​Why Is the At-Fault Insurance Not Paying My Medical Bills?

​Why Is the At-Fault Insurance Not Paying My Medical Bills?
​Why Is the At-Fault Insurance Not Paying My Medical Bills?

Most people understand that if they are injured in an accident caused by someone else’s negligence, they can seek compensation by filing a claim against the at-fault party’s insurance company. However, receiving that compensation is seldom as simple as submitting a claim and receiving a check.

Insurance companies are in the business of making money, which generally doesn’t align with making large payouts on claims resulting from their insured’s negligence. Here is a look at why an at-fault party’s insurance provider hasn’t paid your medical bills.

Reasons for Delayed Payments from the Insurance Company

As noted, insurance companies aren’t in the business to payout claims; they’re in the business to collect premiums off insurance policies. However, they often refuse to payout on claims, delay responding to the claimant, or even employ other questionable tactics to reduce the claim’s value, such as getting the claimant to accept a lowball settlement offer under the threat that if they don’t, they receive nothing.

Insurers may convince the claimant to authorize the release of their entire medical history, which can then be searched for pre-existing conditions to blame for the claimant’s current injury.

In some circumstances, the insurance company’s delayed response or denial of the claim constitutes bad faith insurance practices, which can entitle the claimant to the right to compensation for their personal injury and the insurance company’s bad faith.

Many states have bad faith insurance laws, including Wisconsin, which states that any claim the insurer doesn’t respond to within 30 days is considered overdue. Minnesota’s laws state that if an insurer denies a claim without a reasonable basis, the claimant can seek compensation of up to $250,000 plus attorney’s fees in addition to the award for their injury.

An insurer generally assigns a claims adjuster to third-party insurance claims. The claims adjuster is an insurance company employee hired to evaluate claims and determine how much compensation the insurer owes the claimant. The claims adjuster should quickly conduct interviews of all parties involved in the accident, analyze the details of the claim, including the expenses incurred, decide on compensation owed as a result of their insured’s liability, and issue payment to the claimant for the damage.


​Why Is the At-Fault Insurance Not Paying My Medical Bills?

Unfortunately, several issues can prevent these steps from unfolding as they were designed, such as:

Questions of Liability

To prove that your injury was the result of someone else’s negligence, you must be able to show these elements in the claim:

  • The at-fault party had a duty to take reasonable actions to avoid causing physical harm or property damage to others. For example, if a negligent driver caused your injuries, you must show that the at-fault party was not driving a vehicle safely or legally on a public roadway. Drivers on public roadways must operate their vehicles safely and legally.
  • The at-fault party breached this duty by taking unsafe or illegal actions.
  • These unsafe or illegal actions caused an accident that injured you.

Again, while proving these elements seems like a simple task, accidents often do not feature one source of liability and one injured party. Often there is negligence by multiple parties, and multiple parties injured.

Doubts About the Seriousness of Your Injuries

Insurance claims adjusters won’t just take your word for it that you have been injured and are receiving medical treatment. They will want to know what type of injury you sustained, your treatment, and whether doctors believe your injury is permanent. In cases where the claimant had pre-existing conditions to the same body part that sustained the injury in the accident, the insurance provider is not responsible for compensating you for the pre-existing condition but is responsible for any worsening or aggravation caused by the insured’s negligence.

Your Case Has a High Value

As mentioned, insurance claims adjusters attempt to avoid high payouts on claims. However, one thing they tend to dislike even more than paying out a high claim is having to appear in court for a lawsuit. Litigation is expensive and time-consuming, and the outcome is uncertain. When a claim has a high value and the claimant can prove liability, the claims adjuster will try to settle for far less than its value.

Settlement agreements require a claimant to release the at-fault party and insurer from future claims involving the same accident. In other words, if you accept a low settlement and later find out it isn’t enough to compensate your expenses, you cannot demand more money.

When You Should Find an Attorney to Help With Your Claim

Claims that languish for months with no response. Claimants repeatedly questioned by a claims adjuster without any sign of payment of the claim. Claimants pressured to accept a settlement without knowing if it will fully compensate the injury.

These issues are often experienced by those simply trying to obtain the compensation they’re entitled to after being injured due to someone else’s carelessness or recklessness. Because of this, one of the most important steps after being injured in an accident that is someone else’s fault is to hire an experienced personal injury lawyer to help you with your claim.

