Related Articles: Personal Injury

Helping Clients Negotiate the Insurance Maze

You don't have to know much about auto insurance to know that you should resist the temptation to give in to the adjuster's persuasive offer, "If you'll just sign this release, I'll see that you get paid right away." All too often, though, the injured person may have no better understanding of what insurance coverage is actually available to him than he has of why his neck or his lower back hurts. Frequently the victim of an automobile collision needs as much help in understanding his own insurance policy as he does in knowing what he may recover from the driver at fault.

This is where a good lawyer, who is highly knowledgeable about the workings of insurance, can be most helpful to the chiropractor in leading him and his patient through what has been called "The Insurance Maze." Such an attorney will know where to look for sources of coverage that the policyholder does not know exist (and you can be sure the insurance company isn't going to tell him about them).

The auto insurance policy is a complex contract that provides policyholders with benefits of which they may not be aware. One of these benefits is coverage for medical treatment, which is essential to an accident victim, as well as to the treating doctor. Furthermore, the experienced attorney will try to maximize the client's ultimate recovery by resisting the insurance companies' efforts to recapture payments they have made for treatment. Most people do not realize that in Virginia, under most circumstances, an automobile insurance company may not attempt to recover payments made to an insured after a third-party claim has been paid. In most cases, health insurance benefits are similarly shielded from subrogation.

What about the tendency of some insurers to try to set a cap on payments for medical treatment? The standard definition of medical expense in Virginia auto policies reads in part, "... all reasonable and necessary expenses for medical, hospital, chiropractic [emphasis added], x-ray, professional nursing ... services ... incurred within three years after the date of the accident." Does that mean what it says? You bet! And the accident victim should be able to count on a savvy attorney to fight to get the full insurance benefit to which he is entitled.

Some accident victims know about uninsured motorists coverage that will compensate the insured if the party at fault is uninsured or cannot be located. But, they may not know about Virginia's "underinsured" endorsement, which allows the victim to collect from his own company even though the party at fault may be insured, when the liability limit of the negligent party's policy falls short of his own policy's uninsured motorists coverage.

It is the attorney's ultimate responsibility to locate all sources for compensating his client. The responsible party's insurance may be only one source and often is insufficient. Other potential sources may include policies held by family members, employers and individuals partly responsible for the collision.