This post is admittedly a little “inside baseball” in that it deals with a very particular question in the claims management process. But it’s a question that’s arisen enough that I think it merits its own blog post, so here we go…

When we begin your claim, one of the many things I tell you is that when you’re released from medical care and deemed to be at “maximum medical improvement,” (MMI) that’s the point at which I request all of your records and bills. So it’s vital that I know precisely when that occurs.

What often happens is that a health care provider will predict to a patient that their next visit will be their last, or they’ll be done in 2 more weeks. The patient/client might hear that as fact and then report to me that they will be (future tense) done then.

The problem with that from my perspective is two fold: First, you might not actually be done, and second, you might not be at MMI.

I would say that more often than not, when a provider says you’re going to be done in 2 weeks, they actually end up having you come back at least once more, and maybe for a whole new round. The thing is, we just don’t know! So what I don’t want to do is take the 2 week prediction as fact and send out requests, only to find out it was inaccurate and then have to send those same requests yet again some other time when you are actually released. Let’s not do extra work. Let’s just wait until you’re actually released and truly done with treatment.

And even if that provider says you’re done with treatment, are you really at MMI? They may not think you’re at MMI until 1 year post-incident, or maybe 3 months post-release from care. Until you’re at MMI, they ‘re not going to be able to give me a full picture of your recovery in their notes, so even if they’ve predicted your release, you may not be at MMI, which means it’s just not time for me to go fetching stuff.

In short, you’re not REALLY done with treatment until your doc says, past tense, you are done with treatment. That’s when you know you’re done, and then it’s time to tell me. Not two weeks before. Not any time before. But AFTER you’re ACTUALLY released.

I know, I know, it’s a little picky, but that’s what you’re paying me for, to be picky about your claim. That just means I’m doing it right! If you have an injury claim in NC, call me at 919-929-2992.

I’ll be the first to tell you that any kind of insurance claim can be needlessly complicated. That’s essentially why my job exists. If handling your own bodily injury claim in North Carolina was easy, I would be out of a job. The good news is that handling the property damage portion of your claim is probably something you can handle on your own. In fact, having your attorney handle that bit, too, might even make it worse. Why is that? Soooo glad you asked!

The first thing you should know is that if you’re in an automobile accident in NC your property damage claim and your bodily injury claim are SEPARATE. It’s OK to handle the first one without finalizing anything on the second. If you’re worried about it, get an attorney for your injury claim and they can walk you through it, but you don’t need them to handle the property damage portion (more than likely, anyway).

There are really just two kinds of property damage claims: Repairs and Total Losses. If your car needs repairing, take it to whatever shop you want (you’re not forced to use anyone the insurance carrier recommends, but you can) and have them work on it. The carrier might send you an initial check, but don’t worry! That’s not the last one, I bet! If the body shop sees other stuff that needs work (they almost always do) they’ll ask the carrier themselves to send a supplemental check and that’s normally done pretty seamlessly. When you get the car back, just make sure everything feels right and the second you notice anything off, take it right back and tell them. That should keep it on the at-fault carrier’s dime and not yours, so don’t wait too long!

If the costs of repairing your car exceed 75% of the car’s value (a moving target, btw), then the carrier can deem it a “total loss.” At that point what they owe you is the fair market value of the vehicle at the time of the accident. An average of the stuff you find on websites will give you an idea as to what that number is (let them give you their number first, as sometimes it will exceed yours, but not always). If you really, really, really love your car and want to salvage it, they’ll give you near FMV (minus a few hundred bucks) and you can have it and do with it as you wish.

