Handling My Own Claim - Lessons Learned

A guest blog by Joee Reyes 

Handling My Own Claim - Lessons Learned

I thought I was 'doing the right thing' when I attempted to handle an insurance claim on my own after being struck by a car. Call it being socially and ethically responsible. Maybe it was pride. I grew up with the stigma that you only need a lawyer if you go to court and that if something life changing, like a workplace injury, transpired.  Truth be told, I should have placed the machismo in the back seat, done the right thing and asked for help.

In the spring of 2016, I was stopped at an intersection, resting on the white painted line. Since drivers tend to miss seeing cyclists, I placed myself in front of the car so the driver would see me. After looking at the driver, I proceeded through the intersection once the light turned green. I was 'greeted' from behind by the same driver with whom I had just made eye contact. The car clipped my rear tire. This caused me to bounce off the right fender and sent me sliding into the curb.

I quickly popped up to get out of the road so I would not get injured any further.  Adrenaline works when you need it the most! I walked over to the sidewalk to lie down and figure out what had just happened. The driver of the car that hit me came over to see how I was. He did not seem too concerned about my well being. I asked him to stay while I called police so I could get a report written. That was the extent of my general knowledge about what to do if involved in an accident; call the police and file a report.

After police arrived and EMS conducted a basic physical field assessment, they gave me the go-ahead to go home. Since I was struck two blocks from my apartment, I opted to walk home and drag my broken bike with me. I had gotten it less than a week before the accident.

Thinking that this would be a straightforward claim, since there were no trips to the hospital and I had not been seriously injured, I was hoping for a quick turnaround to this whole ordeal. The faster I could put this behind me, the better. Irony and hindsight are the key takeaways from this whole ordeal. Nothing was quick and the gaps in getting everything resolved were about as painful as being hit.

Here's a 'not so quick' timeline of handling my claim:

April 2016 - Struck by a car:

○      I called the driver's insurance company the same day.

○      Two weeks later the police completed their report citing the driver at fault.

○      Insurance company confirmed receipt of my email regarding the claim on April 25.

May - Some progress on the claim is being made:

o   Multiple adjusters working on various parts of the claim. Communication is not ideal.

o   Requested to speak to adjuster handling property damage portion of the claim as I felt it was not being handled properly. Submitted documentation in April for damaged property but still had not heard back from adjuster.

o   Was advised that the adjuster was actively working on the claim for a resolution.

June – Going on month two now:

o   The bike was dropped off at a local shop so the insurance adjuster could make an assessment.

o   Sent adjuster a copy of the sales invoice for my bike. Also sent the cost of aftermarket brakes that were purchased and installed. Cost was $99.00 for the parts and $90.00 to install.

o    Nothing really out of the norm. All actions seem to be moving at a 'normal' speed.

○      On June 6, I requested to keep the damaged bike or have the ability to buy it back at the totaled cost after the wreck. There were the aftermarket fenders and a handful of parts that were not destroyed, e.g. the seat, that I wanted to keep.

○      The adjuster was not very professional in his response towards me. He informed me that I could not recover the value of the bike and keep it.

○      At this point, I was less than excited about handling my own claim.

○      Still had not heard back from the second adjuster handling the property damage portion of the claim even though I had been assured that it was being worked on. None of my calls were returned.

○      The adjuster changed his mind one day later and offered me the full value of the bike plus I was able to keep it. So all in all, this experience was not the worst, yet.

Mind you this is only month two of the claim. The settlement for the bike went relatively quickly, which was the most expensive part of this accident, but I still needed the issue regarding the damaged personal items to be resolved.

Never give up! That is what I was taught from my parents and from being in the military. Do not be bullied. Ask a lot of questions. But seriously, this is when having a lawyer would have been more ideal.

o   On June 13, I sent another follow-up email asking about a settlement.

I would call once a month all summer long and leave a voicemail to the agent handling my claim. I was ignored repeatedly to the point I quit calling. I know, I know. I failed to live up to my own rhetoric about never giving up but screaming into the void was becoming pointless. At this time, I gave myself a break from the constant rejection. I’m human too. This whole insurance act was getting old. The runaround was beyond frustrating to say the least. I sent another email on September 12 with the receipts for the destroyed items as well as my medical bill. I followed up again in December.

Finally, six months later, on December 14, I received an email from the adjuster handling the PD portion and medical bill. Awesome!

○      Resolution………… almost. Finally, the last of my items were getting covered from the event. Taking a step back to analyze this whole scenario. I knew that I undervalued my medical costs but I was quick to settle to try move along the whole process. Sorting through the myriad of time and emotional effort this event took, I should have called a lawyer to handle it.

If you are ever in a similar situation, I highly recommend getting professional legal help. In my case, I met Megan a year later and wish that I had gotten to know her earlier to help me tackle the headaches that come with such a process. 

A Quick Review of Important Auto Insurance Coverage For Cyclists

Right now, go get your auto policy “DEC” page(s).  Seriously.  I’ll wait.  Go get it.  This is the page that comes on the front of your policy; it line items your coverage and premiums page per item.  Grab the DEC page for each vehicle/scooter/motorcycle you own, as well as those for any “resident-relatives” with whom you share your residence (typically defined as related by blood or marriage).

            We are looking for two specific types of coverage that come up in almost every case involving a cyclist injured by a motorist (i.e. there is at least one motor vehicle involved).  We are looking for MPC (med pay coverage) and UM/UIM (uninsured/underinsured coverage). 

