Which Insurance Companies Do I Have to Talk to After an Auto Accident?

Which Insurance Companies Do I Have to Talk to After an Auto Accident?

Following an auto accident, victims are often bombarded with calls from claims personnel connected with various insurance companies asking how the accident happened and what injuries were sustained. Usually, there are three different insurance companies trying to get information: (1) the liability insurer for the at-fault driver, (2) your own auto insurance company and (3) your health insurance company.

The insurance company you have no obligation to speak to and who we recommend you do not speak to is the liability insurer for the at-fault driver. Almost without fail, soon after an accident, injured drivers will receive a call from a claims person from the responsible party’s insurance company. This claims person will likely be recording the conversation and will ask questions about how the accident occurred and what injuries were sustained; rarely is this to your benefit. Being only a few days out from the collision, the injured victim will not have the police crash report and investigation findings, will have only been discharged from urgent care or the ER and not had an opportunity to see their doctor or a specialist for their injuries. In other words, the injured victim usually does not know the full extent of their injuries or the details of the accident.

In spite of this information deficit, the at-fault insurance company will use this opportunity to lock you into how the collision occurred and what your injuries are all without the benefit and protection of counsel. This is a statement that may be used against you at future depositions and trial. Worse still, there are some insurance companies who use this early opportunity to pressure you into a accepting a settlement offer.

On the other hand, you do have a duty to communicate and cooperate with your own auto insurance and your health insurance company. Your insurance policies have specific terms and conditions that you must abide by, one of which is that the insured has a duty to cooperate and inform the insurance company about the loss (i.e. the collision and your injuries). If you choose to ignore your own insurance companies, you risk them not paying for medical treatment related to the collision and possibly risk your uninsured and underinsured motorist coverages should you need them. We are often told by our clients that one of the services they appreciate most is our office’s ability to force all insurance companies to run their questions, forms and requests through our office which we handle. This allows our clients to focus on the most important thing after an accident: getting better.

 

Understanding Your Auto and Home Insurance Policies Through Declarations Pages

Understanding Your Auto and Home Insurance Policies Through Declarations Pages

I have frequently talked about the importance of having adequate insurance coverage, particularly automobile and homeowner’s insurance. In the past, I have presented this topic at our firm sponsored seminars, written on the subject in my article Insurance Plays Critical Role and I have even created a video titled Importance of Having Adequate Auto Insurance.

However, determining whether you are adequately insured first requires a basic understanding of what is contained in your insurance policies and where you can locate critical information about your coverages.  While your complete insurance policy contains many pages of conditions, exclusions and endorsements, many of which are written such that they are difficult to understand, the first place you should look in your policy is the declarations pages.  The declarations pages consist of the first few pages of your policy which identify the specific automobile and homeowner’s coverages and the amounts of coverage.  Not all policies are the same for each individual, as you need to specifically pay premiums for each of the different components of coverage.  The primary categories of coverage that you typically will find in your insurance policy include the following:

Automobile Insurance Coverages

  • Bodily Injury Liability – Identifies how much coverage you have if you are responsible for causing injuries to someone else in an automobile collision.
  • Property Damage Liability – Identifies how much coverage you have if you are responsible for causing property damage to someone else in an automobile collision.
  • Medical Payment Coverage – Identifies the amount of coverage you have for injuries to you or your passengers in your vehicle sustained in an accident, regardless of who is at fault. This amount is usually $10,000.00 or less.
  • Comprehensive Insurance – Identifies coverage that helps pay to replace or repair your vehicle if it is stolen or damaged in an incident that does not involve a collision. This would include damage from fire, vandalism, or trees or hail falling on the vehicle.
  • Collision Coverage – Identifies the coverage to help pay to repair or replace your car if it is damaged in an accident with another vehicle or object.
  • Uninsured Motorist Coverage – Identifies how much coverage you have for bodily injuries you sustain in an accident as a result of the negligence of a driver who has no insurance.
  • Underinsured Motorist Coverage – Identifies how much coverage you have for injuries you sustain if you are struck by a negligent driver who has some insurance but inadequate amounts of insurance.

