not help my niece reduce her symptoms, she told her Kaiser instructer that she may benefit from a phys therapy program administered by a licensed therapist. The instructor referred her for PT and she had that treatment(PT) with a chiropractor recommended by her neighbor's daughter.

I did speak with the adj and he tells even if they had obtained the Kaiser recs, their evaluation would have remained unchanged as they do not believe my niece sustained anything other than superficial soft tissue injuries from this $18k impact.

I was under the impression that Insurance code 790 maintains that a low ball offer may violate the duty by the carrier to properly evaluate any claim presented by first party claimants?

Any help here would be appreciated. Thank you again, Stephen for your concern.
 

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