Legal Question in Personal Injury in California
My 24 year old was a passenger in a not at fault accident. His friend's coverage did not have med-pay. They had to wait to collect from the third party insurance. My son seeked medical and chiropractic care immediately after the accident. But the chiropractor's office refused to bill his personal health insurance, instead they want to wait to collect from the third party insurance. After several months of treatment, the chiropractor's bill totaled about $4300, while his medical bill was $1200. The third party insurance company came back with a low offer of 4000 to settle his medical and chiropractor bills and $1000 to pay for pain and suffering and $500 for work loss. Stupid as it seems, my naive son accepted the offer.
Does this mean my son have to pay the chiropractor's outstanding bill with his pain and suffering money? Can he demand the chiropractor to bill his personal health insurance after the settlement? In CA, isn't your own health insurance the primary insurance under any circumstance? Also the chiropractor's office asked him to sign a Irrevocable assignment of benefits, does this paper has any legal say?
2 Answers from Attorneys
Tell the Chiro to bill son's health care insurance or he won't get paid - period. Don't argue with him, just state your position as a fact and hang up.
The chances that he will sue your son is possible but remote. Should he sue, the Court may well order the Chiro to accept payment from your son's health insurance as settlement of his bill in full.
Do not let the Chiro try to push you people around.
The answer is yes and the major medical carrier has a duty to accept that bill as long as there is applicable. Additionally, the health carrier cannot say that the payment was not timely submitted according to it's policy terms whether those terms say the charge must be submitted within 60, 90 days or even 6 months. Under the law a claim for payment even a year and policy terms that are shorter and thus inconsistent are wrong and irrelevant. The chiropractor is not in control. Get an attorney to help you if the medical insurance denies your claim. I hope this helps. Regards. Bob
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