Pedestrian Claim

[Diane060421]

I have a question (or 10) about a pedestrian claim.

My youngest daughter accidently hit a pedestrian. She ran over his leg, broke his ankle. Per the police report, it was a simple break, no surgery, etc required (he didn’t even drop his cigarette when he was hit). My daughter was at a stop light and got the green arrow to turn left. The guy was standing in the crosswalk arguing with his girlfriend who was already on the curb (and that is who my daughter was watching when she hit him). Because he was in the crosswalk, she is automatically at fault, even though the report says he was crossing against the signal. That is fine, no dispute there. He attained one of those accident, I don’t get paid unless you get paid, lawyers who is going after the full limits of my insurance ($100,000). The insurance (Progressive) countered for only this guy’s medical costs. The lawyer is stating that the insurance has until 6/17 to comply with the $100k demand or he will file a suit against us. For some background, the guy is currently on trial for not registering his address (he’s a sex offender) with a public attorney as his lawyer for that. The girl he was with, that was standing on the curb, is now in jail for the next 18 months for manufacturing meth (and she stole his money while he was on the ground after being hit).

I guess my question is – how likely that this will end up making us pay out of pocket? My daughter was given a minor traffic ticket, assigned a fee and traffic school, which has all been completed and that part is closed now. I have NO issues with the medical bills. Fault or no fault, she did hit him. But I am not familiar with this situation or what my insurance might do in this situation. I know they bring in their own lawyers if we get sued, but does anyone have any experience with this kind of thing? The anxiety is quite literally making me sick worrying about it.

 

[AZDave]

This crack head will soon be $100,000 richer. If policy limits are paid, will they sue for more? I doubt it, but one never knows.

Your deragotory comments about this claimant have nothing to do with the liabilty due.
Who suffered more damage - the car or this dude with broken bones? That is what a jury would be asked at the end of a trial.

Doubtful it would go that far. They probobly will file suit and let Progressive do their job of representing you. When they settle, it will (most likely) include a release for you from further liability. If not, then it is the time to get an attorney.

Takes much attorney effort, gross negiligence along with serious injury to sue over policy limits. I have seen it happen, but very rare.

What does your agent advise you to do?

 

[Diane060421]

From what my agent says, they will not sue if they get the full $100K limit. And Progressive doesn’t want to give them that. Otherwise, my agent has no advice or anything to say. I’m not adding the derogatory comments to convey anything other than just basic information about his character. Regardless of where he was or what he was doing, he definitely suffered (and there isn’t actually even a scratch on the car but I wasn’t concerned about that) and we owe his medical bills. I’m just concerned with how much extra they are asking for and even more concerned with being sued. I just don’t know how the process might work. I’m really hoping for a settlement but Progressive made their counter offer (for medical costs) and so far neither they or the lawyer are budging.

 

[fed up]

Best that you can hope for is that Progressive stalls long enough in an effort to see if there is any medical follow-up which tye pedestrian does not follow and the final result is payment for damages only.
My mom knocked someone down in a shopping center parking lot and was sued for policy limits (100K). The pedestrian went via ambulance to hospital, got a cast, but never followed through with PT or saw a physician afterwards. 2 years later they settled for $25K.

 

[Al3x Lee]

For some background, the guy is currently on trial for not registering his address (he’s a sex offender) with a public attorney as his lawyer for that. The girl he was with, that was standing on the curb, is now in jail for the next 18 months for manufacturing meth (and she stole his money while he was on the ground after being hit).

Irrelevant.

Per the police report, it was a simple break, no surgery, etc

How did the police decide that? Did that report come from a doctor? A statement on this from police or EMT is relatively worthless.

full limits of my insurance ($100,000).

Is that a per-person split limit or CSL?

IThe lawyer is stating that the insurance has until 6/17 to comply with the $100k demand or he will file a suit against us.
I guess my question is – how likely that this will end up making us pay out of pocket?

It depends on how much the claim is worth. They generally can't come after you personally until your liability limits are exhausted, after that, it's fair game. For example, my auto policy has the following language (As do most auto policies)

We will settle or defend, as we consider appropriate, any claim or suit asking for these damages.
In addition to our limit of liability, we will pay all defense costs we incur. Our duty to settle or defend ends when our limit of liability for this coverage has been exhausted.

Most personal auto policies include defense costs outside the limit of liability. This means that any costs incurred by the insurance company while defending a claim against you does not reduce the limit for settlement. You'll need to review your policy to know that for sure.

If they're defending you instead of just paying limits and walking away, that's a good sign.

