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After an accident, follow these steps to protect your rights to compensation:
Never leave the scene of an accident. If you are conscious and can do so without further injuring yourself, take as many photos as possible.
Check to see if there are any injuries to those involved in the accident. Call 911 immediately if medical attention is needed. Make sure that the police have made a report of the accident. Police reports are useful for determining fault and negligence.
Talk to anyone who may have witnessed the accident. Take down names, contact information, and any other information or details they can provide. Take as many pictures if possible if you are in a condition to do so.
Do not delay or avoid obtaining medical care. Responsible insurance companies will use any delay in obtaining medical care as a possible excuse for not paying the fair value of your claim.
It is important to visit your doctor after an injury, even if you are unsure if you have been injured. Make sure to explain exactly how the accident occurred, and mention any injury or pain you have suffered as a result. Follow all of the advice given by your medial provider and take all the medication prescribed to you. If you do not, the insurance company is likely to use this against you to avoid paying the full value of your claim.
Immediately report the accident to your own insurance company. Failing to do so could result in the insurance company not covering you for the accident. However, if dealing with an insurance adjustor, do not sign or admit to anything. We recommend that you never talk to the insurance adjuster without first talking to a qualified injury lawyer.
Before giving a statement to an insurance adjuster or signing anything, consult with a lawyer experienced in helping injury victims. Seeking the advice of an experienced lawyer after is the best way to ensure that your rights will be protected.
One of the most common strategies used by insurance companies to avoid paying accident victims the full amount owed is the “quick settlement” approach. If an insurance company senses that an accident victim is facing financial pressures such as mounting medical bills, the company may aggressively try to reach a quick - and often very low - settlement.
Be very careful if approached early on by an insurance company with an offer to settle the case -- many people make costly mistakes by settling their case for too little and then face the reality of future medical bills that they must pay out of their own pocket.
An insurance company using the “quick settlement” tactic may have a claims adjuster contact you very soon after your accident, sometimes even before you have filed a claim. This is when accident victims are often most vulnerable. You may still be adjusting to the physical and emotional impact of the accident and you might be under a lot of pressure due to lost work time and expensive medical bills. If you do not have health insurance, you might also be having difficulty even getting all the medical attention you require.
The insurance company may offer to pay you money to resolve your injury claim which is far less than your case is worth. If you accept this money, the insurer will usually require you to sign a release of all of your rights which will prevent you from recovering anything else in the future even if you later discover severe problems arising from your accident.
Claims adjusters know that if they contact an injury victim shortly after an accident, it is statistically more likely that the victim will not yet had the chance to consult with a lawyer. The insurance company may try to take advantage of injury victims who do not know their rights.
Be very careful if the insurance company is pushing for a quick settlement and always obtain a case evaluation by a qualified lawyer before agreeing to anything. We are here to evaluate your case and answer your questions, without charge.
If you recover money for your injury claim, there is a very complicated set of rules for when your health insurers need to be paid back out of the settlement for money they paid for your medical care. This depends, in part, on the type of medical plan involved. Importantly, some of these plans will frequently compromise the amount that needs to be paid back to them out of a settlement if you are skilled in negotiation with them.
There are generally three categories of medical coverage plans: Private Plans, Employer-Sponsored Plans, and Medicare/Medicaid coverage. Injury victims may experience problems obtaining proper payment for their medical bills with any of these plans.
Direct plans are health care plans which are paid for directly by the injury victim, the injury victim’s family, or someone else on the injury victim’s behalf. These are different from plans which are sponsored by an employer, even if the employee is required to pay part of the insurance premiums. Employer-sponsored health benefits are almost always governed by a complex set of federal laws known as ERISA (discussed below).
For example, a private health insurer may refuse to pay the full amount of a medical bill because the insurer claims the amount of the bill is not “reasonable and customary” for the type of medical service provided. The insurer might also claim that the medical treatment is “experimental” or was “unnecessary” and therefore not covered.
Private insurers may also refuse to pay for a victim’s medical treatment on the grounds that the type of injury is not covered under the insurance contract. We have even experienced insurers refusing to pay a victim’s medical bills on the basis that the injury victim was injured due to the fault of another person!
If a private insurer is refusing to pay all of the victim’s medical bills, the proper remedy often depends on the contractual language of the medical insurance policy and governing state law.
If you or a loved one has been injured due to the negligence of another person and you are having difficulty obtaining payment of your medical bills by your private health plan, contact us. We will review your circumstances and answer your questions without charge.
If a private insurance plan refuses to pay all medical bills, it is important that you contact us quickly, because many private insurance contracts require that you appeal an insurance company’s decision quickly – sometimes within 30 days.