How an Attorney Can Help

An experienced personal injury lawyer can bring to your claim both knowledge of the process and an understanding of the type of compensation needed. Here is a look at some of the services they can provide to help you recover from medical bills and other expenses and psychological impacts you incurred due to your injury.

Determining Liability and Insurance

Because accidents often have more than one source of liability, your attorney and their legal team will conduct a thorough investigation to determine what happened and everyone who was at fault. Once the attorney determines the liable parties, they will also work to determine the liability insurance resources available through those parties to compensate your claim.

Properly Valuing Your Claim

In establishing the value of a personal injury claim, the timing of when the value is established is an important detail. Usually, a personal injury lawyer will wait until the claimant has reached maximum medical improvement before valuing the claim.

Maximum medical improvement is the point in your recovery when your injury has stabilized, and no additional treatment will improve your condition. This point is a good time to determine your claim’s worth because you don’t expect to incur any additional medical expenses. Additionally, your physician will have a better idea of the permanence of your injuries and how they will impact your ability to earn an income and conduct normal activities.

Managing Communication with the Claims Adjuster

As previously noted, claims adjusters are in the business to protect their employer’s bottom line, not to ensure you have the compensation you need. Having an attorney handle communications with the claims adjuster helps protect the value of your claim from common insurance company tactics and keeps the conversation focused on negotiating a fair settlement.

Filing a Personal Injury Lawsuit

Claims adjusters can choose to either accept a claim, deny a claim with reason, or make an offer to settle. If the insurance company fails to pay the claim, however, you have recourse via a personal injury lawsuit filed in civil court. This legal claim asks a judge or jury to determine whether the at-fault party was liable for your injury and how much compensation you’re owed. The court then orders the insurance company to pay that compensation to you.

The most important aspect of a lawsuit is that this action has a time limit to file, known as the statute of limitations. In Wisconsin, the statute of limitations is generally three years from the accident’s date. Minnesota claimants generally have six years after an accident in which to file a lawsuit.

Failing to file a personal injury lawsuit within the statute of limitations will generally result in losing your ability to use the court process when seeking compensation for your injury. Without the court process available to you, most insurance providers will fail to settle your claim because there are no legal ramifications if they don’t.

Negotiating a Settlement

Your attorney often bridges the gap between your claim’s value and how much the claims adjuster offers. They will usually make as low an offer as possible, and your attorney will use their negotiation skills to convince the claims adjuster to increase the offer. A settlement offer can be made at any time, including after your attorney files a personal injury lawsuit or litigation has begun, as long as a judge or jury has not ruled.

Assisting You In Collecting Your Compensation

When your personal injury claim resolves through a negotiated settlement or court award, the insurer will send your compensation directly to your attorney. They will deduct their service fee at that time and work to satisfy any medical liens placed on the award by health care providers or group health insurers. Medical liens are a legal claim to a portion of the proceeds of a settlement or award to satisfy debts incurred during the treatment of your injury.

Yes, You Can Afford an Attorney

Russell Nicolet - Managing Attorney at Nicolet Law
Russell Nicolet, Personal Injury Attorney

While personal injury attorneys provide services like those listed above to help their clients obtain compensation for the expenses and impacts of an injury caused by someone else’s negligence, what happens if you can’t afford an attorney?

In truth, because of how personal injury lawyers bill for their services, anyone who needs help can afford it. Personal injury attorneys usually use a contingent fee billing method that allows you to only pay for services after they successfully resolve your claim.

Here’s how it works:

  • When you decide to hire an attorney to assist with your claim, they will ask you to enter a contingent fee agreement with them. This legal document outlines the services they will provide and designates a percentage of the award you receive as payment to the attorney and their legal team.
  • Work begins immediately on your claim without any need to wait for you to come up with an upfront retainer, and work continues throughout the process without you having to worry about staying current on hourly billing.
  • After your claim, your attorney will receive your payment, deduct the percentage designated for their payment, satisfy medical liens, and provide you with an accounting of these actions before turning over the remainder to you.

If an accident caused by someone else’s negligence injured you, let an experienced personal injury attorney help you understand your rights and the claims process. Contact a personal injury lawyer for your free case evaluation and take the first step toward recovery.