Is Progressive Dragging Their Feet?

[djs]

Not sure what you are thinking.

Blueshield has hard costs that they are out of pocket. They will be reimbursed. This goes for you as well.

Problem is, if the person who hit you had only 15K in liability coverage, you may (have) exceeded this. In that case, they will prorate your expenses and BlueCross expenses and pay both a prorated part. No real settlement to accept here. Money runs out first.

If the limits are higher, say 25K, which may be enough to cover the expenses, then expenses will be settled first and then there may be some additional for a settlement offer.

If their coverage is higher, then you may be able to recover loss of wages and other settlement issues.

Dan

 

[lorrieduke]

So are you saying Progressive will just take it upon themselves to pay Blueshield without discussing it with me first? Because suing the at fault party is still under consideration. I mean if the at fault party didn't purchase enough insurance to pay for all my medical bills plus my pain and suffering I will sue him and how can Progressive just pay my medical like that? Isn't that part of the "settlement?" I understand what your saying about the at fault party may not have enough or barely enough to cover my expenses.
It's frustrating. I'm just wondering if Progressive will automatically just pay Progressive without involving me? I know, anything that might be left could be my pain and suffering.

 

[djs]

I'm saying they likely won't pay anything until all the bills are in.

I'm guessing that policy limits may be coming into play. Things always slow down when there is a chance, even remotely, that policy limits may be an issue. I'm only guessing that this is an issue though.

When it comes to payouts, they will cover 'economic' losses first. These are the things you can put a real $$$ value to, from the property damage to medical bills to lost wages.

After those are covered, if there is policy limit room and the case warrants, they will look at non-economic losses. This is basically pain and suffering.

So yes, unless there is a problem, they will pay bluecross without talking to you about that. They are required to. Bluecross paid that money on your behalf. This should cause them to reimburse you for deductibles and copays though.

At the same time, Progressive should send you a check for your economic losses. If there is a policy limit problem, they will prorate between your losses and Blueshields losses. If that happens, then deductibles and copays will also be prorated.

Yes, you have the option to sue the other driver. It may take a while, make sure there is something there to sue for. If policy limits were exhausted, then the insurance company is out of the picture.

You can also file through your own carrier if you have uninsured / underinsured motorist coverage. This probably will not cover pain and suffering though (you would have to check your policy). It would possibly cover shortage of coverage to cover economic losses though.

Dan

 

[BlockO]

hate to tell you, but that's probably not a good option. if the at fault party was worth anything as far as assets, you wouldn't be in the spot you're in now.

higher liability limits would have cost pennies on the dollar, if they had assets valuable enough to be sued for.

 

[indienoise]

Indienoise- what do you mean I'm still under 60 days? The accident was September 24, 2014. I don't understand what you're saying.
Dan- they can't just pay Blueshield unless I accept a settlement offer right? I mean they won't just pay Blueshield before settling up. Is that correct?

The adjuster is not going to attempt to make payment until all the facts are in. While you are still receiving medical treatment and/or waitingbto discover nedical bills, you cant hold that time against them. Once all the expenses are known, THEN you have reached the settlement phase. It appears that has happened in the past 60 days.

To put it another way, you don't start shopping for an item, make your final decision a month later, buy it from amazon, and then email them the following day that you've been waiting on it to ship for a month. You've been waiting on it one day. I understand your wreck was over 6 months ago, and you probably have medical billing departments hounding you for what remains of their bill. I'm just saying in all fairness, you've not been waiting for progressive to pay you for 6 months. I do hope they are able to resolve your claim quickly though. I know sometimes adjusters DO handle things very slowly. just trying to help you see it from their perspective as well.
Also, even though it's not right, some adjusters are imperfect people and can be vindictive. Ive dealt with the type of adjysters before that, if you bug them enough aand say the wrong thing to them, they'll move you to the back of their line.

 

[lorrieduke]

Sounds to me like an adjuster who became vindictive and moves a person to the back of the line is behaving in bad faith. That's the kind of crap that gets insures sued. There are a lot of assumptions made on this forum and it's aggravating.

 

[VolAgent]

Sounds to me like an adjuster who became vindictive and moves a person to the back of the line is behaving in bad faith. That's the kind of crap that gets insures sued. There are a lot of assumptions made on this forum and it's aggravating.

Exactly what were you expecting? You have come here and given less than a complete picture and asked for opinions. Those opinions are going to be based upon assumptions and past experience.

I really hope you aren't speaking to the adjuster in an angry tone. He does have the ability to prioritize his work and if he feels you are a pain to deal with, he certainly may not make you a priority.

