What medical amounts should I use when preparing my Pain and Suffering settlement proposal in an auto accident case?

Question

For instance, one EOB shows Total Charges of $344 and Amount Allowed (and paid by) is $196.08. Can I expect the insurance company to consider my proposed settlement amount for Pain and Suffering to include $344 or just the discounted $196.08?

Steve McCann · Answer

You should refrain from speaking with the insurance company immediately, and consult with an attorney individually to assess your options.  You may be entitled to far more money than you think, and insurance companies often times attempt to take advantage of parties that are not represented by counsel.  Thus, organize all information you have in your possession that is relevant to this matter, including all medical records and bills, and consult with an attorney individually.  Many of us offer free consultations, and will represent you on a contingent basis, so it will not cost you anything to obtain the opinion and representation of an experienced professional.

Charles Candiano · Answer

All demands in Illinois are based on the amount charged by the provider, NOT what your insurance paid.  By responding, without counsel, you are shooting yourself in the foot and guaranteeing a lower settlement.  Moreover, if you health insurance actually paid $196.08, you OWE them that amount if you settle on your own.  If you hire counsel, you would get more money and you would only owe them $130.72.  Representing yourself is a lose-lose proposition.

Q: What medical amounts should I use when preparing my Pain and Suffering settlement proposal in an auto accident case?