If you have health insurance, you will rely on that coverage for medical treatment after an accident with an Uninsured or Underinsured Motorist.
In Louisiana, healthcare professionals collect auto insurance information in addition to health insurance information when providing services to treat injuries sustained in a motor vehicle accident. This is done to allow a lien to be filed against MedPay. MedPay does not have contractually reduced rates like private health insurance companies. These private companies have contracted with providers to be billed at lower than what their actual billing codes would dictate.
In many situations, ER billing will not bill private health carriers. Instead, they will wait to determine the third-party at-fault driver’s insurance company.
In Louisiana, a Statutory Lien can be perfected against a claim by sending the appropriate notice to the insurance carrier and/or by submitting the same type of notice to a plaintiff’s lawyer.
This process creates a Statutory Lien. Why would ER billing departments do this? It provides them with the opportunity to be paid for their services in the total amount instead of the discounted carrier rate.
The Balance Billing Act requires health care professionals to bill the remaining balance of medical expenses to the private health insurance company of the claimant (plaintiff) in these cases. Unfortunately, they often avoid doing this to ensure that they are paid the higher non-contract rate that they may receive from the third party at-fault’s insurance company. However, a simple letter sent by an attorney instructing them to bill the claimant’s insurance under the Balance Billing Act will ensure that the claimant is not left with outstanding payments.
If the injured party does not have health insurance, the liens filed against MedPay will have to be honored. These liens would be paid out of a settlement. Unfortunately, there is often not enough money in a policy to cover the total medical bills; therefore, it becomes the attorney’s responsibility to be creative in finding additional coverage.
For example, if an injured party was working at the time of the accident, their attorney may file suit against the employer, in addition to the at-fault driver.
So, while private health insurance is often the only way to get medical expenses fully paid for, there are other ways to find extra coverage for damages.
Do I File A Claim With My Own Insurance If I’m Hit And Injured By An Uninsured Or Underinsured Driver In Louisiana?
It is always important to file a claim with your own insurance company when injured in a car accident caused by an Uninsured or Underinsured motorist. Motorists in Louisiana with minimum policies will only have $15,000 available in coverage. This amount is rarely enough to cover medical expenses, so it is essential to notify your insurance carrier as early as possible that you will require Uninsured/Underinsured motorist coverage.
For “regular” and Underinsured motorist accident cases, the Statute of Limitations (time you have to file suit before losing that right) is one year. However, in accident cases where the at-fault party is an Uninsured motorist, the Statute of Limitations is two years.
Typically, a suit is filed against an Uninsured/Underinsured motorist at the same time as a claim is made against your insurance company. This is done because it’s not often apparent how much coverage will be needed or whether the Uninsured/Underinsured motorist’s coverage will be sufficient.
Under Louisiana state law, your insurance company is obligated to adjust your medical claims in a fair and timely manner. Third requires your insurance carrier to access your medical bills, records, and other evidence of injury in a timely fashion and tender (pay) the undisputed amount punctually.
While there’s no “scientific method” to summarize what the indisputable portion of these medical expenses is, insurance companies have an obligation in Louisiana to what is called McDill.
McDill is the name of a Louisiana Supreme Court Case that provided new rules for insurance companies handling UM policies. Through the law, insurance providers must make a “McDill tender”, which means they must pay a portion (if not all) of the UM policy that is clearly owed based on the evidence submitted to support the injury claim. This evidence may include proof of lost earnings, photographs of injuries, medical bills and records, etc.
After assessing the evidence and finding that the costs will involve an amount in damages above and beyond the underlying policy, the insurance policy will assume their obligation to determine their responsibility to their insured and pay those damages unconditionally. These unconditional tenders must be paid because they are legally owed, and insurance companies cannot seek reimbursement for those payments.
When a McDill tender is made under your UM policy by your insurance company, the “clock” of statutory limitations restarts, and you have another two years to file suit. This happens each time a McDill tender is made and the “restart” is a result of the fact that each McDill tender is an acknowledgment that an obligation is owed. The McDill tender partially satisfies that obligation and further coverage can be found by arguing that there is still more coverage they are obligated to pay.
A person typically has more rights when making claims against their insurance carrier than a third-party insurance company. Suppose your insurance company has not made a tender in a timely, reasonable, and fairly-adjusted manner. In that case, you can seek penalties and attorney’s fees against your insurance carrier for arbitrary failure to pay the unconditional amount. This would expose an insurance carrier to payment amounts that exceed the initial policy’s limits.
For example, if you have a $100,000 Uninsured Motorist policy, but your insurance carrier fails to act according to their obligations under the contract (which is to fairly and timely adjust the claim and make an unconditional tender). You may be able to prove that the carrier failed to act and that their failure was arbitrary, capricious, and unreasonable. In this case, a court may award damages far beyond the initial $100,000 UM policy.
For more information on Auto Accident Cases In Louisiana, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (337) 289-0626 today.
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