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post #1 of 33 (permalink) Old 01-16-2011, 06:44 PM Thread Starter
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Insurance question

As some of you know, I suffered a near fatal motorcycle accident on July 5th of last year. My attorney secured a $100,000 settlement, however my health insurance has laid a lien against it for $60,000.

My attorney is working on contingency for 1/3rd. So if I accept their terms, I will be left $6,667, and $22,000. in bills to pay on what they didn't cover.

My attorney thinks they are out of their minds, and recommended not to sign anything.

My question is, has anyone here had to deal with something like this?

If so, how did it end up?

Thanks,

Maloy

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'86 Honda XL500 (wrecked RIP)
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post #2 of 33 (permalink) Old 01-16-2011, 07:54 PM
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I haven't been through this but I agree with your attorney.

You were not at fault in this accident and it is up to the person who it at fault to set things as right as they can be set. That includes replacing your bike, your gear, paying your medical bills, paying for lost wages, and so on.

And you can always get a second opinion from a different attorney.

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post #3 of 33 (permalink) Old 01-16-2011, 09:01 PM
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Some thoughts:

When you say your attorney "secured a settlement", is it a done deal or an offer?

Who is the "they" that your attorney thinks is out of their minds? The responsible party? The responsible party's insurance company? Your health insurance?

I'm no lawyer, but here are my opinions, for what they are worth (not much):

Your attorney is entitled to his share (that's how things are done).

Your health insurance is entitled to be reimbursed if your policy so states, but I would think only for the actual amount of checks they wrote, not for reductions in hospital price, etc that they negotiated. They lost money on this accident too.

(I HATE to defend attorneys and insurance companies.)

The responsible party should cover your losses. Everything! Including Versys, gear, medical costs, lost time from work, pain, suffering, etc. This can go beyond their insurance company's limits, if you want to go to trial.

If the $100,000 is their insurance limit, then you would have to decide to go after other assets like bank account, real estate, etc. This would require a trial judgment, I believe. It's a waste of time if the RP has few assets.

If the insurance limit (both medical and property combined) is greater than $100,000, then you shouldn't settle for less than you actual losses including attorney fees and insurance reimbursements.

I was once in an accident where the responsible party's limits were 15K medical and 5K property. I had about 10K in property loss, but only about $800 of out-of-pocket medical. I talked his insurance company into giving me the total $20K. This was done without an attorney, and my health insurance never asked for reimbursement (it might have been an oversight on their part). I "made out" on that deal, unless you toss in an emergency room visit, pain, suffering, etc.

Like I say, my opinion is worth exactly what you paid for it.

Make sure you know what the RP's insurance limits are and what kind of deep pockets they have before you sign off.

Good Luck,

Michael
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post #4 of 33 (permalink) Old 01-16-2011, 11:03 PM Thread Starter
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My health insurance company has paid out $209,000. The woman that hit me had state minimum insurance of $12,500. My attorney took this case under contingency for 1/3rd of any settlement. He negotiated a settlement from her insurance for a total $100,000. I already agreed that he is entitled to his share so that isn't the issue.

My health insurance does not begrudge his share either as he did the work, but from their perspective I'm not. I've got permanent damage to my left leg and right hand and wrist, and $22,000. in cost they will not cover.

The woman that hit me doesn't have a pot to pi$$ in. So the only money that can be squeezed out of this is the $100,000. My attorney made them an offer of $30,000 for them, $30,000 for him, and $40,000 for me. $40,000 will cover my $22,000 in cost and lost wages, but that is it. There will be nothing for the future cost I'm going to accumulate and I just started physical therapy and those cost have to come out of my pocket until I meet my deductible and co-pay.

My health insurance came back and in so many words, answered NO. Their view seems that this will give them 30% of their cost back and leave me 30% of my cost. My attorney has a problem with this as, I as his client would make less than him.

My problem is that they were not busted up and laying in the road with two shattered arms and wrist as well as a broken leg just below the knee, spend five days in intensive care, three surgeries, nor did they spend months of pain from July through a good part of November. I know insurance companies have ways to write some of their cost off. How do I write off the above?

I've been off work for going on seven months and still do not have a return to work date. If I fall, my arms are not strong enough, nor my left leg to help me get up. For them, its just a money thing, for me it is life altering. What ever the outcome, it requires my signature for the settlement, and it's not worth signing as there isn't anything in this to address my needs.