Homeowner’s Insurance Coverages

  • Dwelling Coverage – Identifies the amount of coverage for your actual home in the event you sustain damages due to a fire or weather event.
  • Personal Injury Liability – Identifies the amount of coverage you have if someone is injured on your property due to your negligence.
  • Personal Property Coverage – Identifies the amount of coverage you have for the actual contents of personal belongings in your home, such as furniture, appliances, etc. Your declarations page will also tell you whether or not you have replacement cost or actual cash value  Replacement cost coverage is better because then you can recover the amount it actually costs to replace the items that are damaged or lost.  Actual cash value only provides you with that amount of damages you sustained based upon the depreciated value of those items you lost.  For example, if you paid $1,000.00 for a couch that is now 20 years old, the actual cash value amount may be extremely low, such as $50.00.  However, if you had replacement cost coverage, you would be able to replace that $1,000.00 couch with a new one and you would receive the full amount for that replacement couch.  Replacement cost coverage does cost more in premium amount; however, as you can see, it is much better coverage.

Umbrella Endorsement Coverage

Umbrella endorsement coverage is extremely important and can apply to both automobile and homeowner’s coverages.  This is perhaps the most important coverage you can purchase.  For approximately $200.00 to $250.00 per year, you can add an additional $1 million or more of coverage to the following:

  • Automobile liability limits if you are at fault in an automobile collision;
  • Uninsured and underinsured motorist coverage if someone injures you in an automobile collision; and
  • Homeowner’s liability limits if you are negligent and someone is injured on your property.

In order to obtain an umbrella policy that covers all of the above, you need to specifically request this from your insurance agent.  Many companies will only sell policies that simply provide a liability umbrella policy which would add another million dollars in coverage to your liability coverage for home and auto.  However, it is extremely valuable to have the additional protection for your automobile, uninsured and underinsured motorist coverage, as well.  That is what you will need to specifically request when you speak with your insurance agent.  This would help protect you and provide additional benefits if you or others in your vehicle are injured in an automobile collision caused by someone who is either uninsured or underinsured.

If you are injured in an automobile collision or sustain significant property damage to your home or its contents, it is important for you to consult with an attorney to assist you in obtaining fair and reasonable compensation for your losses and to utilize your insurance coverage to the fullest extent.  You should review your declarations pages with your insurance agent and discuss whether or not there is a need to increase your insurance coverages.  Simply because an agent says that you have “full coverage” does not mean that you have enough insurance to cover the typical losses that our law firm sees on a daily basis.

 

Using a Special Needs Trust to Ensure Your Settlement Does Not Affect Public Benefits

Using a Special Needs Trust to Ensure Your Settlement Does Not Affect Public Benefits

In Wisconsin, Medicaid (sometimes also called Medical Assistance) covers 1 in 9 adults and 1 in 3 children; in fact, 16% of the Wisconsin population gets its health care coverage through Medicaid.  Unlike the similar sounding Medicare, Medicaid is a means tested, needs-based health care coverage program, which means there are various income and asset limits that determine a person’s, or his/her family’s, eligibility.

By virtue of being a means tested program, Medicaid eligibility can be affected by receipt of funds, such as a personal injury settlement, if proper steps are not taken.  For example, to qualify for Medicaid, a single person can have no more than $2,000 in total countable assets.  If that Medicaid recipient receives a personal injury settlement of $25,000, he or she is going to be above the asset limit and at risk to lose Medicaid coverage.  Considering the exorbitant cost of medical procedures and medications, the loss of Medicaid coverage, or any needs-based benefits, can be devastating.

No injury victim should face the choice of being fully and fairly compensated for his or her injuries versus keeping his or her health care coverage.  Such a harsh outcome can be avoided by transferring the settlement funds to a properly drafted “special needs trust.”  Under normal rules, if a Medicaid recipient gives away or transfers assets to someone else, or to a trust, this results in disqualification from Medicaid (a penalty period).  A special needs trust is a type of trust that is specifically allowed under the Medicaid rules as an exception to the asset transfer rule.  A Medicaid recipient can transfer assets to a special needs trust without disqualification, and the recipient will no longer be over the asset limit.  Although the injury victim no longer has access to the funds, the trustee of the special needs trust can make distributions for his or her benefit, and there will be no loss of public benefits.

