Learn What You Need to Know About Your Injury and Disability Claim.
Answering the Most Frequently Asked Questions Is Good, Answering The Questions You Should Be Asking Is Even Better
We have been answering questions about Oregon and Washington personal injury and auto injury claims, Oregon Workers' Compensation claims, and Social Security Disability claims for more than a little while. People have a lot of the same concerns, so they ask the same questions. That's good. However, our job is not just to answer the most frequently asked questions, but also the ones you should be asking. That's better.
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What is a Back Up Denial?
When a worker is injured on the job in Oregon, they can file a claim for workers's compensation benefits. The insurance company investigates the claim, and if it finds the claim valid, issues a Notice of Acceptance. Benefits are provided with the goal of getting the injured worker back on the job, or helping them find other work if they have some permanent work restrictions.
If, on the other hand, the insurance company does not feel the injury is work related, or that there was no injury at all, then the claim is denied. The injured worker can seek a hearing with the Oregon Workers' Compensation Board.
Accepting a Claim is Owning a Claim
When an Oregon Workers’ Compensation carrier or claims administrator accepts a claim, it owns that claim, and must provide benefits. It may later regret its decision to accept the claim, but nonetheless must carry through with its responsibility. The insurer cannot later change its mind, "back up," and deny the claim.
The Back Up Denial
There is an exception, however to this general rule. If the insurance company discovers “new and material” evidence that it did not have at the time the claim was accepted, it may be able to issue a “backup” denial. The evidence must be “new” and “material.” New evidence is pretty self-explanatory. For example, the insurance company may find evidence that the worker treated for the exact same injury a week before the on the job injury, or that the injured worker was actually injured when not at work.
However, whether the new evidence is “material” is another issue. Usually, newly discovered medical treatment prior to the date of injury is material evidence, and if an injured worker denies the existence of pre-injury medical care, there is a very good chance this will be considered “material” evidence, depending on the severity of the prior medical problem.
This is why it is so important for an injured worker to be honest and forthright when going through the claims process. In many cases, an injured worker may have a prior medical issue with the same area the body injured at work, but still as a valid claim
If you have a claim denial for an on-the-job injury in Oregon, contact us with your questions. We help injured workers every day.
Why didn't the police cite the other driver, and does that affect my case?
The short answer is that whether a careless driver receives a ticket has little to do with proving a claim of negligence.
In many cases, police will choose not to cite a careless driver. It may be that there is insufficient evidence to prove a violation. It also may be a matter of department policy. Even if a driver received a citation, that fact, along with any conviction for a traffic offense is generally not admissible in another case involving an injury claim against that same driver. The rationale in the evidence code is that many people decide not to "fight" a traffic ticket, and for this reason, the mere conviction of a moving violation is not reliable evidence of negligent behavior.
However, when a careless driver receives a citation, and decides to contest the citation, some evidence may be helpful. For example, if the driver testifies in a court hearing, and that testimony is recorded, the testimony can be admitted in another trial. This is because the driver was placed under oath, and the law assumes that testimony under oath is generally reliable.
When we investigate a case, we determine whether not the negligent driver contested the citation, and in certain cases, we might even attend the court hearing.
If you have been in a collision in Oregon or Washington, and have questions about investigating liability, or proving the other parts of your case, call us at 503-325-8600. We offered 20 years of experience, and can explain how we investigate and pursue claims for injured drivers.
What is an "Offer of Judgment?"
When a Case is Filed in Court
Offers of judgment can only occur after a case has been filed in court, and must be served on the opposing party at least fourteen days of the date of trial. In our office, we occasionally see offers of judgment from insurance defense attorneys on Oregon personal injury claims. There is usually some disagreement on the value of the personal injury claim, and it is usually close to trial. This tactic is used to increase the risk of going to trial because, depending on the trial's outcome, a Plaintiff may end up recovering less money in any judgment. It's a way for an insurance defense attorney to call a plaintiff's bluff, or make a "dare." Offers of judgment force a reevaluation of the claim, and we receive an offer like this, we go over it with our client to make sure that they are making an informed decision on moving forward to trial.
