QUESTION:

In a personal injury case, do you request reimbursement for co-pay fees of the actual costs that a hospital would charge without insurance? I was in an automobile accident and received medical treatment from a Kaiser Facility. My concern is when writing a demand letter, do I list only the co-pay fees or the actual fees that would be charged for the services received.

ANSWER:

Some insurance policies (e.g., Kaiser) cover the insured’s medical bills, but give the carrier a right of reimbursement from the insured claimant in the event of recovery from a third party. Such medical liens (or rights of subrogation) reduce the net value of the potential claim and thus might make legal action economically impractical. Generally, under the “collateral source rule,” defendant’s liability is not reduced by claimant’s medical expense recoveries from claimant’s own insurance carriers and re government entity defendant’s right to “verdict adjustment” to reflect collateral source benefits, therefore, claimant’s insurance policies should be reviewed for applicable medical pay coverage.

Moreover, an early “policy limits demand” letter to defense insurance carriers is a popular plaintiffs’ tactic to speed along the settlement process. The demand letter recaps the liability case against the insured and itemizes plaintiff’s consequential damages to date (itemized wage losses, medical expenses, etc.). It typically requests a “policy limits” settlement, “reminding” the insurer of its “excess liability” exposure to its insured in the event the case does not settle and a judgment beyond policy limits is entered against the insured defendant.  As to the medical bills, it is important to itemize each cost that the claimant has incurred and/or will incur in diagnosis and treatment of the injuries, and also to attach copies of the bills to date. It would be best to seek personal assistance from a lawyer in order to assist you in your personal injury case.

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