Maloy

Bikes owned
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'74 Honda CL360

Past
'08 Versys (lost in head on collision 07-05-2010)
'86 Honda XL500 (wrecked RIP)
'08 KLR650
'00 Vulcan Classic Fi 1500cc
'06 Kymco 250cc scooter
'93 Honda VLX 600cc
'85 Honda XL500
'85 Honda Rebel 250cc
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post #5 of 33 (permalink) Old 01-17-2011, 03:35 AM
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This money thing is making me upset and sad again.
Please consider moving to Canada or some place with socialized medical care.

Best wishes to you Maloy and I hope you'll weather the storm.
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post #6 of 33 (permalink) Old 01-17-2011, 04:05 AM
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Well put Ivan, it's a sad situation.

Sorry I can only offer my moral support Maloy. All the best.
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post #7 of 33 (permalink) Old 01-17-2011, 12:44 PM
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Very sorry to hear of your condition. Makes me think twice about the riding thing again.

And while I can see how you're looking at the financial situation with the insurance company I don't think you'll get anywhere trying to negotiate a reduced payment for the medical expenses they've covered. You can certainly try though. Insurance companies are heartless - it's just business for them.

Wishing you the best possible in a bad situation.

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post #8 of 33 (permalink) Old 01-17-2011, 01:22 PM
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I have no great advice other than maybe your attorney could negotiate with you and atleast make sure you walk away without owing any more money. He would take a hit on his side but still be making a chunk of money.

This is a great example of a reason to bump up your uninsured/underinsurred coverage. I got rear ended in my car and maxed out the other drivers coverage just between my doctor and chiropractor.

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post #9 of 33 (permalink) Old 01-17-2011, 02:30 PM
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I carry $500,000 injury/property damage liability and $500,000 uninsured/underinsured motorist on the Versys at a cost of $119/yr. I don't carry comprehensive on it because it's cheaper for me to self-insure. I also have a $1million umbrella policy carried on my homeowner's policy for all of my vehicles.

It's not that expensive to get good coverage.

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post #10 of 33 (permalink) Old 01-17-2011, 02:59 PM
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Maloy, I was in almost an identical situation last August '09 (with seemingly the same injuries even). My health insurance company also covered me for while I was in the hospital before things were worked out, but did of course demand reimbursement once we got things settled. They were asking for >$90k reimbursement (which my state's law allowed), which would have left me with little to pay for Physical Therapy and pray to cover anything that might arise in the future. My attorney, not happy with this, essentially wrote them bringing up some loophole about how a federal ruling on health insurance reimbursements in said situations is apparently not required? Or something around those terms. What ended up happening is them dropping the requested reimbursement from >$90k to $30k then down to $19k. They didn't want to deal with a legal battle, so figured it would be easier (and cheaper) to reduce the amount they wanted. Talk to your lawyer about this, maybe?

PM me if you want. I don't mind calling my attorney up to see what he did exactly.

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post #11 of 33 (permalink) Old 01-18-2011, 09:04 AM
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I'm absolutely astound by the turn of event
Of course I think that you are getting the bed end of the stick

Since I'm not an american, I can't understand all of these subtilities

BUT

Can't you get a better attorney that will turn the world upside down to get restitution of all cost

From my point of view from accross the border, USA is the land of lawsuit and attorney
Is yours making all that he can ?

All this is a very sad story, hopefully it will ended up in your favor

Also, it's a lesson for me, ain't going over the border anymore untill I thouroughly check my insurance and the coverage I have

Hope thing's get better for you

Sincerely


LOP
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post #12 of 33 (permalink) Old 01-18-2011, 09:11 AM
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Quote:
Originally Posted by darkmini View Post
Maloy, I was in almost an identical situation last August '09 (with seemingly the same injuries even). My health insurance company also covered me for while I was in the hospital before things were worked out, but did of course demand reimbursement once we got things settled. They were asking for >$90k reimbursement (which my state's law allowed), which would have left me with little to pay for Physical Therapy and pray to cover anything that might arise in the future. My attorney, not happy with this, essentially wrote them bringing up some loophole about how a federal ruling on health insurance reimbursements in said situations is apparently not required? Or something around those terms. What ended up happening is them dropping the requested reimbursement from >$90k to $30k then down to $19k. They didn't want to deal with a legal battle, so figured it would be easier (and cheaper) to reduce the amount they wanted. Talk to your lawyer about this, maybe?

PM me if you want. I don't mind calling my attorney up to see what he did exactly.