How it Works
When one party files an "offer of judgment" with the other party, the offer is specific, including the amount of money offered, and whether it includes any liens or attorney fees. Usually, it is the defendant, or person or entity being sued that files an offer of judgment.
Under the rule, the plaintiff has seven days to respond to the offer of judgment. If the plaintiff accepts the offer, the plaintiff signs the offer, and files the document with the court. The parties then prepare a stipulated judgment, and the case is resolved. What happens if you decide not to accept the offer?
Rejecting the Offer
If the plaintiff does not accept the offer within the seven day deadline, the rule says that the offer is withdrawn. If the case goes to trial, and the plaintiff recovers more than the offer of judgment, nothing changes. The plaintiff can include in her judgment all the costs that the rules allows. These costs include witness subpoena fees, jury trial fees, and a prevailing party fee. In some cases, there may be a claim for attorney fee under a statute. If the plaintiff's beats the offer of judgment, she can still recover her attorney fees.
But, if the plaintiff does not beat the offer, her recovery is limited. The plaintiff will still recover the damages or compensation the jury determined in the verdict, but the plaintiff will not recover the cost of subpoenas, the prevailing party fee, and if there is a claim for attorney fees, that goes away too.
What is Work Disability?
When an Oregon Workers' Compensation carrier issues a Notice of Closure, one of the benefits it may provide is "work disability." This benefit is actually part of the "permanent partial disability benefit" that a worker may be entitled to, depending on whether he or she made a full recovery from their on the job injury.
The term "work disability" refers to any injured worker who is not able to return to the actual job performed at the date of injury. In order to qualify for this benefit, the attending physician, who is the physician primarily responsible for your medical care must State that you are unable to go back to the job you held at the date of injury.
You may still have the same job title, and work many functions of your position. However, if the duties of the job are changed because of any physical limitations you are left with after an on-the-job injury, then you may very well be entitled to this benefit. Even if you are working certain hours, and is work hours were limited as result of any permanent restrictions flowing directly from your on-the-job injury, this altered work schedule may also entitle you to the work disability benefit.
Generally speaking, this benefit is based upon "social and vocational" factors, including your skill level, your age, the physical requirements of your job before the injury, and your physical abilities after the injury. There is also an Index number known as the "state average weekly wage" that determines the amount of "work disability" benefits.
If you have an open Oregon Workers' Compensation claim, and have questions about this or any other issue, call us at 503-325-8600. We have extensive experience advocating for the injured worker in Oregon.
What is an Overpayment?
Oregon Workers’ Compensation is anything but straightforward. Many clients will contact us after receiving a letter that they were overpaid benefits. This often causes some anxiety and worry, but the fact is that the payments were not really overpaid, but instead paid in advance.
In the rules governing the payment of temporary total disability or temporary partial disability benefits, there are two requirements insurance companies must follow. These benefits are for wage replacement, and I often refer to these benefits as "time loss."
First, the insurance company is only required to pay any temporary total disability or temporary partial disability benefits if there is written authorization for either modified work or complete disability from work from the attending physician. As long as there is written authorization from the attending physician, these payments must continue. These payments must continue until the worker is declared medically stationary. The Oregon Workers’ Compensation people call this “substantive” entitlement to time loss.
However, there is also a procedural limitation on payment of time loss benefits. Another rule provides that the insurance company cannot stop paying temporary total disability or temporary partial disability up until the issuance of a Notice of Closure. This is the "procedural" apsect of time loss benefits.
In many cases, an attending physician will agree that an injured worker is medically stationary as of a certain date. However, the insurance carrier may need additional time to gather sufficient information to issue a Notice of Closure, or they just may not be doing their job. As a result, any payments after the date the injured worker became medically stationary up until the date of the Notice of Closure is referred to as an “overpayment.”
