insurance claim questions

[zrxkawboy]

My wife was involved in an auto accident in which the other driver was at fault. She is trying to work with that driver's insurance co, and is having some difficulty. I know some insurance regs vary state-to-state, but I was hoping someone here with some knowledge of the industry could offer advice.

1. The rep told her they could not issue any payment without her SSN. She refused to provide it, and the rep said they would send a letter asking for it. Then, the rep said that in order to pay the claims, they would also need my SSN. (I wasn't even in the vehicle when the accident occurred!) Again, my wife refused, and again, the rep said they would send a request by mail. When asked the reason, the rep said it had to do with Medicare (my wife is 35 years old).

2. The rep said that we would need to pay all medical bills, and then submit them all at once for reimbursement, as they only issue one payment. We would like them to pay the bills directly to the hospital, doctors, etc, but she said they don't do that. She said our other options are to submit the bills to our ins co and then make a claim for reimbursement of our deductible, or just let the bills pile up and not pay them until we receive the single settlement. I don't think we should have to pay these bills ourselves (will probably be a lot of money). I also don't think our ins co should have to deal with it (and possibly raise our premiums). Lastly, we have excellent credit, so I'm not going to just let the bills pile up for what could be months.

I am going to contact our state's insurance division, but thought maybe someone here who works in the industry may have some advice, too. Thanks!

 

[Jimzz]

I would get an attorney if your wife has any injuries. Let them handle it and make your life much easier.

 

[abycat]

Originally Posted By: Jimzz
I would get an attorney if your wife has any injuries. Let them handle it and make your life much easier.


I +1 the [censored] out of this post. darn good advice! sounds like if you don't you are going to get ripped off by your insurance company.

 

[The_Jeff]

Your insurance company should at least kinda work for you. There isn't much in it for them, for good or for bad, but they should do it for the customer service aspect.

They'll cover it under the guise of uninsured motorist, but get the money back from the other ins co, if they know they're good for it.

When I had surgery for worker's comp the doctor had all the insurance info and I didn't have to put in for anything. The forms has big check marks for WC (me) and MVA (you).

As far as the SSN thing, do you want to be right and difficult, and have them torture and delay you more than usual?

 

[JayhawkRoy]

Here's what 21st Century Insurance has to say about collection of Social Security Numbers, in order to pay a claim. Note that this sharing is limited to federal government use.

"As a subscriber (or spouse or family member of a subscriber) to a group health plan arrangement, your SSN and/or HICN will likely be requested in order to meet the requirements of P.L. 110-173 if this information is not already on file with your insurer. Similarly, individuals who receive ongoing reimbursement for medical care through no-fault insurance or workers’ compensation or who receive a settlement, judgment or award from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation will be asked to furnish information concerning their SSN and/or HICN and whether or not they (or the injured party, if the settlement, judgment or award is based upon an injury to someone else) are Medicare beneficiaries. Employers, insurers, third party administrators, etc. will be asked for EINs.

To confirm that this ALERT is an official Government document and for further information on the mandatory reporting requirements under this law, please visit the CMS website at www.cms.hhs.gov/MandatoryInsRep."


"Medicare Mandatory Reporting Requirements
Why do I need to provide you with my Social Security Number, Date of Birth, Gender and Legal Name when I make an injury claim?

In 2007 president Bush signed into law the “Medicare, Medicaid and SCHIP Extension Act of 2007.” This law, known as “Mandatory Insurer Reporting,” establishes the requirement of all insurers and self insurers to report the settlement of all claims involving a Medicare eligible claimant to the federal government. In order to determine who is Medicare eligible, we need identifying information which includes the legal name, date of birth, gender and social security number. We require this information on all parties making a BI, UMBI, UIM, Med Pay or PIP claim."

"Couldn’t I just advise you if I am eligible for Medicare or not?

Unfortunately no. We are responsible for checking the Medicare eligibility of each party making an injury claim with the federal government ourselves."

"What if I don’t feel comfortable providing my Social Security number to you?

Without it, we would not be able to settle your claim. Please see our privacy policy posted on our webpage, www.21stautoclaims.com."

 

[04SE]

File a claim with your insurance company under your comprehensive policy. They WILL fight for you!!!

My wife was rear ended by a 16 year old girl. Her mom wanted to give us $300. I never even worked with her, filed a claim w/ my carrier (state farm) paid $1,000 deductible, got our car fixed and let them fight for me. 3 months later I got my $1,000 back and it does not count as a claim against me. We pay premiums for a reason, make them work for you!! Your insurance company will pay any car/medical bills and then sue the other company and/or policy holder on your behalf.

 

[JimPghPA]

Contact all 3 of the credit management companies and get each of them to put a credit lock on your credit information. With all three of you credit scores locked no one can use your SS no. to open up any new bank accounts or loans. And then you can safely release your SS no. to anyone like an insurance company. The down side to this is you will have to contact the credit company your bank uses and unlock that one credit report for a couple of weeks when your credit card(s) are coming up for renewal review. Usually the bank checks your credit score with one agency about two months before your credit card(s) expire. You will have to pay attention to when your credit card(s) are coming up for renewal. Also you will need to unlock the appropriate credit company if you ever want to take out a loan.

Locking your credit reports is a very low cost way to protect yourself from anyone stealing your information.

If the other drivers insurance company is giving you a hard time then you should contact your insurance company and get them to deal with the other insurance company.

I once had a claim with another drivers insurance company and they were not cooperating with me. I said "I had hoped to keep the lawyers out of this but if that is the way you want to deal with me then I have no choice." A short time after I finished that phone call the other drivers insurance company called me and scheduled a time when they could stop by and deliver the check.

 

[crazyoildude]

Call your insurance company and let them deal with everything unless you are really hurt then call a P.I. Lawyer.

 

[The Critic]

1) I believe this is correct.

2) Not sure - but I can check.

 

[Kuato]

I used to work in the industry, this sounds like [censored].

Not sure about the SSN deal, Bush's legislature was after my time doing auto claims. But they should pay your bills as they come in; the "one check at the end" is a way for them to pay the claim, get you to sign off, and if you have any more issues, to deny those further issues since you accepted payment.

Consult with your insurance company and explain to them what is happening; if you have the coverage on your policy, they should pay you as required while going to bat against the other company on your behalf.

You shouldn't need a lawyer just yet, but if their stonewalling continues, use the phrase "good faith" in a letter and keep a copy. If bad faith can be proved against an insurance company, they can be subjected to huge fines and also getting sued. Lots of info online, here's a good start: http://en.wikipedia.org/wiki/Insurance_bad_faith

 

[DuckRyder]

Is SD a PIP or MPC State?

Health insurance?

I guess we are talking BI (Bodily Injury) if so 2 is usually correct. You generally can't submit a BI claim to your insurance company in absence of PIP/MPC.

For a PD claim, they should pay to have the car repaired or totaled and if you have collision coverage you can have your company handle that and they will subrogate the at fault party.

I don't know about the SS#

 

[zrxkawboy]

Thanks for all the input, I appreciate it!