This is why everyone needs to have uninsured/underinsured motorist insurance coverage. It's really inexpensive.

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post #13 of 33 (permalink) Old 01-18-2011, 09:29 AM
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Quote:
Originally Posted by Lours_Polaire View Post
I'm absolutely astound by the turn of event
Of course I think that you are getting the bed end of the stick

Since I'm not an american, I can't understand all of these subtilities

BUT

Can't you get a better attorney that will turn the world upside down to get restitution of all cost

From my point of view from accross the border, USA is the land of lawsuit and attorney
Is yours making all that he can ?

All this is a very sad story, hopefully it will ended up in your favor

Also, it's a lesson for me, ain't going over the border anymore untill I thouroughly check my insurance and the coverage I have

Hope thing's get better for you

Sincerely


LOP
When you purchase hazard insurance coverage there is a stated policy maximum claim limit. This goes both ways, for the insured party and the claiment party. If you are claiming on your own coverage you have your policy limits. The insurance underwriters are not liable for excess amounts over the policy limits. So if your claim is in excess of someone else's policy you can sue the insured personally and go after their assets. However, if they do not have any assets you can't get anything more from them. Hence the old adage, "You can't blood from a turnip." You can't get money from an individual that has no income or valuable assets. Many people buy coverage for this situation under 'uninsured' or 'underinsured'. Again, there is a set limit of coverage written into the policy.

Most people are underinsured as the minimum amounts for liability to meet the law is whoefully less than most claims. The coverage limits you purchase should also be dictated by your net worth and how much you have to lose. There are some good discussions over on ADVRider on this topic with comments from experts in the insurance industry.

In this unfortunate case the insured was underinsured and our claiments monetary claim exceeds those policy coverage limits. Getting a different attorney to represent may have zero effect.

The negotiation here is with the medical insurance company that has already paid for the expenses for the claiment and has sought recovery of those costs against the insureds policy. It is highly unlikely that they are going to accept less than that to which they are legally entitled.

If you are traveling out of your own country and are purchasing insurance coverage for a foreign country you do want to consider the policy limits. When you go to Mexico you have to have coverage issued by an insurance company licensed in that country, otherwise your coverage is not recognized by the Mexican government and you can be detained until monetary responsibility is established, which can be exceedingly difficult to do if you're locked up in a Mexican jail. And it can take time. Not most people's idea of fun.

Hope this helps.

Chris Brown
In SoCal
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post #14 of 33 (permalink) Old 01-18-2011, 03:16 PM
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I carry $500,000 uninsured/underinsured motorist insurance coverage. It costs $40/yr. I consider it money well spent.

10 Duc Streetfighter S (black)
09 Versys
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post #15 of 33 (permalink) Old 01-18-2011, 04:56 PM
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Thru geico full coverage with 100,00/300,000/100,000 liability and 100,000/300,000 Uninsured/underinsured is like 287.00 a year with comp collision and medical payments.i have a clean record and a M1 license for 18 years so it will very by person.My dad has always said there is always someone out there dumber and poorer than you that will **** you in ass sooner or later.
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post #16 of 33 (permalink) Old 01-18-2011, 05:08 PM
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Quote:
Originally Posted by CJBROWN View Post
When you purchase hazard insurance coverage there is a stated policy maximum claim limit. This goes both ways, for the insured party and the claiment party. If you are claiming on your own coverage you have your policy limits. The insurance underwriters are not liable for excess amounts over the policy limits. So if your claim is in excess of someone else's policy you can sue the insured personally and go after their assets. However, if they do not have any assets you can't get anything more from them. Hence the old adage, "You can't blood from a turnip." You can't get money from an individual that has no income or valuable assets. Many people buy coverage for this situation under 'uninsured' or 'underinsured'. Again, there is a set limit of coverage written into the policy.

Most people are underinsured as the minimum amounts for liability to meet the law is whoefully less than most claims. The coverage limits you purchase should also be dictated by your net worth and how much you have to lose. There are some good discussions over on ADVRider on this topic with comments from experts in the insurance industry.

In this unfortunate case the insured was underinsured and our claiments monetary claim exceeds those policy coverage limits. Getting a different attorney to represent may have zero effect.

The negotiation here is with the medical insurance company that has already paid for the expenses for the claiment and has sought recovery of those costs against the insureds policy. It is highly unlikely that they are going to accept less than that to which they are legally entitled.