When the Notice of Closure is issued, the insurance company may notify the injured worker that it made an “overpayment” of benefits, and will take a credit for the overpayment by reducing the amounts due in the Notice of Closure. This is not really an “overpayment,” but instead an advance on the payment of permanent partial disability benefits.
In some cases, the injured worker may not be due any permanent partial disability, or the amount of permanent partial disability benefits due may not be sufficient to completely cover the “overpayment.” The most important thing to realize is that you are not personally responsible for any overpayments made by the insurance company. Instead, the insurance company will have a credit on any future permanent partial disability payments.
If you have questions about your Oregon Workers’ Compensation claim, call us at 503-325-8600. We deal with these issues every day.
Does my health plan cover medical care for a personal injury claim or denied Workers' Compensation claim?
We are addressing both the Oregon Workers' Compensation claim and the Oregon and Washington personal injury claim. So, where does health insurance fit in to each of these claims. Let's start off with the personal injury claim, and then address workers' compensation.
In an injury claim, you may have PIP if your car is insured in Washington, and you will have PIP if insured in Oregon. PIP, or "personal injury protection," includes coverage for medical expenses. However, if you are seriously injured, you may use the available PIP coverage. If this happens, you have "exhausted" your PIP coverage, and if you have health insurance, that health plan should step up and process the remaining medical bills. Your health plan is going to want verification that you have used all your PIP coverage, and may plans will require that you sign an agreement that it will be reimbursed for medical benefits provided out of any settlement.
On the Oregon Workers' Compensation end of things, your medical providers cannot collect any bills while the appeal of the denied claim is pending. However, you may need to treat for your injuries, and if you have a private health plan, it will likely cover your medical expenses so you can treat your injury, and get back to work sooner. Like a personal injury claim, your health plan may have you sign an agreement that provides you will reimburse the health plan for medical expenses paid if you resolve your claim by settlement. If you prevail on the claim, the medical provider usually reimburses your health plan, and then bills the workers' compensation carrier.
If you have questions about medical bills and a personal injury or Oregon Workers' Compensation claim, call us at 503 325 8600. We work with clients on these issues every day.
What happens with my medical bills after my claim has been denied?
Oregon statute provides some protection for the injured worker who has a denied workers' compensation claim.
If a claim is denied, and the injured worker denies the appeal, medical providers must defer collection on any outsanding bills while the appeal is pending. The key is to appeal the denial. If a medical provider insists on collecting an outstanding bill, the injured worker should notify the medical provider that Oregon statute prevents any collection efforts while the bill is pending.
Many providers are well aware of the statute the prohibits collection of oustanding accounts. Instead of an actual bill, an injured worker may receive a notice of the outstanding balance, just ot make sure that the injured worker is aware of the bill. Just to be sure that the insurance company is aware of the outstanding bill, we forward these bills to the workers' compensation carrier while the appeal is pending. If the case settles, or if the injured worker prevails on the appeal, the bill is paid.
If you or a loved one have a denied workers' compensation claim with oustanding medical bills, remember that you have only 60 days to appeal the denial. If you have questions, call us at 503-325-8600. We have over twenty years' experience working with injured workers.
The Police did not cite the other driver. Does this hurt my case?
Police officers use their own discretion in deciding whether or not to cite a negligent or careless driver at a collision scene. Drunk or reckless drivers are going to be cited, or charged with a crime. However, police may not cite drivers who commit lesser offenses, like speeding, or even failing to obey a traffic signal.
The general rule in Oregon is that convictions for moving violations are not admissible in a civil claim against the negligent driver for personal injury or property damage. The commentary that accompanies this rule of evidence explains that these convictions are not inherently reliable indicators of an admission of fault. The rationale is that the driver receiving the citation may not believe that he or she is guilty of the moving infraction, but has chosen not to go through the time and expense of contesting the ticket. However, if the driver cited with a moving violation pleads "not guilty," and testifies in a court of record, that testimony can be introduced at a later trial or hearing to prove liability.
This rule of evidence does not apply to more serious infractions, like a felony hit and run, or a felony assault conviction arising from a collision. In some cases, a plaintiff may choose to defer any lawsuit until after a criminal conviction because a guilty plea to a serious crime may prevent the defendant from denying responsibility in a later civil case.
