Excuse my memory if it’s not exactly the way I remember it, but when referring to the basic tenets of insurance, the party to the claim is prohibited from “profiting from their injury” in that it is “mutually repugnant” to expect all defendants (tort feasors and their insurance carriers) to pay the full amount of the “specials damages” (known as medical bills, etc.). Simply put, this is “double-dipping”, and it “ain’t gonna fly!” The “general damages”: (pain and suffering,etc) is a different issue and subject to more subjective evaluations.
The article states “The Lynches were not left with any unpaid medical bills, but they said State Farm should have paid $470 in claims it denied in addition to the $1,436 it did pay.”
If they did not have any unpaid medical bills, for what was the $470 in claims supposed to reimburse the Lynches?
State Farm will have language in their policy allowing them to pay for necessary and reasonable medical; not exact words, but essentially if someone visits a chiro for a $100 treatment, State Farm (and most other carriers) will have the bill reviewed to confirm if was reasonable and medically necessary; the reasonable area will allow State Farm to pay what the going rate is for the treatment allotted; if the typcial treatment received by the injured party is $85 for their region, State Farm will reimburse $85, not the $100 charged.
This is so common it makes this suit laughable; this is undoubtedly and attorney trying to find a backdoor method to push a ‘class action’ and retire a billionaire; the vast majority of states allow this practice; if memory serves one of the few that does not is Montana…
But here’s the best part:
the victims here had an accident, and received medical treatment. The incurred medical bills. The bills were submitted to the following:
State Farm for medpay covg
at fault carrier for bodily injury
Health carrier for payment to med providers
So, the claimants were attempting to triple dip, which is perfectly legal in many states, but they were upset because they weren’t allowed enough of a triple dip; their health covg paid their medical bills; odds are they may have paid even less that State Farm (State Farm would have paid the family direct since the bills were already paid). But then the victims are also allowed to pursue their medical bills (and pain/suffering of course) against the at fault party.
So, a judge wisely ruled they had no damages. In a more liberal jurisdiction, a judge may rule differently, but the concept that State Farm is handling these medical bills with is pretty common. 99% of medical providers agree to accept the adjusted amount the carrier (State Farm) offers. One could wonder why it is still allowed for med providers to bill such differing rates, when in the long run they will accept the same rate. The folks who get screwed here are the uninsured, who do not get the benefit of having their bills reviewed for reasonableness. Of course, few do pay those bills.
are actively seeking ways to keep down the cost of their claim, and in doing so help keep down the cost of their auto policy in Nebraska, along with the other SF MUTUAL policyholders in Nebraska. Maybe someone, like their attorney, should let them understand how sueing your own company needlessly drives up the cost of insurance for all of us. I mean, I can assume can’t I, that they like me want to do their part to keep the cost of insurance down? Can’t I?
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Excuse my memory if it’s not exactly the way I remember it, but when referring to the basic tenets of insurance, the party to the claim is prohibited from “profiting from their injury” in that it is “mutually repugnant” to expect all defendants (tort feasors and their insurance carriers) to pay the full amount of the “specials damages” (known as medical bills, etc.). Simply put, this is “double-dipping”, and it “ain’t gonna fly!” The “general damages”: (pain and suffering,etc) is a different issue and subject to more subjective evaluations.
The article states “The Lynches were not left with any unpaid medical bills, but they said State Farm should have paid $470 in claims it denied in addition to the $1,436 it did pay.”
If they did not have any unpaid medical bills, for what was the $470 in claims supposed to reimburse the Lynches?
State Farm will have language in their policy allowing them to pay for necessary and reasonable medical; not exact words, but essentially if someone visits a chiro for a $100 treatment, State Farm (and most other carriers) will have the bill reviewed to confirm if was reasonable and medically necessary; the reasonable area will allow State Farm to pay what the going rate is for the treatment allotted; if the typcial treatment received by the injured party is $85 for their region, State Farm will reimburse $85, not the $100 charged.
This is so common it makes this suit laughable; this is undoubtedly and attorney trying to find a backdoor method to push a ‘class action’ and retire a billionaire; the vast majority of states allow this practice; if memory serves one of the few that does not is Montana…
But here’s the best part:
the victims here had an accident, and received medical treatment. The incurred medical bills. The bills were submitted to the following:
State Farm for medpay covg
at fault carrier for bodily injury
Health carrier for payment to med providers
So, the claimants were attempting to triple dip, which is perfectly legal in many states, but they were upset because they weren’t allowed enough of a triple dip; their health covg paid their medical bills; odds are they may have paid even less that State Farm (State Farm would have paid the family direct since the bills were already paid). But then the victims are also allowed to pursue their medical bills (and pain/suffering of course) against the at fault party.
So, a judge wisely ruled they had no damages. In a more liberal jurisdiction, a judge may rule differently, but the concept that State Farm is handling these medical bills with is pretty common. 99% of medical providers agree to accept the adjusted amount the carrier (State Farm) offers. One could wonder why it is still allowed for med providers to bill such differing rates, when in the long run they will accept the same rate. The folks who get screwed here are the uninsured, who do not get the benefit of having their bills reviewed for reasonableness. Of course, few do pay those bills.
Thanks. That is what I suspected. Wonder how much time and money their lawyer wasted. Too bad.
are actively seeking ways to keep down the cost of their claim, and in doing so help keep down the cost of their auto policy in Nebraska, along with the other SF MUTUAL policyholders in Nebraska. Maybe someone, like their attorney, should let them understand how sueing your own company needlessly drives up the cost of insurance for all of us. I mean, I can assume can’t I, that they like me want to do their part to keep the cost of insurance down? Can’t I?