If you are traveling out of your own country and are purchasing insurance coverage for a foreign country you do want to consider the policy limits. When you go to Mexico you have to have coverage issued by an insurance company licensed in that country, otherwise your coverage is not recognized by the Mexican government and you can be detained until monetary responsibility is established, which can be exceedingly difficult to do if you're locked up in a Mexican jail. And it can take time. Not most people's idea of fun.

Hope this helps.

got a link to the thread?
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post #17 of 33 (permalink) Old 01-18-2011, 11:02 PM
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I carry $500,000 uninsured/underinsured motorist insurance coverage. It costs $40/yr. I consider it money well spent.
Either the other parties insurance isn't enough, or, god forbid, you hit someone else. Even if it's an accident, you lose your house, your savings, probably your wife, and ...........on and on. Insurance is cheap.
You get what you pay for.
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post #18 of 33 (permalink) Old 01-19-2011, 08:30 AM
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Quote:
Originally Posted by CJBROWN View Post
When you purchase hazard insurance coverage there is a stated policy maximum claim limit. This goes both ways, for the insured party and the claiment party. If you are claiming on your own coverage you have your policy limits. The insurance underwriters are not liable for excess amounts over the policy limits. So if your claim is in excess of someone else's policy you can sue the insured personally and go after their assets. However, if they do not have any assets you can't get anything more from them. Hence the old adage, "You can't blood from a turnip." You can't get money from an individual that has no income or valuable assets. Many people buy coverage for this situation under 'uninsured' or 'underinsured'. Again, there is a set limit of coverage written into the policy.

Most people are underinsured as the minimum amounts for liability to meet the law is whoefully less than most claims. The coverage limits you purchase should also be dictated by your net worth and how much you have to lose. There are some good discussions over on ADVRider on this topic with comments from experts in the insurance industry.

In this unfortunate case the insured was underinsured and our claiments monetary claim exceeds those policy coverage limits. Getting a different attorney to represent may have zero effect.

The negotiation here is with the medical insurance company that has already paid for the expenses for the claiment and has sought recovery of those costs against the insureds policy. It is highly unlikely that they are going to accept less than that to which they are legally entitled.

If you are traveling out of your own country and are purchasing insurance coverage for a foreign country you do want to consider the policy limits. When you go to Mexico you have to have coverage issued by an insurance company licensed in that country, otherwise your coverage is not recognized by the Mexican government and you can be detained until monetary responsibility is established, which can be exceedingly difficult to do if you're locked up in a Mexican jail. And it can take time. Not most people's idea of fun.

Hope this helps.

Thank's for the in depth explanation CBrown


LOP
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post #19 of 33 (permalink) Old 01-19-2011, 10:26 AM
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i know that in Georgia you can go after uninsured motorist coverage on ANY POLICY under your roof in the event of a situation such as this. check and see if Ohio law allows for this.

this means that if i get downed and injured, i can seek the following:

-RP's insurance
-my own moto uninsured motorist coverage
-my cage uninsured motorist coverage (it's a separate policy)
-my wife's cage uninsured motorist coverage

that equates to about a million bucks in uninsured motorist coverage between the 3 policies we own.

note that this only works if the policies are separate. we split my wife's coverage from mine just in case something happens so we could go after all 3 uninsured motorist policies. sure we lost our multi car discount, but it was pennies compared what it could be if i'm banged up. this was done on the advice of my lawyer who is a rider and represents injured motorcyclists on the side.

YMMV depending on the state, but check into it.

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post #20 of 33 (permalink) Old 01-19-2011, 11:44 AM
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sucks & sucks

pretty much everybody I know has been crashed up on a bike or car at some point in their lives....and the lawyers & insurance companies all seem to be out for the same(and its not you).....its a ****ty situation(and as I type this there have been 2 commercials for ambulance chasers on the TV)......

I agree with the others....load up.
we have the most coverage money can buy on our policies, itsa small price to pay when you need it....on the ninja im at like $348year/progressive for the max on everything including gear & farks...if I payed for just the minimums its like 270...not a tough choice & never scimp on uninsured/underinsured in Colorado, all the cages run minimums..

good luck with it, a second attorneys look at this may help you/or not....and why do you have to settle now? I think in colorado we have a 2 year statue of limitations thing, meaning you can have time to see about your medical issues....I know that an accident I was in in '95 I didnot settle the medical stuff for over a year & then I still had plenty of treatment left through health ins
peace

Scott
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