If you have questions about a recent collision, in Oregon or Washington, call us at 503-325-8600. We have extensive experience handling serious injury claims.
What does "no recovery, no fee" mean in an Oregon or Washington personal injury case?
Many lawyers, including our office, probably has an advertisement somewhere that claims there is no fee, unless there is recovery for the client. This is a good thing, because it gives people access to an attorney without, in most cases, having to pay any money for the lawyer's fees, or expenses. However, there is more to it than that.
First, most fee agreements, including ours, will make a distinction between "costs" and "fees." Costs are the things that an attorney will spend money on to prepare your case for a settlement demand, or litigation. This can include copying costs, long distance phone calls, paralegal costs, and the cost of obtaining medical bills, charts, and medical opinions. It is always a good idea to get an idea of typical costs. Some, but not all attorneys will "front" costs, meaning they pay the costs as they are incurred. However, other attorneys may want a client to pay a retainer to be held in trust, for use to cover costs, as they are incurred.
The "no recovery, no fee" really refers to the contingent nature of the fee. This means that the fee is contingent upon the attorney recovering money or other compensation for the claim. Only then is a fee paid. However, pay attention to the percentage of the fee, and what number is being used to calculate the fee. In other words, what is considered to be the "recovery" on your case?
We handle most all of our injury cases on a contingent basis, and many times, pay costs up front. To get a clear and full explanation of how our fee agreement works, call us at 503-325-8600.
What happens when my health insurance pays for treatment that is part of an injury claim?
If you are injured in a motor vehicle collision in Oregon, you probably have personal injury protection, which pays medical bills, but only up to a certain amount, and only for a certain period of time. If you have health insurance, it will probably cover these bills, but like your personal injury protection, your health insurance is going to seek reimbursement out of settlement or verdict proceeds.
Before resolving a case, we always make sure we have information about how much the health insurance is seeking for reimbursement. Often times, some of the expensees may be for care unrelated to the injury. There also may be a way to negotiate a discount on the reimbursement, which in some cases, can be significant.
If you have an injury claim and have questions about how medical bills are addressed as part of your claim, call us at 503 325 8600. We answer questions like this every day.
How are medical expenses handled with an Oregon Workers' Compensation Settlement?
Oregon Workers' Comepnsation allows you to enter into a settlement on your claim. There are two basic kinds of settlements, depending on whether your claim is accepted or denied. When an injured worker settles a denied claim that is in dispute, the settlement is referred to as a disputed claims settlement, also known as a "DCS." The rules set out how medical expenses are accounted for in the settlement.
Generally, any medical bills in the posession of the insurance company or employer must be paid out of the settlement. However, the payment is not the face value of the medical bill, but the "audited" amount. This is the amount that would have been paid to the medical provider under the Workers Compensation medical payment schedule had the claim been accepted.
Up to forty percent of the settlement can be used to pay medical bills. If the settlement amount is less than the total outstanding medical bills, then the bills are paid on a pro rata basis. The medical provider can still seek to collect the remaining bill amount from the injured worker. If the insurance company does not have an outstanding bill, then it may not be included in the settlement, and the injured worker would be responsible for that bill as well.
If you are looking at resolving a denied claim, or even an accepted claim, there is a lot to consider. Call us with quesitons at 503-325-8600. We have extensive experience dealing with the many issues an injured worker faces in deciding whether or how to resolve a Workers' Compensation Claim.
What can I do about a denied Oregon Workers' Compensation Claim?
Oregon Workers' Compensation is a privately administered insurance benefit program. However, if you file a claim, and that claim is denied, you have the right to appeal the denial, and have the State of Oregon review the decision. Here are some thoughts on appealing claim denials.
Most importantly, you must file your request for hearing within 60 days of the date on the denial letter. There is an exception if you can show "good cause," but that exception is so narrow, it almost does not exist. You can file your request for hearing by simply writing a letter to the address provided on the denial letter. An attorney can help you fill out the request for hearing form which allows you to be more specific on what issues you are appealing.