 

[djs]

In fairness, insurance companies have state mandated timelines to resolve claims. Most claims don't come close to hitting this requirement.

Some claims go over the required timeframe. In this event, the insurance company needs to file a notice with the state why it is taking longer than it should. This happens, usually when a claim can't be settled for a variety of reasons.

Carriers can only have a certain percentage of extended claims. Since you are probably starting to hit that list, managers and others are going to be pushing this to completion pretty soon, if it can be done.

Progressive has already written the check in their books (as a reserve for the claim) so sending it out isn't an issue to them. They want to get the claim closed, but they don't want to get into a situation where they have to pay more later because they didn't have all the facts up front.

I doubt the adjuster is being vindictive. That might happen and cause a day of delay, but they are held accountable for getting claims closed. They don't keep them open if they have a way to close them.

The adjuster should tell you (in general terms) what the hold up is on getting this resolved. I'm not sure what your last conversation with them was about or when it was, but I would call once a week and check the status. Maybe twice a week.

Nobody here really has any information to provide since there are big gaps in what you presented. I can only surmise there is a policy limit problem, but I'm guessing. Doesn't mean the other person doesn't have assets. I'm not even clear if there are other people involved that are also filing claims. If so, that can raise a lot of other issues.

Dan

 

[Josh]

Sounds to me like an adjuster who became vindictive and moves a person to the back of the line is behaving in bad faith. That's the kind of crap that gets insures sued. There are a lot of assumptions made on this forum and it's aggravating.

To put more emphasis on this point, the adjuster stands to gain absolutely nothing by being vindictive. For you this is very personal, for them it's just a part of their job.

All this talk about suing is probably misplaced angst. The person at-fault in the accident is on the hook for making you whole and the insurance carrier is just the way they financed it.

Rough numbers it looks like you owe $3,590 in copays/deductibles which is a lot less than $20k. If you explain the situation to the medical providers, that Progressive is on the hook for it, that should buy you time to pay without getting any late fees, but it might not.

Are there any other accident victims waiting in line to get a check? They cut you the check for the property, that's easy to valuate. Have they conceded that your medical bills were directly related to the accident and assumed liability for them?

Again, the adjuster has absolutely no reason to be vindictive; people act in their best interest and it doesn't serve him any good to have an angry claimant when it's not even his money he's paying out. Also, the insurance company doesn't care if you sue them. Not at all. It might slow down your claim because they may take a closer look at the facts plus they'd only be able to communicate to you through an attorney at the attorney's convenience.

Are you expecting some type of a payout for pain and suffering or are you just looking to get your medical bills paid?

 

[lorrieduke]

Thank you. Yes, I'm expecting pain and suffering because broken ribs are very painful. I couldn't sit, stand or move for nearly 12 weeks. Sleeping hardly ever happened as I could not get comfortable but when I did sleep it was in an upright position. I couldn't dress myself or even go to the toilet by myself. Couldn't go any where because getting in and out of a vehicle was impossible until right around eight weeks. I missed Street Vibrations and my nieces wedding which was the weekend after the accident. I missed my daughters graduation ceremony in Quantico, VA. because of the pain. Since it has been determined that all my injuries were a direct result of the accident caused by their insured who is 100% at fault, Progressive has stated they accept full liability. And, I totally get it. I mean I'm not the only claim the adjuster has and she's probably over worked. Progressive said they are entitled to the same discounts Blueshield gave when Blueshield paid the doctors (contractural agreements.) So, I faxed the Explanation of Benefits showing what Blueshield paid, to Progressive. So instead of my bills totaling $20k they are discounted down to $15k and I totally agree that Progressive should only have to pay that amount, not the higher amount. I get it and know it was only a few weeks ago that I faxed the EOB's. What Blueshield didn't pay, I just paid myself today. and by the way it was a lot more than $3590. Blueshield is already knocking at my door asking me for their money back. What I paid today was out of pocket. Included my yearly deductible and all co-pays. Put a big dent in my checking account but everything is paid. I'm confused tho. Since sending Progressive the EOB's from Blueshield, will they just reimburse Blueshield directly and how can they do that? I mean I have not given Progressive my consent to access or discuss any of my medical history with anyone because I don't feel it's necessary for them to have access to my entire medical history and instead told Progressive I'd get them anything they need pertaining to the accident and have. They received all doctor, radiology, etc. notes and reports. Everything they've asked for, I've provided. They seem ok with that and told me consent wasn't required anyway. I guess I just thought they'd cut me the check then I'd be responsible for paying back Blueshield and figured if the bodily injury limits were high enough, that check would include pain and suffering. Thank you for being kind. You and Dan are the best. So many others on this forum seem to take offense easily and are slightly arrogant.