 

[Diane060421]

When the accident initially happened, the police told us they were going to review the video and get back to us. They came to our house about an hour later and said the guy just had a break and gave us my daughter's minor traffic citation and police report. Later on (just two weeks ago), when I was speaking with the insurance manager (my agent was on vacation), she also said that there was no surgery and his medical costs were around $60,000, but she couldn't go into anything further.

Is that a per-person split limit or CSL? I'm sorry, I'm not sure what those mean? Like I said, this is all new. All I know, is I have $100k in personal injury coverage and that is what they are trying to get. Progressive will get their own lawyers involved, with no additional cost to me, if they file suit. I'm just concerned about the possibility of them getting more. I have heard some horror stories that they could get the limits and beyond and if you can't pay that beyond part, they could even come after your home. The whole thing is making me sick. My daughter has been racked with guilt since it happened.

Again, please don't think I am trying to deny his medical payments. Those should absolutely be paid for. It's the rest I am worried about.

 

[Al3x Lee]

Is that a per-person split limit or CSL? I'm sorry, I'm not sure what those mean? Like I said, this is all new. All I know, is I have $100k in personal injury coverage and that is what they are trying to get.

1. What is your bodily injury liability limit? It's different than personal injury when it comes to insurance.
2. Split limit and combined single limit are two different types of liability coverage options in auto insurance. Here's an explanation of each:

Split Limit Auto Insurance:
Split-limit auto insurance provides separate coverage limits for different types of damages that may arise from an accident. The coverage limits are typically represented by three numbers, such as 50K/100K/30K. Here's what each number represents:
The first number (e.g., 50K) It represents the maximum amount the insurance company will pay for injuries to a single person in the other party involved in an accident caused by the insured.
The second number (e.g., 100K) represents the maximum coverage amount for bodily injury liability per accident. It represents the total amount the insurance company will pay for injuries to all individuals in the other party involved in an accident caused by the insured.
The third number (e.g., 30K) indicates the maximum coverage amount for property damage liability. It represents the total amount the insurance company will pay for damages to the property of others in an accident caused by the insured.
In a split limit policy, the coverage limits for bodily injury and property damage are separate, and the policyholder must choose the appropriate coverage limits for each category.

Combined Single Limit Auto Insurance:
Combined single limit (CSL) auto insurance provides a single total coverage limit that applies to both bodily injury and property damage liabilities. Unlike split limit coverage, there are no separate sub-limits for different types of damages. Instead, the CSL represents the maximum amount the insurance company will pay for all covered damages in a single accident, regardless of whether they involve bodily injury or property damage.
For example, if a CSL policy has a limit of $100,000, that means the insurance company will pay up to $100,000 in total for all damages resulting from an accident caused by the insured. The distribution of the coverage between bodily injury and property damage will depend on the specifics of the accident and the claims made by affected parties.

When the accident initially happened, the police told us they were going to review the video and get back to us. They came to our house about an hour later and said the guy just had a break and gave us my daughter's minor traffic citation and police report. Later on (just two weeks ago), when I was speaking with the insurance manager (my agent was on vacation), she also said that there was no surgery and his medical costs were around $60,000, but she couldn't go into anything further.

Who's the insurance manager? I'm assuming that's not the claims adjuster. If it's the agent, they likely don't know more than you do about the claim. You need to talk to the claims adjuster.

The police don't have the tools or training to diagnose the extent of an injury like that. It requires at minimum an x-ray and a doctor.

Also, were his medical costs around $60,000, or is that the amount Progressive reserved on the claim? If they've already incurred $60,000 in medical costs, you should definitely be worried.

I have heard some horror stories that they could get the limits and beyond and if you can't pay that beyond part, they could even come after your home.

That's because the stories are real, which is why you need to figure out what your actual liability limits are and probably increase them before you have another claim.

Whoever your agent is is doing a terrible job, no wonder you're so anxious. They should tell you what your actual coverages are, if the claim has a reserve of $60K or an actual incurred expense of $60K and tell you to refer to the claims adjuster for any additional details.

 

[Diane060421]

I believe it's CSL - the claims adjuster said they are entitled to up to $100,000 for this accident. What it actually says on my policy is
Bodily Injury & Property Damage Liability
$100,000 each person,$300,000 each accident,$100,000 each accident
The manager was just the supervisor of the claims adjuster (adjuster was on vacation when I called, so I was directed to the supervisor). She said that the $60000 was what was submitted to them by the lawyer for total medical costs (the accident took place in December).

 

[marindependent]

One thing that has not been stated [or perhaps I missed it] is - Is there any long term damage to the injured party? Is he fully healed? Has he lost time from work?

 

[Diane060421]

I don't believe he had a job. As far as the rest, I have no idea. Any time I ask a question similar to that, I am told that they are not allowed to tell me any specifics.