You should also know that an attorney is able to take your case, and a fee is not payable unless that attorney is "instrumental" and getting the denied claim overturned or set aside. If the attorney is not successful, there is no attorney fee. Also, if your attorney is successful in overturning a denial, he or she may be able to get any case expenses reimbursed by the employer up to certain amounts provided for in the statute.
In many cases, the key to overturning a claim denial is obtaining a favorable medical opinion. Many times, an injured worker will turn to their treating physician, or even retain a physician to review the case, and provide an opinion. Another option is to seek a worker requested medical examination, which is similar to an insurance company seeking an independent medical examination.
If you have a denied Oregon Workers' Compensation claim, call us at 503-325-8600. We have extensive experience representing injured workers before the Workers Compensation Board.
Can I keep my car if it has been "totaled"?
A car is "totaled" when the cost of repair is so close to the car's value, it does not make sense to fix the car. There can be many issues with the repair or replacement of your car.
If your car is totaled, than n most cases, the insurance company will allow you to retain ownership of your car if it has been determined to be a total loss. If you elect to hold onto your car, you will have to submit your title to the Department of Motor Vehicles, and will receive a "branded title." This is a title with a stamp indicating that your car has been declared a total loss. This will obviously affect the resale value of your car.
Some people elect to keep their car for many reasons. They may have the ability or the means to fix the car, or may not want to go through the process of financing a vehicle, and incurring additional debt.
We help our injury clients with property damage issues. If you have been injured in a collision, and also have questions about your property damage claim, call us at 503-325-8600. Even if you're just dealing with a property damage issue, we can provide you free information, and put you in touch with attorneys who handle property damage only claims.
What is Contributory Negligence?
The term "contributory negligence" refers to a defense that is argued in Oregon and Washington negligence and personal injury cases. Essentially, when a defendant asserts a defense of contributory negligence, he or she is alleging that the plaintiff, who is bringing the claim, was at least partially at fault in causing his or her own injury. Both Oregon and Washington allow this defense, but there are some significant differences.
In Oregon, a defendant can allege the defense of contributory negligence. If there is any evidence to support that argument, a jury is then asked to allocate the percentage of fault between each party. In Oregon, if an injured plaintiff is more than 50% at fault, then the injured plaintiff is permitted to make any recovery for her damages. In other words, a defendant in Oregon could be 49% at fault, and if that is the case, then that defendant owes nothing to an injured plaintiff. Of course, there are special rules when there are more than two parties involved in a case.
Washington, on the other hand, is known as a "pure comparative" state. This means that the plaintiff is entitled to recover a pro rata share of the damages based on the defendant's fault. Thus, if a jury found the defendant and Washington only 10% at fault, then the injured Washington plaintiff would be entitled to 10% of any damages the jury decided on the case.
Other states bar any recovery whatsoever if the plaintiff is found at fault, even if it is one or two percentage points.
If you have a question about a comparative fault issue, call us at 503-325-8600. We have experience handling these kinds of issues in Oregon and Washington.
What are the "objective" findings required to prove an Oregon Workers' Compensation claim.
In order to prove an on the job injury is "compensable" under the Oregon Workers' Compensation statute, you must prove more than the mere fact you were hurt at work. You have to show that the injury "arose" from your work. You also have to show that the injury occurred in the "course and scope" of your employment. You have to show that the injury required some type of medical care, or, that it disabled you from work. How this is proven includes providing medical evidence that is "supported by objective findings." This article focuses on "objective findings."
To understand "objective findings," we need to look at how doctors and health care providers evaluate and treat injured workers. First, most providers are going to ask you what happened, and where it hurts. This is the "subjective" part of the examination. In other words, it is what you are feeling, or have experienced; or, your subjective view of things.
