QUESTION:
I was rear-ended in December. CT shows 2 herniated disks in my neck and lower back. I am in tremendous pain and the insurance company said they will only pay after I have the surgery. I have no health insurance so I cannot afford surgery. They told me to call Medi-Cal. Is it true that insurance companies will not pay for needed surgery until I have the operation and pay for it on my own first? I need an attorney but I don’t know who to trust or where to start.
ANSWER:
Insurance companies shall reimburse the claimant upon proof of medical bills. The “value” of plaintiff’s claim ultimately depends on evidence to support it. Plaintiff’s naked assertions as to pain and suffering, medical expenses, loss of earnings and earning capacity, etc. will have little effect on an insurance claims representative or jury without corroborative proof. To evaluate claimant’s first demand and formulate an offer on the carrier’s behalf, the claims person will need to review whatever reports and records are available regarding claimant’s injuries and damages. Indeed, copies of medical reports and bills, and documentation of other out-of-pocket losses, will be essential to support the claims person’s request for authority to extend a settlement offer.
Moreover, to aid you in searching for a trustworthy lawyer, the following are some of the most readily accessible sources to identify potential experts: First, jury verdict summaries (see ¶ 4:64 ff.) may disclose experts who testified in similar cases, and therefore offer good referrals to potential experts. Second, from attorney colleagues since similarly, fellow attorneys who tried similar cases may offer excellent referrals to potential experts. Also, reported appellate decisions can be an excellent source for determining which attorneys to contact. The decisions always contain the names of the lawyers who tried a particular case. If, in reviewing the advance sheets or conducting legal research, you find a recent case involving issues similar to yours, consider contacting the attorneys who tried the case; usually they will gladly identify the experts they used and offer recommendations and opinions regarding those experts. In any event, when consulting with colleagues, don’t limit yourself to attorneys who represented interests similar to yours. Counsel who represented the other side of the issue will usually disclose the experts they confronted in similar cases, and these experts may be the most persuasive.