Open Medical Is A Bad Deal For Injury Victims

For car accidents where their drivers are at fault, insurance adjusters are trained to do everything possible to try and settle with claimants before they speak with an attorney. Statistics show that on claims with an attorney insurance companies will pay out a great deal more money per claim. So the insurance companies want to entice claimants to settle directly with them before they ever speak to an attorney and learn about their rights under the law. For unrepresented  laimants, adjusters used to offer “cash-outs” of between $250-$1,000 depending on the company and whether or not a claimant had already seen a doctor. If a claimant is either not injured but just inconvenienced by an accident or only went to the doctor once for a quick check-up, the cash-out method may be a fair solution. The problem is that the cash out method was not working for adjusters on claims where the injured party had already gone to the ER after the accident. A trip to the ER normally includes four bills–ambulance, hospital, ER doctor, and radiology. An ambulance ride alone normally costs $1,000. If an adjuster were to offer a cash-out of $1,000 to a claimant who went to the ER, not only would the claimant reject this amount, but also she would immediately hire an attorney. Since the goal of all insurance companies is to keep claimants from retaining an attorney, a new strategy was needed for accidents where a claimant had already received medical treatment. The insurance companies’ solution to this dilemma: Open Medical.

Open Medical is where the insurance adjuster will offer (1) a minimal amount for pain and suffering, between $500-$1,000 and (2) to pay reasonable and necessary medical bills of several thousand dollars, with time limitations set on treatment time and when bills must be submitted to the adjuster. On paper, the amount being offered by the adjuster could appear to be $10,000 under Open Medical. The reality though is that under Open Medical, the insurance company is only really paying $500-$1,000 to the claimant. The Open Medical tactic is for lack of a better term, a scam. So, if you’ve found yourself wondering, “do I have a personal injury case,” or “should I settle my lawsuit?” This article is for you.

Open Medical is bad for injury claimants for the following reasons:


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1. It allows the insurance company to settle for less than the medical bills. Typically, it takes a month for ER bills to be processed and sent out for payment. Meanwhile the insurance company is trying to settle directly with the claimants before they receive a bill, often just estimating as to the amount of the bills. Depending on the hospital and the trauma unit level involved, ER bills can range between $2,000-$30,000. So that offer from the insurance company to pay $10,000 in medical bills may sound great, unless your ER bill is $15,000. Once a claimant has settled with the insurance company for a set amount, the case is over, and it does not matter if the bills end up being more than the insurance company has agreed to pay.

2. It allows the insurance company to limit pain and suffering compensation to a minimal amount. With Open Medical, the insurance company pays a set amount for pain and suffering up front plus it agrees to pay medical bills incurred over a certain time period, such as six months. However, if a claimant keeps treating for these six months, under Open Medical the claimant has waived her right to receive any pain and suffering for this six month period.  he $500-$1,000 the insurance company paid up-front is all that the claimant will receive for pain and suffering.

3. The insurance company determines on its own what is reasonable and necessary medical treatment. If the insurance company does not believe that a bill incurred was for reasonable and necessary treatment, then the bill will go unpaid and the claimant will be responsible for payment of the bill from her own pocket. The claimant could always sue the insurance company for not paying the bill, but such a lawsuit will cost the claimant attorneys’ fees and
costs. There is no bad faith if the insurance company refuses to pay a bill and as such, any lawsuit would just be about payment of the bill, no additional damages to the claimant. So even though on paper the insurance company agrees to pay for $10,000 in treatment, it does not have to pay for any treatment if it deems such treatment unreasonable/unnecessary. Given that insurance companies have a financial incentive to pay as little money as possible on claims, it is understandable that adjusters are not going to want to pay full price on a bill. Unfortunately for claimants, whatever the insurance company is not going to pay will come out of their pockets in order to avoid bills going to collections.

Simply stated, Open Medical is a tactic used by insurance companies to settle claims for pennies on the dollar. Open Medical allows insurance companies to limit pain and suffering compensation to less than two weeks and avoid paying any bills it is not willing to accept as reasonable and necessary. To avoid the pitfalls of Open Medical, it is best to contact a Las Vegas personal injury attorney before entering into any negotiations with the insurance company for an injury claim.

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By |October 1st, 2018|Uncategorized|0 Comments

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