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Why Insurance Companies refuse to pay your medical bills

Posted On September 24, 2013 In Personal Injury,Recent News,Truck Accidents

Probably the biggest reason most people decide to call a lawyer after being in an accident is the fact that the insurance company for the driver that caused the accident ALWAYS refuses to pay any medical bills or lost wages unless you are willing to settle the entire claim.

Obviously, this puts the injured person in an impossible situation. How can you possibly settle your claim when you don’t even know how bad you’re hurt, how long you will be off work, if you will need surgery, or how much it will cost? One of the most common questions we get from people who start off trying to handle a claim on their own is “Why does the insurance company refuse to pay my medical bills?” Especially when they know it was their driver’s fault. The answer is sad ….. but simple.

The insurance company knows that if you can not afford to go to the doctor, you will not be able to prove you were hurt in the accident and they will not have to pay you anything. Likewise, if they help you and your family by paying your lost wages while your off work, you are much more likely to be able to afford medical treatment. Again, the insurance company knows that if you have medical treatment, you can prove you are hurt, which means they will have to pay more money. They know that if you can not afford medical treatment … or the light bill, then you will accept pennies on the dollar for your claim out of desperation.

An experienced lawyer can almost always predict what an insurance company will do. Its really simple actually. The insurance company will always do whatever saves them the most money. Unfortunately, with the insurance company, fairness is seldom the deciding factor.

So now that you know the bad news … what do you do about it if you have been hurt in an accident that was someone else’s fault? First, understand that the other drivers’ insurance company is not your friend. The adjuster’s goal is to 1) try and avoid paying anything, and 2) if they have to pay … to pay as little as possible, and 3) delay, delay, delay. Remember, the big insurance companies collect premiums in the billions and cover losses in the hundreds of millions (if not billions). The interest on that kind of money is phenomenal. Every day they can make you wait is more money for them.

So, if you are hurt, do not wait on the other side’s insurance company. Go to the doctor as soon as possible. KEEP GOING TO THE DOCTOR for as long as you still have problems. Each time you go back to the doctor, tell him or her exactly what symptoms you are having.  My advice to all of my clients about the best question to ask your doctor is this: “What next?” In other words, if you are still in pain, or still having problems, still can’t get back to work after a couple of weeks, you need to be telling the doctor: “This isn’t getting any better” and “What is our next step in treatment?”.  “What are my options, or tests to determine what is wrong?” and, “Is there a specialist that I need to see for this condition?”

STRONG WARNING HERE ….. Referrals to specialists are critical if you are suffering from an ongoing injury. However, if you are to this point on your own and have still not consulted an attorney, seriously consider calling someone now. The reason I say this is related to what I mentioned above, insurance companies look to medical documentation to establish whether you are hurt or not (really more of whether you can prove you are hurt or not).  Here’s the problem, there are many qualified specialist out there.  Doctors normally work on what’s called a reciprocal referral basis. In other words, Dr. Smith refers all his hurt back patients to the Dr. that sends him OBGyn patients.

Here’s the problem with that arrangement. Defense attorneys and insurance companies have ‘hired gun’ specialists in every area that they use as ‘expert witnesses’ in their big cases.  In every town of 40,000 people or larger, there will be at least one or two neurologists, and orthopedic surgeons that are c0mmonly used by defense lawyers and insurance companies to ‘review medical records’ and say the patient is not really hurt, or more commonly, not hurt when their drunk driver ran the red light and broad sided your car.

The last thing you need when you have been in an accident, is to have your well-meaning family doctor refer you to the insurance companies hired gun!! Unfortunately, unless you are a trial lawyer who knows the doctors in your area, you have no way of knowing who to avoid. If you have been seriously injured and are at the stage where it is time to start seeing specialists, I would strongly urge you to talk to an experienced attorney that is familiar with the doctors you need to avoid.

For answers on how an attorney can help you get medical treatment if you don’t have health insurance, see my post titled “How your attorney can help you get medical treatment.”

Our firm represents injured people all over the state of Texas and partners with top law firms across the country. If you are located outside the state of Texas and need a referral to a top P.I. law firm in your area, we can gladly help you find someone close to you.

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