            I hope you find that on each policy, you do in fact have MPC and UM/UIM coverage.  If you do not, please call your agent to discuss your options.  Here’s why: 

            MEDPAY coverage –provides medical benefits coverage in any accident involving a motor vehicle, regardless of fault.  It usually costs $2-4 per month, and it provides you $5,000 (typically, though it can be more) in medical benefits.  This can cover copays or health insurance deductibles, as well as medical bills from the ambulance or emergency room.  Your massage, chiropractor, acupuncture, dry needling bills can all be covered too.  Any medical expense you incur from the accident is covered, so long as it is medically necessary and reasonable, up to the policy limits. 

            UM/UIM coverage – if you are hit by a car while riding your bike and the car drives off (aka, a hit-and-run), your Uninsured motorist coverage kicks in.  If you are hit by a motorist with minimal insurance coverage (i.e. $25,000, the minimum coverage required in Colorado) and your damages far exceed those limits, you would first recover policy limits from the driver’s insurance company and then you would pursue a UIM (under-insured) claim with your own auto insurer.  This can be critical, as often in cyclist-motorist collisions, the cyclist suffers extensive bodily injury and incurs very high medical bills.  As a result of their injuries they may also miss a lot of work.  UM/UIM coverage will pay for things like medical bills, lost wages, pain and suffering, and more. 

            In addition, if you want to increase possible coverage, for these or any other claims you may be filing, you can add an “umbrella” policy to all of your existing policies.  To add an additional $1 million in insurance protection will run around $300 per year.  This will stack on top of any automobile or homeowner coverage you have on your existing policies.  In the event of a catastrophic accident involving a cyclist who incurs permanent and life-altering injuries, these umbrellas can be the difference between getting back on one’s feet financially, and filing bankruptcy resulting from the medical bills. 

            Call your agent to review your policies and discuss options.  Keep in mind it is up to the cyclist (or policyholder) to initiate the above claims with the auto insurer.  These claims should be opened as soon after the accident as possible, to prevent any possible denial from the insurer due to delay or failure to provide adequate notice of the accident.  If you plan to hire an attorney, let them initiate these claims on your behalf.

            One final note: If each vehicle is listed on a separate policy and you pay a separate premium, your policies can be “stacked” pursuant to Colorado law.  This means that if you have 3 cars, each with a separate policy and premium, your $5000 MPC coverage may triple to $15,000, for example.  Often, insurance companies will include anti-stacking language in their policy.  It may or may not valid under Colorado law.   A thorough review of your entire policy is often needed to determine coverage applicable to the circumstances.

For more insurance coverage information, please refer back to an earlier article I posted: http://303cycling.com/what-cyclists-should-know-about-insurance

What is Medpay (MPC)?

As the attached American Family Insurance Brochure states, Medpay ("medical expense coverage") 

"protects you and others in the vehicle. It pays for reasonable and necessary medical expenses due to accident-related bodily injury, regardless of who is at fault.

Medical Expense covers:

• You and the passengers in your insured vehicle.

• You and your passengers when you’re driving another vehicle with permission.

• You and covered persons in your household while riding in other vehicles.

• You and covered persons in your household if you are struck by another vehicle as a pedestrian.

Funeral expenses (up to a maximum of $2,500) are also covered under Medical Expenses.

Medical and funeral services must be performed within one year of an accident to be covered.This is extended to three years if you have more than $10,000 of Medical Expense coverage."

(For an example of actual policy language, click SF certified policy -medpay portion only.pdf).

How does this coverage apply to cyclists -and more importantly, why should you as a cyclist have this coverage on your auto insurance policy?

BECAUSE: "You and covered persons in your household if you are struck by another vehicle as a pedestrian" = you are covered if you are hit by a car while riding your bike (for this purpose cyclist = pedestrian).

... most of the time, these policies require only that a vehicle be involved in the accident.  It need not be YOUR vehicle.  If you are struck by a car while riding your bike, your MPC coverage applies!  This coverage is no-fault coverage, meaning the cyclist should strike a car and be entirely at-fault for causing the accident and ...MPC still applies!

Why does this matter?  As more and more cyclists opt out of having health insurance, or have health insurance but with a huge deductible, they need help paying medical bills that result from a car-bike accident.  MPC limits are typically $5,000 and the premium for this benefit is very low -usually around $3-4/month.  You can also upgrade to $10,000 or even $25,000 with certain auto insurers.  For a minor premium, a cyclist can purchase coverage that will help them pay medical bills right after the accident, with or without health insurance.  

*Medpay is usually required to pay first responders first, within the first 30 days of the accident (Ambulance and ER).  Typically the provider will bill MPC at "retail prices" - not the prices your health insurer would pay.  This means a $1200 ambulance ride will be billed to MPC at the full price -not at the substantially reduced price your health insurer would pay.  

MPC can also be used to reimburse the cyclist for out of pocket medical expenses -bandages, wraps, slings, creams, prescription and OTC drugs, massage therapy, chiropractic care and more.  

An insurer providing MPC benefits will require itemized billing statements with billing codes and they are quite picky about the information they require before they will pay the benefits.  A cyclist must be diligent in either compiling this documentation on their own or ensuring their providers are suppying it to their MPC insurer.  A cyclist's failure to ensure bills are timely paid by MPC may result in the cyclist being sent to collections for non-payment of a medical bill. 

MPC usually will pay medical expenses for up to 1 year following the accident.  

For these reasons, we recommend every cyclist get MPC coverage on their car and that they initiate a MPC claim with their auto insurer right after an accident!