In 1974, the U.S. Congress passed a law known as the Employee Retirement Income Security Act, which is abbreviated to “ERISA.” The law was originally passed for the purpose of trying to ensure that workers received pension and other employment benefits they were promised and to make sure that the law governing these types of benefits were uniform. The law impacts virtually all medical benefit plans established through an employer, as well as benefits established by an employer for long and short-term disability.
ERISA laws are helpful in reducing the cost of health benefits to employers. Although Congress may have been well-intention in passing the ERISA law, it is our experience that the law often hurts those with ERISA health plans. This is true especially if they do not know their rights.
ERISA law is extremely complicated. If health benefits are provided to an injury victim through an ERISA health plan, the right to benefits is frequently determined by federal law even if state laws are different and provide greater protection. The law is so different that people who are provided benefits under an ERISA plan are not even considered to be “insured” by an “insurance company”: they are considered to be “subscribers” to a “benefit plan.” State laws that apply to insurers frequently do not apply to ERISA benefit plans and “subscribers” often have fewer consumer protections than those “insured” under a private plan.
For example, an injury victim’s rights are likely very different under a private medical insurance policy than an Employer-Sponsored Health Plan governed by ERISA. If an employer-provided plan refuses to pay the medical bills of an injury victim, the injury victim will likely need to act very quickly to protect the right to payment. A failure to act right away may result in the victim losing coverage for medical bills, even if the plan was required to pay the benefits in the first place. Frequently, these benefit plans have established complex “appeals” processes that the injury victim is required to follow in order to protect the right to payment.
Although an injury victim will not have the same rights under an ERISA-governed plan as a private health plan, federal law does provide some protections which are not provided to people covered by entirely private health insurance. The key to protecting an injury victim’s rights to medical bill payment is to know the rights under both state and federal law.
Our lawyers are experienced in dealing with ERISA plans. In fact, one of our founding lawyers worked frequently with ERISA law while working for the federal court system.
Medicare is a social insurance program which provides health insurance for approximately 45 million Americans. Established in 1967, the federal Medicare program serves almost 38 million people who are age 65 or older and serves another 7 million younger adults who suffer from permanent disability. The Medicare program helps those covered pay for a variety of health care services, including hospitalization, physician services, and prescription drugs. However, Medicare generally does not provide coverage for long-term care services and a variety of other types of services. Because there are many medical needs which Medicare does not cover, or fails to cover completely, many people covered by Medicare benefits also have a Private Plan or Employer Sponsored Health Plan which provides supplemental benefits.
Medicaid, on the other hand, is the largest health coverage program in the United States. It provides coverage to 59 million people, including low income individuals and their families, people with disabilities, and some elderly people also covered by Medicare. Medicaid provides benefits to some 29 million children. Medicaid is also the largest source of financing long-term care, including some 40% of the overall costs for nursing home care.
Because Medicare and Medicaid are government-established health care plan which accounts for over 13% of the entire federal budget, laws and regulations governing these programs are enormously complex. There are numerous special rules which apply when Medicare or Medicaid declines to pay health benefits for an injury victim.
Additionally, when Medicare or Medicaid pays some or all of the cost of an injury victim’s healthcare, there are complex rules governing when and how much an injury victim must pay back to the program if the victim obtains a legal recovery. These are called Medicare and Medicaid “liens.” Special rules apply to these liens.
Often, an injury attorney familiar with these programs will negotiate with Medicare and Medicaid representatives in an effort to reduce any amount an injury victim is required to pay back out of a settlement. Some lawyers charge clients extra to negotiate with Medicare or Medicaid, while other attorneys will not negotiate these liens because of their complexity.
Additionally, there is the possibility that a legal settlement will impact an injury victim’s continued eligibility for Medicare or Medicaid.
Whether you are insured through private insurance, an ERISA plan, or Medicare/Medicaid, there are frequently complex issues with how your injury claims impact your rights under these plans. It is absolutely critical that you understand these complexities. Contact us at any time and we can discuss how your health insurance relates to injury claims in your specific circumstances, without charge.Lawyers in our firm are well-versed in the complexities of Medicare and Medicaid law.
We are often asked by injury victims whether it makes sense to hire a lawyer right away or whether it might be better for the injury victim to try to resolve the case first without a lawyer.
There are some cases - particularly when injuries are not very serious or there is only property damage - when it makes sense for an injury victim to try resolving the case on their own. In these cases, however, an injury victim should first consult with a qualified injury lawyer to determine how best to proceed and to learn the fair value of their case. An honest lawyer will always tell you when are better off trying to resolve the case yourself, and will give you this advice for free.