Then, the examiner will examine, and a lot of what he or she finds is referred to as "objective" findings. This means that the findings are observable without your input. A muscle spasm is a great example of an objective finding. A doctor is going to feel the involuntary muscle contraction. I fracture on an x ray is even more objective. It is a picture of a bone, that is damaged. You do not even have to be in the room for a doctor to observe that objective findings.
Oregon Workers's compensation law requires medical evidence be supported by objective findings, and the statute has its own definition, which can include all kinds of objective findings, including range of motion, atrophy, muscle strength and palpable muscle spasm.
But there is another component. The statute goes on to state objective findings do not include physical findings or subjective responses to physical examinations that are not reproducible, measurable or observable. So, the legal definition of what is objective is arguably more broad than what a doctor may think, because it includes a patient's response to physical examinations, so long as they can be reproduced, or can be measured, or can be observed.
We make sure physicians understand this when seeking an opinion on a Workers' Compensation claim. If you have questions about whether there is objective evidence to support your claim, give us a call at 503-325-8600. We have a lot of experience with this issue, and can answer your questions.
How much time do insurance carriers have to respond to an Oregon Workers' Compensation claim?
If you have been injured on the job, and you filed a claim, certain timelines are triggered before the insurance company to investigate and make a decision on your claim. In the case of a new claim, the Worker's Compensation carrier has sixty days from the date it received notice of your claim to make a decision.
This period of time is referred to as the "deferred status period." The insurance company will obtain your medical records, possibly speak with your doctor, and also has the right to take a statement from you regarding the facts and circumstances surrounding your injury. Do not be surprised if you're asked questions about your past medical history as well. You may also be asked to see an insurance retained Doctor for an examination. Many of these doctors are biased against the injured worker, but some are genuinely objective.
If you are physician has taken you off work, and confirmed your disability in writing, you may be entitled to a temporary total disability benefit during the deferred status period. In some cases, you may be only missing some work, and will receive temporary partial disability benefits. In many cases, the employer may find something for you to do within your physical limitations, which would disqualify you from any temporary total or temporary partial disability benefits.
The insurance company must make a decision within sixty days by issuing a written notice of acceptance, or some form of a claim denial. The rules require that these letters be put together in a certain format, and advise you of your right to appeal any adverse decision.
If you have a recent claim denial, or suspect a denial is coming in, give us a call at 503-325-8600. We can review your file, and let you know if it makes sense to contest the denial. Please note that there are time limits for appealing a denial, so even if you do not call us, appeal that denial. You can always withdraw the appeal at a later date.
What is the difference between SSI and SSDI?
SSI is also known as "Supplemental Security Income," or Title XVI benefits. SSDI is known as "Social Security Disability Insurance," or Title II benefits. Both of these programs require proof of "disability," but the source of payment distinguishes the two programs.
Social Security Disability Insurance is a disability insurance program. If you meet the definition of a "disability," then you are entitled to insurance benefits. The benefit amount is based upon your past earnings, and whether you're "insured" at the time your disability began.
Supplemental Security Income benefits are a federal welfare benefit, and in addition to proving you are disabled, you must show that you meet the income and resource limitations set out in the statute, rules and policies. Generally, any "income" that you receive, whether or not it is earned, read results in a dollar per dollar reduction in your monthly benefit. Also, if you are "resources" exceed two thousand dollars for an individual, then you are not eligible for SSI benefits. The determination of whether you meet the "non-disability" requirements for SSI is made at the local branch level.
Do you have questions about your disability application and SSI or SSDI? Call us at 503-325-8600. We answer these questions every day.
What is a Consultative Examination?
A "consultative examination" typically occurs early in a Social Security disability claim. Depending upon the nature of your medical condition, the State agency that initially reviews your application may ask you to see a doctor or other health care provider for an examination.
It would be nice to say that these physicians are truly objective, and have no "agenda" driving their opinions. Unfortunately, that is not always the case. However, many doctors who perform these examinations are truly fair and objective. Here are some things to think about when attending the examination.
First, you have to realize that if the physician has an agenda, or some bias, there's not much you can do about convincing the doctor that you have a disability. In fact, the harder you try to explain your condition, the more harm you may do!