Most of the time, these things go fairly smoothly. More importantly, there’s not much that an attorney can do to change them. Repairs need doing or they don’t. The car is worth roughly what it’s worth. There’s not a lot to argue about in these situations. Of course, there are exceptions to every rule…maybe it’s taking too long, maybe the values you’re discussing are night and day, etc. If you’re really having trouble, you can talk about those issues with an attorney, but just keep this in mind: Almost no one is happy about their property damage. It either took too long, it was too inconvenient, they hated the rental car, or they really wanted their car to be worth more than it was. It’s just hard to be satisfied with the state of our system. But there’s a lot more that an attorney can do with your injury claim, so maybe that’s where you can find some satisfaction. Call me at 919-929-2992.

You’ve been hurt in an accident in North Carolina. You need to make a claim to make sure you’re reimbursed for your losses. What are the best tips a seasoned NC personal injury attorney would give you? Here ya go:

1. Everything you say can and will be used against you. You will probably be asked to make a statement about how the accident leading to your injury occurred. You should assume that every word out of your mouth will be turned against you, so think twice before making a statement. If you’re in a position where you feel like you have to talk, then make your statement clear, simple, and concise. But also consider that you should maybe talk to an attorney before talking to anyone else about how the accident occurred.
2. Don’t “tough it out.” I know, I know. You don’t want to make a big deal out of it or whatever. But if you’re hurt, you’re hurt. And that means you should seek medical treatment/advice. The longer you delay that, the worse your claim will be treated by the insurance companies involved in it. You get ZERO points and do your claim no favors by trying to be a tough nut and act like you’re not hurt. If you’re feeling in any way different after the accident than you did before it, get checked out.
3. Use your health insurance. This is one of the common mistakes that people make, thinking that the at-fault insurance carrier is going to pay for their medical treatment. They might. But that’s only AFTER the fact. In our state, you own your medical bills until you make someone else own them. And this is why you have health insurance, so use it! If the health care provider thinks they shouldn’t, tell them they’re wrong. If they insist they can’t, then seek another provider. Chiropractors are the exception to this rule in that the co-pays compared to the frequency of treatment really make it somewhat unattractive to use your health insurance with them. But for pretty much every other health care provider, use your health insurance!
4. As soon as your health care situation is stable, talk to an attorney. I never want to be someone’s first call after an accident. If you’re in an auto accident, call the police first. Then get your care situated. THEN call me. But at the same time, don’t delay too long! Seeking advice too late in the process just increases the pool of time during which you can be manipulated into making a mistake. So talk to an attorney as soon as you can after your health care situation is stable.

Could I give you more? Maybe. But these are the high points. Follow these rules and you’re setting your claim up for success. Fail to follow them and you’ll see what happens. Call me at 919-929-2992.

Perhaps you’ve heard horror stories of dealing with attorneys (no call backs, they get paid more than you do, etc.). Perhaps you’re worried about the claim taking longer than it would otherwise if you hire an attorney. Perhaps you think hiring an attorney is an unnecessary escalation that is going to create a worse outcome. Whatever the reason, lots of people have given me lots of reasons why they were hesitant to hire an attorney. For the most part, they were unfounded (though very understandable). They simply just didn’t know the truth. Here’s as much truth as I’m legally allowed to put in one blog post:

Some attorneys do suck. I’m not naming names, but some attorneys (or their offices, really, to be more precise) have a bad reputation for not being very communicative, not calling clients back, not keeping clients in the loop, etc. It’s a thing, for sure. The trick is NOT hiring one of those. But how are you supposed to know? First, ask your friends and family for referrals. If someone says they had a good experience with an attorney, ask them what was good about it and go from there. That might assuage your fears. Second, for the most part, you can trust Google Reviews. Those are not easy to fake, so for the most part those are actual clients sharing actual experiences, so you can probably go by what they say. Third, call around and see what you get. Who is answering the phone? Is there some Byzantine system for actually talking to an attorney, or do you get to talk to an attorney (not a case manager, not a secretary, but THE attorney) immediately? This will tell you a lot about what to expect.