In cases involving injuries, especially those involving a hospital visit and ongoing medical treatment, hiring a qualified injury lawyer early on is extremely important to protecting your rights and to ensure recovery of the full amount you are entitled to.
It is also important to preserve as much evidence related to your accident as possible. This may include obtaining statements from police officers who responded to the accident scene, other witnesses, and medical providers. Acting quickly will help ensure that witnesses remember as much as possible and often makes it easier to locate witnesses. Additionally, the insurance company is likely conducting its own investigation. Experienced injury lawyers often find it helpful to speak to the witnesses before the insurance company does.
In evaluating whether you should obtain legal help now or wait until later, the question should be whether there is anything a lawyer can do now to protect you rights that a lawyer would not be able to do as effectively later on. The answer to this question depends on the circumstances. Generally speaking, however, the sooner you get help from a qualified lawyer the better.
First, there may be issues involving the statute of limitations. If you do not resolve your claim before the expiration of the statute of limitation, you may lose all of your rights related to your claim. Statutes of limitation can sometimes be very complicated and a qualified lawyer can help make sure that your rights don’t expire.
Second, having legal representation soon after your accident can help ensure that medical providers are creating and maintaining records of your injuries in a way that truly reflects the impact the accident has had on your life. We can help guide you through the complicated process of finding and working with the right health care providers in order for you to get healthy.
Insurance industry studies suggest that this is not true for many people. The Insurance Research Council, an organization funded by the largest insurance companies, conducted a comprehensive study comparing the amount of money people with similar injuries received in insurance settlements. The study concluded that, on average, a person represented by an attorney received almost three and a half times more money - even after subtracting attorney fees. Similarly, a study by Allstate Insurance Company concluded that accident victims represented by a lawyer recovered 2 to 3 times more money after attorney fees were paid than if they handled the claims themselves. The insurance adjusters know this and that is why they may try to settle your claim quickly before you talk to a lawyer.
Insurance adjusters are trained in sophisticated ways to get you to take less for your claim than it may be worth. In fact, some insurance companies give their adjusters financial bonuses if they settle your claim for less. These adjusters have years of experience, and some of the biggest insurance companies have invested millions of dollars in studies showing how to get injury victims to take less. Some of these tactics include (1) making it seem like the insurance adjuster is on your side; (2) discouraging you from talking to a lawyer; (3) refusing to put things in writing; (4) having you give recorded statements in order to get you to say something that can be used against you; and (5) having you sign documents which can unknowingly hurt your financial recovery.
We know these tactics inside and out because we deal with them every day. We know the true value of your claim, we know how to deal with the insurance company’s strategies to pay less, and we know how to fully protect your rights so you receive the full compensation owed to you.
There is no reason for anyone to deal with these issues alone. Our legal team is ready to answer all of your questions and fully evaluate your case, free of charge, whether or not you want to hire us as your lawyers.
Don is a founding partner and one of the nation’s top-ranked personal injury litigators. He is a member of the Multi-million Dollar Advocates Forum, which includes less than 1% of the nation’s trial lawyers, and awarded the highest ranking given by Martindale Hubbel and AVVO.
More importantly, Don understands representing personal injury victims is about more than recovering the best settlement: it’s about helping clients get back on their feet and supporting them in every aspect of their recovery.
In nearly all cases, our clients seek compensation from the wrongdoer’s insurance company. Before forming Wruck Paupore, Jason worked for a prominent law firm representing some of the world’s largest insurers. This experience gives Jason a deep understanding of the insurance industry and the strategies it uses to pay injury victims as little as possible.
Jason -- and our entire team -- put this inside knowledge to work to force insurance companies to pay what is actually owed. Often, we use the insurance company’s own tactics against them as we fight for the full compensation our client deserves.
For more than four decades, Keith has been fighting for injury victims. During that time, he’s watched the insurance industry change, with insurers now more interested in protecting their stock price than treating injury victims fairly.
Since the beginning, Keith has put people first. From his childhood in Gary, Indiana during the 1960’s and working his way through law school, Keith has risen to become one of the Midwest’s most respected trial lawyers. He has never forgotten that being a lawyer is about helping people -- and seeing injury victims through struggles in a way that could change their lives forever.
Over the decades, Keith, Don and Jason have fought relentlessly for clients, even when other lawyers have said the case was impossible to win.
Contact Us:
Wruck Paupore P.C.
Injury Lawyers
275 Joliet St. Suite #250
Dyer, IN 46311
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