Gardena, CA asked in Personal Injury for California

Q: Adjuster want to pay separately for my compensation $2000 and medicals up to reasonable amount directly to provider.

Adjuster said they can’t give the entire settlement to me instead they need to issue payment separately such as compensation $2000 to me and reasonable medical bills related to auto accident up to $10,000 to doctors. I told them I am the responsible person to pay back and want to entire settlement issue to me but would not give me a reason why they won’t do it. Is there a law that settlement needs to be issued to way?

Update: I was a passenger in hit and run accident. There is no lien but just a payment agreement with providers. Also, just worried that since the settlement terms says, “up to reasonable medicals related to accident,” I am worried that I will be left with medical bills that they find that is not “reasonable”.

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5 Lawyer Answers
William John Light
William John Light
Answered
  • Santa Ana, CA
  • Licensed in California

A: If the medical provider has a lien for their services, the defendant/insurer just can't give you the money and hope that you pay the bills. The defendant/insurer would still be liable to the medical provider even though it paid you. See Civil Code 3045.1, for starters.

Edward A. Smith
Edward A. Smith pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
Answered
  • Sacramento, CA
  • Licensed in California

A: The adjuster is trying to bully you. There is no law requiring an insurance carrier to pay medical providers separately from you, the person injured. Insist that he pay you directly. If he refuses you can file suit yourself against the insured or hire an attorney to do so.

James L. Arrasmith
PREMIUM
James L. Arrasmith pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
Answered
  • Sacramento, CA
  • Licensed in California

A: Insurance adjusters often separate compensation and medical payments in settlement agreements. While the specific reasons may vary, it is a common practice. If you have concerns or questions about the payment structure or the terms of the settlement, it's important to seek clarification from the adjuster. Consider consulting with a personal injury attorney who can provide guidance and negotiate on your behalf if needed. Remember that this information is not legal advice, and consulting with an attorney is recommended for specific legal guidance

Patrick William Steinfeld
Patrick William Steinfeld
Answered
  • Coronado, CA
  • Licensed in California

A: The insurance company wants to deal with the medical providers bc the insurer will negotiate a lower bill and save some money. So if your bills are $10,000, the insurance company will offer substantially less to settle the debt and pocket the rest. You want to control the money so you can do the same thing. Attorneys generally recover the gross settlement on the condition that they will satisfy lien holders and indemnify the insurance company.

Tim Akpinar
Tim Akpinar
Answered
  • Little Neck, NY

A: It sounds like the adjuster may have concerns about being left on the hook for obligations to medical providers, despite the point you make about there being no liens. If that's in the carrier's standard operating procedures, it's possible their discretion could be limited. Your concern about "reasonable" is valid - as liens and outstanding medicals are sometimes negotiated at the conclusion of a case. Good luck

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