Legal Question in Personal Injury in California

I was in an automobile accident about 9 months ago and am in the process of filing a claim with the insurance company of the driver who was at fault they have instructed me to remit all medical documents including the billing information, since I have health insurance my bills have all been paid and it shows this on the bills I am going to send the claims adjuster now my question is this: on one bill it shows $1375.00 as the total billed and it shows that my heath insurance has paid $218.17 and it also says paid in full, now can I black out the amount that my health insurance provider has paid leaving only the total billed or is that not legal. The reason I ask is I am assuming that the claims adjuster will base the settlement off of the dollar amount of my medical expenses. any info would be much appreciated. Thank you


Asked on 3/31/10, 11:36 am

2 Answers from Attorneys

George Shers Law Offices of Georges H. Shers

What you do as to blacking out numbers is not a question of being legal or not. The adjuster will assume that your medical insurance did not pay the full amount becuase they neer do. Seeing the actual figure wil remind him/her and such a sharp discount might make them down play the amount of the billing. You could black it out and just say in an accompaning note that what your medical insurance paid is irrelevant. Either the California Supreme Court or United States Supreme Court, I thnk the latter, is going to hear somethime this court year whether the defendant must use the full amount billed or can use the amount reimbursed as a measure of the damages. But your case will likely settle before that issue is decided.

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Answered on 4/05/10, 12:35 pm
Edward Hoffman Law Offices of Edward A. Hoffman

You are entitled to be reimbursed for the amount the insurer paid plus the amount that you either have paid or are responsible for. Once you receive the payment, you must then reimburse the insurer for its share.

(This answer is a bit oversimplified, especially if your claim exceeds your policy limits. But it's a useful summary.)

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Answered on 4/06/10, 5:43 pm


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