Legal Question in Personal Injury in Pennsylvania
medical calculation
When adjusters add the total medical expenses for settlement, do they take the provider's billed amount, or the amount allowed by the health insurance company for the $ amount of the medical expenses?
Asked on 6/27/07, 11:39 am
1 Answer from Attorneys
Re: medical calculation
Adjusters look at the actual out-of-pocket number of the claimant, whether it is an unpaid bill or anything that an insurance company paid that it has the right to re-claim. Adjusters take the lower of those numbers or the "Act VI" number, and base their decision on that. (Act VI is short-hand for a Pennsylvania law that puts particular dollar amounts on specific medical procedures.) Although it is straightforward in theory, the mechanics of calculating economic damages can be complex.
Answered on 6/27/07, 11:45 am
Related Questions & Answers
Looking for something else?
10,200 active attorneys ready to answer your legal questions today.
Featured Attorneys
Earn additional revenue and grow your business.