For example, our hypothetical accident victim, Courtney, receives a $25,000 settlement but is on Medicaid and Social Security Income (SSI), which are public benefits with asset limits.  Courtney wants to save this money for a car (a non-countable asset) or other items but is not sure what she would like to purchase.  If she is going to stay on public benefits, she only has ten days to report that she has received the money, and then will receive a notice that her benefits will be terminated.  Instead, Courtney’s attorney creates a special needs trust for Courtney, naming her mother as the trustee.  Courtney transfers the $25,000 to the trust without any disqualification for public benefits.  Later, Courtney decides she wants to buy a car with the settlement proceeds.  The car is bought and paid for by the special needs trust; the funds to buy the car come directly from the special needs trust, not Courtney.  Courtney gets her car and continues to receive Medicaid and SSI.

It is important to remember that Medicaid and SSI are just a couple examples of means tested/needs-based public benefits that could be affected by receipt of personal injury settlement funds.  This all serves to highlight the risk of going it alone following an accident or injury, as well as the need to hire a skilled attorney.  To be sure, when the insurance adjuster is pressuring you to settle your claim, the insurance company is not going to care whether the settlement will cause you to lose your public benefits.

 

What Do I Do Now That I Have Been in a Motor Vehicle Accident?

What Do I Do Now That I Have Been in a Motor Vehicle Accident?

When you head out on the road, a motor vehicle accident is the last thing you want to happen. However, if you fall victim to a motor vehicle accident on account of another driver’s negligence, you do not want to do anything to jeopardize receiving full compensation for your injuries and damages.

The first thing you want to do is address the immediate medical needs of yourself and others. If you, a friend or family member are able, get the names and contact information from potential witnesses and take photographs of the scene and vehicle damage. Responding officers will likely want statements. Following the incident, be sure to contact the responding agency and request copies of all reports, 911 calls, dash cam video, body cam video, photographs, statements and any other evidence that may have been gathered from the scene of the accident. Depending on the location, street camera surveillance may be available as well. Some of this evidence, especially body cam video, may be discarded shortly after the accident. Therefore, it is critical you request this information promptly. In reviewing the reports and your statement, if you believe there are errors or omissions, bring this to the attention of the responsible agency as soon as possible.

Contacting your insurance company promptly is important as well. Immediately review your most recent insurance declarations. If you have what is referred to as underinsured or uninsured motor vehicle coverage (UIM/UM), your insurance company may provide coverage for injuries and damages you sustained as part of the accident if the negligent party has insufficient insurance coverage or no coverage at all. Your insurance company will also need to be notified to address the property damage to your motor vehicle.

You will also most likely be contacted soon after the collision by the other driver’s insurer. His or her company will likely want to abruptly resolve matters with you for an amount that may be far less than the true value of your loss. If your accident occurred in the State of Wisconsin, you have 3 years from the date of the accident to bring a lawsuit. Therefore, there is no immediate need to settle your claim within days or weeks of the accident. What may seem like an expected ache or pain that you feel will go away in days or weeks, could be a far more serious (even permanent) soft tissue injury. Waiting to more fully assess the extent of your injuries and damages is vital to being fully compensated.

The other driver’s insurance company will also likely want you to give a statement that is recorded. This insurance company does not represent you and does not have your best interests in mind. This statement could be used against you later. You have no obligation to give a statement to the other driver’s insurer. If you do give a statement, you are entitled to a copy of the statement and we recommend securing one as soon as possible.

If you are involved in a motor vehicle collision, the attorneys at Anderson O’Brien are here to help. We have decades of experience representing those injured in motor vehicle accidents to ensure that they are protected. We are only a call away.

 

Children Moving Out?  Make Sure They are Still Insured

Children Moving Out? Make Sure They are Still Insured

Often families with teenage drivers living at home do not have those teenage drivers listed as named insureds on the auto insurance policy.  Frequently, Mom and Dad are the named insureds on the insurance policy and all the vehicles are listed, and the teenagers qualify for coverage by virtue of being related to Mom and Dad and living in their home.  This type of familial relationship coverage for the teenage drivers usually has a special term of art in the insurance policy, such as “resident relative,” “member of same household” or “resident of your household.”

While each insurance company defines their terms differently, generally speaking, this type of familial coverage means that drivers who are living with their parents qualify for insurance coverage even though they are not the “named insureds” on the auto insurance policy.  This type of coverage is usually defined as a person related by blood (or adoption) to the named insured and living with the named insured; some insurers may limit this category to minor children only, but others may include adult children as well.

