Insurance question.

[LAS14]

My daughter recently was awarded $50000 from another motorist's insurance company for pain and suffering. Her own insurance company paid her medical bills. But it turns out her insurance company asked for $6500 of the $50000. Her lawyer negotiated it down to $5000. We don't want to pester the lawyer for an explanation that we understand.... I'm just in the habit of not taking up lawyers' time, although maybe it would be covered in his 1/3 of the 50,000. Anyway, does anyone understand how the amount of $6500 was determined? It was a lot less than her medical bills. An what would influence negotiations on the amount.

The whole world of insurance is, to me, a great big fog. But I'm curious.

tia
las

[hueymahl]

1. You should ask your attorney

He or she would know all of the background facts that lead to the charge. It is part of the job. Plus, because it is contingency instead of hourly, you won't owe anything else.

[mr_lebowski]

2. Perhaps the un-met Yearly Deductible on her plan for the treatment she rec'd?

You didn't say if it's her Automotive Ins. Co, or her regular Health Insurance Co that grabbed the $5K .. do you know?

[LAS14]

3. Her health insurance.

[mr_lebowski]

5. That's what I thought. $5K is a real common yearly deductible on mid-range Ins Plans

They sometimes have some other separate deductible categories that allow it to go up from there (like, say, $1500 for meds). Lawyer may've negotiated it down to only the main deductible or some such. That'd be my guess, but I'm def. guessing.

[LAS14]

7. Well, yeah, but deductibles hit you before insurance pays, not after..

... the fact. She's been getting medical insurance payments for two years. And I've never heard of negotiating a deductible.... Although I've never heard much about insurance that made sense to me.

[mr_lebowski]

9. If you just up and get sick, yes that's how it works, but when there's liability

and another insurance company involved, things can get a lot more complex. I'd guess that, in a negotiation you maybe don't even know about, her health insurance company recovered a significant amount of what they spent on her medical bills ... from the other motorist's car insurance company.

I.E. if the other driver (say he had Geico) was found 100% at fault, and her HMO/PPO spent 100K on the medical care, her HMO probably collected $95K (or maybe only whatever his max injury coverage was for) from Geico, and then collected $5K out of her settlement, on the basis of that being around what her yearly deductible was. But the two companies negotiate that stuff between themselves for the most part.

I'm betting it's something to that effect. But ask the Lawyer if you really want to know

[LAS14]

10. Thanks for taking the time with all this. Very helpful! nt

[Elston]

4. Insurance lien

There could have been a lien by the insurance company for providing medical coverage

[rampartc]

6. the assignment of insurance payments is normal

if your own auto insurance and/or your health insurance have been covering your bills they will be repaid off the top of your settlement with the other party's insurance.

insurance companies negotiate different fees with health car providers which may result in different hospital bills.

your lawyer gets his contingincy as a percent of the entire settlement.

hope your daughter is ok.

[LAS14]

8. Thanks. Very helpful. She's pretty much OK after...

... dealing with post-concussion stuff. Eye focus problems, concentration issues, light sensitivity, etc., etc. I never knew a concussion could leave you with so many symptoms, though they certainly don't all the time.