YOUR MOTOR VEHICLE CLAIM
It is important in your motor vehicle accident claim that you seek immediate medical treatment. Your first treatment is usually at a hospital, with follow up to a family doctor. That doctor is often called a primary care physician, or PCP. He or she may refer you to a specialist, such as an orthopedic doctor for neck and back injuries. You may be referred to a physiatrist for soft tissue injures, who will probably send you to a physical therapist for treatment. Some clients go to chiropractors, who use regular physical therapy along with manipulation to correct misalignment in the spine. Chiropractors believe that most back and neck injuries are caused by your discs being out of alignment, and the adjustments are meant to correct that problem. Although many orthopedics do not believe in chiropractic care, many patients do get symptomatic relief from it.
Your own insurance coverage usually pays for your medical care under PIP, or Personal Injury Protection. If you have health insurance, PIP pays for the first $2,000 and your own health insurance pays anything in excess of that amount. A PIP form must be completed. Be careful with your medical treatment under your HMO, if you go outside your insurance, and do not get a referral from your primary doctor. The PIP carrier can refuse to pay for expenses above $2,000 that are not paid for by your insurance. This is often called the Dominguez rule. Wage loss forms should be sent in to get you paid for time out of work. PIP usually pays 75% of your average weekly wage for lost wages for time out of work. You cannot get PIP if you were on a motorcycle, entitled to Workers' Compensation, under the influence of drugs or alcohol, or committed a felony at the time of accident.
With any motor vehicle claim you must have $2,000 in medical costs or a broken bone to get paid for what is called "pain and suffering." Please note that no pain and suffering is awarded for Workers' Compensation. In a motor vehicle accident claim you must prove that you are not at fault, or if you are partially responsible, that the other party is more at fault than you are. You are then paid based upon that percentage of fault attributed to the other party. Damages relating to pain and suffering tend to be subjective. It is important that you keep a record of your day-to-day activities, your medical appointments, and the pain you feel on a day-to-day basis. In evaluating damages, the severity of your injury, the amount of lost wages, and disfigurement or loss of function is all considered. After you finished medical treatment a demand is often made for settlement with the insurance company. A package of medical records and reports, bills, pictures, statements of lost wages, and other records are submitted. If a case is settled, liens may have to be negotiated with your private health carrier, who pays for medical treatment after you have "exhausted" your PIP coverage of $2,000, or if this was a work related accident your Workers' Compensation carrier. Special rules apply to Workers' Compensation liens. The insurer is generally allowed to get reimbursed or paid 2/3 of their total payout in weekly benefit and medical expenses. A Section 15 Agreement must be drawn up and approved by the Accident Board or Superior Court. If you had no PIP coverage, which is often the case in motorcycle accidents, then liens may exist with regard to your medical treatment. A good lawyer should be able to negotiate these liens down to manageable amounts to allow you to come out of the case with some money.
If you are not able to get a satisfactory offer from the insurance company you may have to file suit. In most tort actions you have to file suit within three years after the accident. An exception is made for the MBTA, where suit must be filed within two years. Special notice must be given for the Commonwealth or a city or town and with defects in public way. Other limitations may apply, so you must make sure that you have an attorney ready to file suit within the required time periods. After suit is filed you will be asked to answer questions, called interrogatories, and may need to produce documents. In some cases, when the person who is at fault, most often called a defendant, does not carry insurance, you may be able to go after your own insurance for coverage under an uninsured motorist claim, or UM claim.
The above is a general statement on motor vehicle accident claims, and is not meant to be an exhaustive analysis into your personal case. Your statute of limitations period may be longer or shorter, and you may have other damages not listed above. You can call me at any time on my cell phone with any questions regarding your case. I do not charge a fee or bill you for my time. My fee is only paid when you win your case, and is generally 1/3 of the total settlement. Call me at (617) 669-2345 to discuss your case.
