(no subject)

[rivka]

I wanted to write something glowy and happy about the Washington Spring Ball, and I even started an entry. But the fact of the matter is that, while I was incredibly glowy and happy at the ball, and had a marvelous time, and felt truly beautiful in a way that rarely happens, before and after the ball I felt pretty tired and sickly, and thus not terribly given to jubilant posting.

I've been coughing, a weird sort of wheezing can't-catch-my-breath nonproductive cough, and for the past couple of days I've had headaches and pain in my jaw. I don't know where the cough came from, but I bet the jaw pain is from clenching or grinding my teeth due to being stressed out and in pain and not sleeping well. Grr. I have often suspected that TMJ syndrome lies somewhere in my not-too-distant future. My mother and grandmother both had jaw problems, including - on my mother's part - a tendency to dislocate her jaw when yawning, leaving it stuck wide open. (Now there's an image that has always haunted me while performing certain sexual acts. Not so much the prospect of dislocation, but the inevitable subsequent awkwardness at the emergency room.)

Jeez, I can really sound like a hypochondriac in my journal sometimes.

Anyway:

curiousangel and I have been soliciting advice from all quarters, on the matter of settling our claim with the insurance company of the guy who hit us. They want to have a meeting with us to work out a reasonable figure to cover our expenses plus "pain and suffering." That's a phrase I associate with the kind of mindset that equates an accident with winning the lottery, but on the other hand I can't deny that the accident has had painful sequelae. But on the third hand, we didn't really know how to go about setting a dollar value on our troubles, after we'd thought of the obvious things like our emergency room bill, our pain medicine prescriptions, and a day's worth of lost wages. (Obviously, the company will also be picking up the body shop bill and the rental car we'll be using until our car is repaired.)

So, the advice we've been getting: My father pointed out that, by virtue of having been in an accident, our car has lost resale value. He thought we should try to recoup the amount of that loss from the insurance company. wcg knew how to figure out the amount of loss in resale value using an online bluebook. More importantly, he warned us that the car may have sustained damage beyond what is already broken (i.e., things that were stressed and are about to break), and advised us to refuse to sign off on the car repairs until we've had a chance to drive it a couple hundred miles. Most importantly, he asked me if my EAP (Employee Assistance Program) at work covered legal assistance. Mine doesn't, but I remembered that Misha's does.

Amazingly, Misha's EAP put him on the phone for a free consultation with a Maryland lawyer within about fifteen minutes of his call. The lawyer told us we can't do much about the lost resale value. However, he also said that Maryland law allows us to bill both our own insurance company and the at-fault insurance company for our medical expenses and lost wages. (I want to double-check that information elsewhere, because it sure sounds weird.) He also told us that, conventionally, pain and suffering compensation is set at an amount equal to the medical bills. (I'm much more comfortable knowing that there's a sensible metric for the amount, because I wouldn't have had the slightest idea of where to start deciding how much my neck and back pain have been "worth.") And finally, he was able to clarify for us various points regarding how long we can leave claims open and how to handle problems that may show up after the fact.

Honestly, it would have never occurred to me that we could benefit from talking to a lawyer. Again, I guess I was thinking of those horrible sleazy late-night TV ads for personal injury lawyers. This guy from the EAP was quite reasonable and helpful. Yay, Misha's company, for offering such a useful employee benefit.

Comments

[jenett]

Rivka -

I have mild TMJ stuff (well, relatively mild. My jaw pops not quite at the same time on each side any time I open it more than a certain amount. And yeah, it does make me nervous about certain sex stuff.)

My chiropractor tried both acupuncture and some smalll electrostim pads on me, both of which helped to get rid of a lot of the residual soreness and inflamation there. He thinks that part of it is tied in to the fact I tend to keep a lot of tension in my neck.

He also said that he works with one of the specialists on TMJ in the area (who has, apparently a great national reputation) and that there have generally been a number of strides forward in treating TMJ in the last few years. I haven't gone into specifics with him, because mine just hasn't been that bad, but I hope that might be somewhat reassuring. x

TMJ

[anisoptera.livejournal.com]

Rivka and Gwynyth;

A massage therapist training in Neuromuscular Therapy (NMT) can help with TMJ. I have have good results with my clients using NMT, including my own physican.

I can help you find NMT trained therapists in your area. The work may involve inter-oral work, but the therapist will wear rubber gloves. This work can be quite uncomfortable to recieve so make sure you let the therapist know when the discomfort goes above 6-8 on a 1-10 pain scale, 10 being the worse.

NMT can help and beats the hell out wearing a bruxing guard at night.

[jodawi.livejournal.com]

My jaw has been hurting for a few weeks. Everytime someone else has what i have, i suddenly think that there's a massive mostly-invisible biowarfare thing raging back and forth with weirdons and antiweirdons not quite cancelling out and leaving us slightly out of whack rather than puddles of purple goo.

