Is the settlement offer for actual costs?

by Paula

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.

Visitor Question:
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ANSWER for "Is the settlement offer for actual costs?":

Paula (USA):

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.

Best of luck,

Judge Calisi

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