Legal Question in Insurance Law in California

Insurance claim

my wife met an accident and was operated.the medical bill cost almost$50,000.00 and the bills keep filing up.the doctor said that she may need another operation if complication comes. the estimate for such operation might cost for another $40,000.00. also my brother who is the driver and owner of the car also has some medical expense for such accident already in the amount of $15,000.00.a court case was filed with the state of california versus the other party involved regarding this accident and the said party pleaded no contest plea. and agreed with their insurance company to settle the medical bills only up to the policy limit(referenced matter is 100/300 or $100,000.00 per person and $300,000.00 per incident.)the defendant have no available excess or umbrella policy. since my wife's medical bill is $50,000.00

plus attorney's fee can we claim beyond the $100,000.00 for future medical and bone operation of $40,000.00? is this covered on

the $300,000.00 per incident? since the other

party has no capacity to pay the excess expenses

can we compel the insurance company to shoulder

the medical expenses? if not what other options

are open to us?

thank you.


Asked on 1/30/99, 6:13 pm

2 Answers from Attorneys
Edward Hoffman Law Offices of Edward A. Hoffman

Re: Insurance claim

If you can prove the necessity of additional medical treatment, then you should be able to include the cost of that treatment in your damage claim. However, the insurer will not pay you more than the $100,000.00 per person limit in the policy, even if your damages exceed this amount.

Your options include pursuing the insured for the balance -- you say that the insured has no funds to pay, but people who claim to be broke often aren't. You should also see if your own insurance will cover the difference. The other insurer, however, is off the hook once they've paid the $100,000 per person policy limits.

Edward Hoffman

Law Offices of Edward A. Hoffman

11620 Wilshire Boulevard, #340


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Answered on 2/02/99, 8:02 pm
Steven Murray Steven W. Murray, APC

Re: Insurance claim

You have to review the defendant's policy before

you can tell if the $100K/per person limit is involved,

or if any injury to you (as her husband you may also

have a claim) exists. Also the brother has a claim

and that involves a separate $100K/per person limit.

It sounds like your wife was a passenger. If so, she

may have a claim against the brother, and that would

be separate coverage from the defendant's $100K.

And your own insurance may provide underinsured

motorist coverage, depending on the amount you

carry.

The brother's policy and your own policy should have

some form of medical payments coverage also, separate

and apart from any liability limits.

And if a policy limits demand has been made against

the defendant, and refused by the insurer, those

policy limits may be "opened." The defendant may have

a claim against his own insurer for not settling

him out, and this is assignable to you and can be

worth money.

Make sure your lawyer carefully review your medical

insurance plans/policies, since it may be possible

that you do not have to repay them out of any

recovery you get from any defendant. Subrogation

is not always allowed if the insured person is not

first made whole.

Your claims are complicated and involve some specialized

areas of insurance law, so proceed carefully.

Steven Murray

Steven W. Murray, APC

16055 Ventura Blvd., Ste. 900


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Answered on 3/18/99, 9:27 pm


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