But luckily the online test assures me that i'm not very paranoid, so i can't think the above, so it's not true.

[sashajwolf.livejournal.com]

However, he also said that Maryland law allows us to bill both our own insurance company and the at-fault insurance company for our medical expenses and lost wages. (I want to double-check that information elsewhere, because it sure sounds weird.)

What about it sounds weird to you?

I'm assuming what he means is that you can submit a bill to both and then the two companies will sort out between themselves which of them pays what proportion, not that you can get back twice the money. Insurance companies usually have agreements that cover this kind of thing - in this country, we call them "knock for knock" agreements, and the end result is usually that each insurance company pays approximately 50%.

Re:

[rivka.livejournal.com]

I'm assuming what he means is that you can submit a bill to both and then the two companies will sort out between themselves which of them pays what proportion, not that you can get back twice the money.

No, he said specifically that Maryland law permitted duplicate billing and payment for medical bills and lost wages, so that we could get back twice the money. Unless Misha completely failed to understand him, which seems unlikely. This is what seems so weird to me, and why we're going to get a second opinion from another lawyer. (I tried to figure it out myself by looking at the Maryland Code, but it was impossible to understand.)

Insurance companies usually have agreements that cover this kind of thing - in this country, we call them "knock for knock" agreements, and the end result is usually that each insurance company pays approximately 50%.

This wouldn't strike me as weird at all. It's the double billing that sounds suspicious.

[sashajwolf.livejournal.com]

*googles*

Huh. Looks like it's right.

From the opinion of the Court of Appeals of Maryland in the case of Dutta v. State Farm Insurance Company, No. 85, September term, 2000:-

Does the PIP coverage at issue require State Farm to pay for petitioner’s medical treatment, even though petitioner’s health care provider and/or a third party, tortfeasor, actually paid the medical bills?

We answer the question in the affirmative.

The full opinion is available as a Word document at http://www.claimrep.com/states/RP1MD.asp . The situation does look quite complicated, though, so getting confirmation from another lawyer does seem sensible. The part I'm not clear on from the opinion is whether the settlement with the tortfeasor (probably in reality his insurers) covered 100% of the loss, or whether Datta would have been left genuinely out of pocket but for the Court of Appeals decision.

[rivka.livejournal.com]

Huh. Yeah, that seems pretty clear. I wonder why this case didn't come up in my Google search last night - although it's also clearly possible that it did, and I didn't understand it. I got pretty bogged down in all the legal terminology.

Thanks a lot, Liz. I realize that it would probably still be good for us to check it out with another Maryland-licensed lawyer, but I feel much more comfortable now.

[curiousangel.livejournal.com]

Based on my further conversation with the State Farm adjuster handling our case, I can clarify a bit here.

PIP coverage will actually pay the medical bills. That's the coverage that comes with our auto insurance. When the other guy's insurance company gets off their butt and offers us a "please-
God-don't-sue-us" settlement, they'll ask us to send them copies of all our medical bills, whereupon they will offer us a settlement. Typically, when there's no extensive prolonged injury to anyone, the total settlement comes to two to four times the amount of the medical bills, plus lost wages. This isn't hard and fast; it's just a rule of thumb. They're also going to be looking to limit whatever they're liable for, but we have up to three years to get any injuries taken care of.

For fairly small bills, the insurers are looking to get it cleared up, and they aren't going to make a big fuss over a few hundred dollars one way or the other. The adjuster indicated that it mostly comes out in the wash, so to speak, so they don't expend a lot of energy on claims less than a thousand dollars or so. If State Farm picks up this one, the other company will probably get another one somewhere down the line.

Let me echo Rivka's thanks for providing a more skilled look at this, as it didn't seem to completely add up to me, either. It's reassuring to have some confirmation that we weren't totally barking up the wrong tree.

Addendum

[rivka.livejournal.com]

The rep from the responsible insurance company just told us outright: "Maryland law allows what's called 'double dipping.' That means you submit your bills to your own insurance company under your Personal Injury Protection, and then you submit them to us and we pay you too."

Huh. Yay for Maryland law, I guess.

Re: Addendum

[johnpalmer.livejournal.com]

Actually, the allowing for "double dipping" isn't too crazy, if you think about it right.

You pre-paid your medical bills by paying insurance premiums.

Someone caused you an injury, rendering them liable for your medical bills.

The fact that you've pre-paid those medical bills does not relieve that other person of his or her responsibility.

Of course, it's hard to decide what insurance really *IS*, and so the regulations change from state to state. Some states may decide that you weren't pre-paying medical bills, you were just paying to make sure that you had no out-of-pocket costs if injured.