The reason this topic is being raised, is that sole reliance on resident relative coverage can create potential problems when that child moves away from home (goes to college or armed forces) or splits time between two homes (divorced parents).  Hopefully, a hypothetical will illustrate.

Billy is a hypothetical 18-year-old high school senior living with Mom and Dad.  The family has a hypothetical auto insurance policy that lists Mom and Dad as the named insureds and covers both of the family vehicles.  While Billy is not a named insured on the policy, by virtue of being related by blood to Mom and Dad and living in the same household with them, he qualifies as a resident relative insured, even as an 18-year-old.

Billy graduates from high school and goes off to college in another city; he is no longer living with Mom and Dad, nor is he listed as a named insured under any other auto insurance policy.  While at college, Billy gets injured in a terrible auto wreck while riding in a friend’s car.  Unfortunately, the at‑fault driver does not have sufficient insurance (or worse, no insurance at all) to cover Billy’s extensive injuries and damages.  However, Billy and his parents think that Billy should have underinsured motorist coverage available to him under Mom and Dad’s auto policy.

The problem is, Billy may no longer qualify as an insured under Mom and Dad’s auto policy.  Billy was never a named insured, the crash did not involve Mom and Dad’s cars, and Billy may no longer qualify as a resident relative.  Because Billy was not living with Mom and Dad at the time of the car crash, he may not qualify as a resident relative anymore.  Whether Billy qualifies for coverage under Mom and Dad’s policy will depend on the policy’s definition of resident relative and Billy’s precise living situation at the time of the wreck.  Had Billy completely moved out or did he leave his furniture and personal belongings at home?  Where was he getting his mail, or what was his voting address?  Regardless of the facts, by virtue of no longer living under the same roof with Mom and Dad at the time of the wreck, the insurance company will likely argue that Billy does not qualify as an insured.

You and your family, can avoid being left in this limbo by making sure your children who are leaving and not getting their own auto insurance are specifically listed as named insureds on your auto policies.  That way, if they are injured in a car wreck, they can have the benefits and protection of the uninsured and underinsured (if underinsured was purchased, and it should be purchased) coverage.

 

Who Pays Medical Bills Before a Settlement?

Who Pays Medical Bills Before a Settlement?

If you are involved in a motor vehicle accident, you probably have many questions, including questions about how your medical bills will be paid. If you were injured in a motor vehicle accident due to the negligence of another person, you may recover your medical bills through a lawsuit. However, it may be months or even years before you receive a settlement or judgment from the negligent driver and his or her insurance company. In the meantime, you need to ensure that your medical bills are covered. How those bills are paid will ultimately affect your recovery.

The first place you will want to look for insurance coverage for medical bills is your own automobile policy. Many drivers are unaware that their automobile policy may carry a certain amount of coverage for medical bills arising from an automobile accident. This amount is usually minimal, but every bit helps. If you reach a settlement with the negligent driver’s insurer, your automobile insurer generally is not entitled to be refunded for the medical bills it paid unless and until you are made whole by the settlement – meaning that you are fully compensated for all elements of damage. In most cases, a negotiated reduction is reached to avoid a separate mini-trial on this issue.

The next place you will want to look for medical coverage is your own health insurance. If you have health insurance through an employer-sponsored plan that is fully-funded by the employer, you may have to pay that health plan back all of the amount it paid for your medical bills regardless of whether you are made whole. These plans, referred to as self-funded ERISA plans, are governed by federal law, which preempts state law concepts such as the made whole doctrine. Some of these plans, however, are insured by a third party. An experienced lawyer will know to research the plan to determine whether it is insured or self-funded and whether arguments can be made in an effort to reduce the amount you are required to refund the plan from your settlement.

Finally, if you are insured through Medicare, the federal government has established a specific formula to calculate the amount that must be refunded. That formula is based on the amount of the settlement or judgment and the amount of legal fees and costs associated with achieving it.

Before resolving any case, it is always important to know what your payback obligations are to third parties that paid for medical bills related to the accident. Having an experienced lawyer involved gives you the benefit of determining what these payback obligations are and how to negotiate reductions where possible to account for the time and effort you and your counsel spent to recover from the negligent party.

 

Pin It on Pinterest