Auto Accidents

My First Word of Warning in Speaking With Insurance Companies

My first bit of advice to you is please be careful in speaking with your insurance company about the accident!  It is important to tell the insurance company about the accident as soon as possible after an accident, but insurance adjusters are always looking for ways to downplay your injuries!  I cannot begin to tell you how many times a client has told me that they told the insurance company that they felt “fine,” only to feel pain afterward, and the insurance company resisting payment of treatment because the client said they felt “fine.”

What is the Law in Massachusetts as it Pertains to Automobile Accidents?

Under Massachusetts law, you must be able to show that the other driver was more than 50 percent at fault for the incident. 

Once fault has been established, there are other specific requirements that must be met in order to file a claim for pain and suffering, including the following:

  • You must have reasonable and necessary medical bills in excess of $2,000 or the injury must have resulted in a permanent scar, fracture, disfigurement or death.

What Am I Entitled to If I am Injured in An Automobile Accident?

While every case is unique, auto accident victims are generally entitled to recover medical costs, lost wages and earning capacity, future medical costs, pain and suffering, and related out-of-pocket expenses. However, many of these amounts can be difficult to determine and insurance company lawyers will fight to reduce your losses – or even try to eliminate them.

Massachusetts is a no-fault state. Regardless of who caused the accident, your medical bills are supposed to be covered. Under that provision, your initial medical bills will be submitted to the insurance company that covers the vehicle you were in. That insurance company is supposed to pay the first $2,000. Any medical bills more than $2,000 must be submitted to your private health insurance company. If a bill is denied or only partially paid by your health insurer, the outstanding balance can then be submitted to the vehicle insurance company for payment. If you have no health insurance, the vehicle insurer should pay an additional $6,000 in medical bills above and beyond the initial $2,000.

Sound confusing? It is. The reality is that vehicle insurance companies don’t always do what they’re supposed to. They have the right to review your medical care and the reasonableness of the bills submitted by your medical care providers. They can have their own doctor review your medical records to determine the necessity of treatment. They can even require you to be examined by a doctor of their choosing, which can result in a denial of coverage for future treatment – even if your treating doctor says otherwise.

Who Will Cover My Lost Wages?

If you’ve been injured, you need time to recover and may miss days of work. Under the same coverage as your medical bills, your lost wages will be reimbursed at 75 percent of your pre-tax wage. The other 25 percent must be retrieved and negotiated with the at-fault party’s insurer.

If you were compensated using your sick time, the law provides that, in the 365 day period following your loss, if your sick time is exhausted and you are out of work, the insurance company will then reimburse you for the time you were out.

What about other costs and expenses?

Medical costs and lost wages are obvious recoverables. However, you may also be entitled to receive compensation for lost earning capacity if you’re unable to go back to work or lose your job due to your injury. You may also be compensated for injury-related out-of-pocket expenses, such as childcare costs, snow shoveling costs or lawn care for having to pay someone to help you for work, or other obligations you can no longer do yourself. You may also be able to recover costs for future medical treatment, such as reconstructive surgery or lifetime medical care in the case of a permanent injury. Finally, there’s pain and suffering, which is the physical and emotional distress caused by your injury.

If you are injured in an automobile accident in Massachusetts, click here to see my words of advice to follow if you are in an automobile accident.

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