However, you can minimize the damage done by giving good voluntary effort at the examination, and being polite and cooperative. I have had clients tell me that the examining physician actually laughed at them when reporting their symptoms. This is where you simply have to ignore the response, continue to give your best effort, and respond politely to all questions.
Often times, the examining physician will not have all of the facts, and we can point this out to the Administrative Law Judge at the time of the hearing. Also keep in mind that the rules and policies that direct the Administrative Law Judge's evaluation of medical opinions can be used to discount the consultative examiner's opinions. Generally, a treating physician with a well reasoned opinion will trump the opinion of the one time consultative examination.
If you are working her way through a Social Security disability application, and have questions, call us at 503-325-8600. You can also download our free eBook, which answers the most commonly asked questions, and advises you on the most commonly made mistakes.
How long does it take to resolve an injury claim in Oregon or Washington?
Next to asking about the value of a case, this is an often asked question, but there are too many factors that allow for a simple answer. Still, there are some factors at play that determine how long you may be dealing with an injury claim.
Ideally, it makes sense to approach an insurance company with a settlement demand after you have completed your medical care, and your doctor is able to provide some opinion as to the nature and extent of your injuries, and your future outlook. It may take a long to time to heal, which will delay the time the demand for settlement demand goes out.
Statute of Limitations
If anything trumps waiting for medical care to wrap up, it is the statute of limitations. The statue of limitations is the time you have to either resolve your case, or have it filed in court. In some cases, a person may be injured, and still treating with their doctors, but because the statute of limitation is approaching, the case will be filed in court.
Different courts have different dockets, or schedules. If a court is really busy, your trial may not be scheduled for some time from the filing date. Also, if a case involves complex issues, it may have to be postponed to make sure that all the witnesses, attorneys, and exhibits will be ready for the trial, which could take several days.
Courts also have statutory obligations to give certain cases priority over other kinds of cases. We have gotten calls the week before the trial letting us know that our case has been "bumped" and that the trial will have to be rescheduled.
Every case requires a person to prove certain issues, like liabiliy, damages, and the relationship between the two. If there is no issue about liability, and the injuries are obvious, then the case may resolve quickly, without much trouble. However, if there are disputes about any issue, then the case could drag out.
Our firm has extensive experience handling a variety of injury claims, and can answer any quesitons you have about an injury claim. Call us at 503-325-8600. If we cannot help you, we will find someone who can.
What is Subrogation?
This is a legally loaded term, so we are going to focus on how subrogation works in personal injury claim. Subrogation occurs when an insurance company or a health plan pays benefits to its insured for losses caused by a third party (someone other than the insurance company and the insured). The insurance company has a subrogation interest in the injured person's claim because that injured person is going to claim losses already paid by a health plan or PIP carrier. An example is probably the best way to illustrate this concept.
I am injured in an auto collision as a result of being rear ended by Careless Driver. My insurance pays my medical bills and a disability benefit. I have been injured. My insurance company and I are in the same boat in that we each suffered a loss. I lost my health, and my insurance company lost money, all as a result of Careless Driver's behavior.
I can make a claim against Careless Driver for all my losses, even if my insurance company covered some of those losses. However, my insurance company, by state law or contract, probably has a subrogation interest. This means that I am required, if I make any recovery, to reimburse my insurance company for the benefits that it provided me.
There are a lot of issues with subrogation, however. If I hire an attorney and incur attorney fees and other expenses to make a recovery, shouldn't my insurance company share in that expense? Also, what if I am partially at fault, say by 20%, and my recovery is reduced by that amount? Does that mean I only have to pay 80% of what my insurance company provided?
A lot of these questions are answered by statute, or by case law decisions, but it gets pretty tricky with federally regulated health plans, or situations where an insurance policy is issued in one state, and an auto collision occurs in another state.
If you have a claim, and you are facing issues about subrogation, or claims for reimbursement from a health care plan, call us at 503-325-8600. We sort these issues out for our clients all the time.