I am currently in negotiations with an insurance adjuster for a slip and fall injury. My demand is for the total of the actual out-of-pocket expenses that I've incurred. The adjuster gave me an offer with the notion that I would pay much less medical expenses if I send the medical bills to my own private health insurance company.
Does she have to go by the actual costs sent to her (i.e. my total medical expenses), or can she base the settlement offer on what my private insurance would pay? Thanks.
Disclaimer: Information provided in our response is NOT formal legal advice. It is generic legal information based on the very limited information provided. Under no circumstances should the information in our response, or anywhere else on this site be relied upon when deciding the proper course of a legal matter. Our response does NOT create an attorney-client relationship. Always get a formal case review from a licensed attorney in your area.
ANSWER for "Is the settlement offer for actual costs?":
The insurance adjuster can make any offer she wants. In fact, she doesn't have a legal duty to make any offer at all. She can deny the claim and force you to file a lawsuit. It appears the adjuster does want to settle your claim.
If you settle your claim for the higher amount, and by so doing have your private medical insurance pay some or all of your medical bills and out of pocket expenses, it is likely your private insurance company will want to subrogate. This means they will require you to reimburse them for any of the medical bills or related out of pocket expenses they paid on your behalf.
Your insurance policy affords them the legal right to subrogate. This information can be found under the "third party interest" section your policy.
You might be better off not having your private insurance pay your medical bills, and instead negotiate the highest settlement you can with the other party's insurance company. It would be wise to speak with an attorney for a professional opinion.
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.
The accuracy of information provided on this site is not guaranteed. It is generic information for informal purposes only. It is NOT formal legal advice. Your use of this site does NOT create an attorney-client relationship. Before relying on any information found in this site you should consult with a licensed attorney in your state. If you are currently represented by an attorney, you should strictly abide by his/her counsel.