< SECTION IV | SECTION VI >
Duke Breitenbach
Insurance and Legal Representation
Please keep in mind that I have no training in insurance or legal matters. The terminology and opinions stated here are derived from the experiences associated with my crash.
There can certainly be less complicated recovery and settlement process than those I encountered, but they can be much more complex as well. I only address the situation where a bicyclist is involved in a crash with an insured driver of a motorized vehicle. Consult your insurance agent and attorney for specific details.
Florida’s NO FAULT insurance
Not all states have a NO FAULT insurance law, so the following may not be accurate in other states.
Florida’s NO FAULT law states that YOUR automobile insurance company will pay your medical bills up to the limits of your Personal Injury Protection (PIP) limits if you are riding a bicycle, regardless of who may have been at fault. A standard amount is $10,000. There were some deductions, which reduced my coverage to about $8,000 for PIP.
An optional coverage you can obtain is “Automobile Medical Payments.” My limit for this coverage is $5,000 and the premium is only $12.39 per six months. Again, in my case that provided medical coverage for me under my automobile policy of approximately $13,000.
It is my understanding that expenses beyond the stated limits would be paid under the provisions of your major medical insurance. However, they will request to be reimbursed for their coverage in the final settlement from the motorist’s automobile insurance.
Typically, we do not tend to understand all of these interactions until we are involved in an incident.
Lesson 22 – Take the time to have a basic understanding of how your insurance coverage would work in the event of a crash while you are riding a bicycle.
It will also shed light on the general provisions of the policy.
This may sound straightforward, but beware of complications. Insurance companies, even your own, are not inclined to always make payments according to the rules you think are applicable. A few examples I encountered are:
- My automobile insurance agent was unaware of the bicycle coverage.
- My automobile insurance company paid some, but not all of the medical expenses.
They invoked a 30-day invoice-billing rule by not accepting the first claim, and by the time the provider resubmitted the claim, the 30 days had expired. As noted in a previous segment, your medical provider should send claims in a manner that clearly documents the date of the first submission.
These unpaid claims just add to the complication of the care and settlement process. Unless you pay them—not recommended—it is difficult to obtain further care from that medical provider.
Our primary residence is in Idaho and we have a long established relationship with the medical community in our hometown. My shoulder required additional care—surgery to be specific—to alleviate pain that increased in severity the summer following the crash.
A controversy ensued between the Florida automobile insurance company and my Idaho major medical provider over which company should pay the bill.
Your insurance company will assign an adjuster to your case. That person is not likely to be your local agent. Your local agent is basically a salesman and does not directly mange your claim. However, they do a great job of managing your bills!
I tried to deal directly with my insurance company adjuster and found that tactic to be ineffective. It would appear that their role is to save the company money, not necessarily help pay your bills. Over a drawn out claim, the your adjuster will likely change several times.
I very naively thought that I could communicate with the opposing insurance adjuster and get an idea of where this process was going. Boy was I wrong! I got totally stonewalled by that person (“There was no crash; you did no damage to the truck.”).
You may be lucky to have an insurance agent that is thoroughly knowledgeable about all of your specific issues, but it became clear to me early in the program that additional resources would be required to sort out all of the issues. I was reluctant to seek assistance but soon realized it was time to call in the legal team.
Personal Injury (PI) attorneys deal with all of this on a daily basis. They are aware of the correct avenues to settle the claim and the “games” that are played in that process.
Lesson 23 – Obtain the services of a PI attorney as soon as practically possible after the incident.
Obtaining an attorney
Some of the issues regarding the services of acquiring an attorney were outlined under the previous section – Legal Advice.
If you have an attorney or firm with whom you have established a working relationship, consult with them first and see if they handle PI cases. If they do, follow their recommendations.
If you do not already have an attorney whom you deal with, try to obtain the names of potential candidates from friends or cycling acquaintances.
In general, I have found it better to use someone that is personally recommended rather than making a ‘blind’ phone call from a telephone directory. The more experience they have with bicycle related crashes, the better they will be able to represent you as an injured bicyclist.
It is even better if they are bicyclists themselves. From my crash experience, it is clear that the Florida law enforcement and legal system are biased towards motorists, so the more expertise you have on your side the better your results will be.
Lesson 24 – Obtain legal council that has extensive experience in bicycle incidents.
Aside from your recovery one of the first questions is: Who pays the legal fees?
Based on my case, where there was reasonable expectation that the motorist was at fault, the attorney will work on a contingency basis. That is, they get a percentage of the final settlement. That means you do not have to pay their expenses out of your pocket. Based on their experience and knowledge, they know they will be compensated for their efforts.
There is a standard representation contract you sign that explicitly defines their percentages and other costs based on how far the settlement process needs to go.
Lesson 25 – Understand the provisions of the representation contract you sign
Interview the prospective attorneys before signing on the dotted line! Make sure the person and firm you select shares your same priorities and agenda.
My priorities were the best medical care and treatment to assure the best possible recovery. Some firm’s goals are to maximize the final settlement so they make the most money. There seem to be ways this can be accomplished, but they may not fit your agenda.
Lesson 26 – Select an attorney that understands and supports your objectives and goals.
Depending on how far your settlement goes, you may be dealing with your legal representative over a long period of time. Choose carefully!
Signing with legal council will take a good burden off your shoulders. They can help settle the billing issues and other similar tasks.
As you reach the end of your recovery process they can recommend medical evaluations that will clearly document your recovery and permanent injuries. If you have questions, and you will, related to the crash and settlement process, they are there to answer them.
Lesson 27 – Establish a good working relationship with your attorney and have a lot of patience.
The end game here is to arrive at a fair and just settlement. This can be a very complex procedure with many variables.
If the motorist was issued a citation, that will work in your favor and may bring a quicker settlement from the motorist’s insurance company. If there is no infraction or no criminal charges against the motorist, it is likely to be a whole different ball game.
As an injured party, you have the right to file “civil charges” against the motorist.
There are many directions this can take and I will outline the avenue I took for my 1999 crash in the next segment.
< SECTION IV | SECTION VI > |