Yes, sometimes claims take longer than you think. But maybe that’s more about your expectations being wrong and less about the performance of your attorney (though that can be a factor, of course). The first thing you should know about how long your claim should take to resolve is that there is normally no reason that settlement discussions should happen until AFTER you’re done with your care. So the length of your recovery is the biggest factor in how long your claim will take to resolve. It’s not the only one, but it’s massively important. Your reaching maximum medical improvement is the indicator for an attorney to start trying to gather all relevant material to value your claim, so until you reach that, you’re just going to have to be patient. Moreover, JUST because you hire an attorney doesn’t mean your claim will take longer. Think about it: What do I have to do with how long your treatment takes? And if that’s the biggest factor, how am I prolonging things? Now, don’t get me wrong; handling insurance claims does fall under the old maxim, “Do you want it done quickly or do you want it done right?” Sometimes for me to do a thorough job I need time to do my job, but that normally doesn’t add a significant amount of time to the claims process.

Hiring an attorney is not an unnecessary escalation and will not/should not result in some negative consequence in and of itself. Think about it: If you’re an adjuster, would you rather work with a personal injury attorney who knows exactly what you need to give him the best value on a case or some first-timer who is injured, stressed out, and totally clueless? Trust me, adjusters don’t take it personally when you hire an attorney, and they may even thank you (silently, of course). But more importantly, who cares? Are you worried about pissing off your toilet by hiring a plumber to fix it? That’s just dumb. If you have a problem that requires a professional, hire a professional to deal with it.

I get it. It’s a big deal and you want to make sure you’re making the right decision. The thing is you just don’t know until you try, but to me, the logic is on the side of trying as opposed to winging it on your own. Call me if you want to talk about it. 919-929-2992.

In the Triangle, and in Chapel Hill specifically, we probably have a LOT more pedestrian activity than most areas in North Carolina. With lots of college kids, youngsters, and commuters, auto accidents involving pedestrians are all too common.

You would think these wouldn’t happen as much as they do. We have traffic lights and crosswalks galore to help prevent these accidents. But people on both sides have problems following the rules (often because they don’t know them, but more often because they are distracted). But even then, once a pedestrian is in the roadway, drivers have a duty to yield, even if the pedestrian shouldn’t have been there. This is quite reasonable when you think about it because we’re just allowed to kill people simply because they’ve made poor decisions. But this can look very different in different situations. We are all under a “reasonable person” standard – drivers AND pedestrians (see my work on Contributory Negligence) – so we have to do what a reasonably prudent person would do in similar circumstances. So should someone walk across I40 at night wearing dark clothes? Probably a bad idea. Conversely, if someone jay walks on Franklin Street, can I run them over without fear of consequence just because they were breaking the law? Nope.

As with many aspects of the law, things can be nuanced and you’d probably be best served to speak with an experienced personal injury attorney if you have a pedestrian v. auto accident claim.

Call me for help with any injury claim. 919-929-2992.

Let’s cut to the chase: You could handle the negotiation of your injury claim if you wanted to. Totally. But I could also build a house if I wanted to. But that would be one shitty house. So how do you think your claim is going to work out?

Here’s the main reasons you should hire an attorney:

• You’ve only got so much time; do you have time to learn how to do my job?
• You want to focus on your healthcare and your family, not dealing with the insurance company.
• The insurance company adjusters will use the rules to hurt your case.
• An Attorney can help level the playing field for you.
• An Attorney is trained to counter the adjuster’s tactics, develop the strengths of your claim, and help maximize your recovery.
• With an attorney, you can save your time, and maybe get more of the money you deserve.

I would be terrible at your job the first time I tried to do it. And probably the second time and third time, too. So if this isn’t your field of expertise why do you want to risk your claim? This could be a life-altering transaction, so why wing it?

If you have an injury claim in NC, call an attorney. Call me at 919-929-2992.

Many times an accident is just an accident. You get banged up a little and you move on. But sometimes it’s just not so simple.

If you have emotional trauma following an auto accident in North Carolina, you’re not alone. PTSD and associated conditions are legitimate injuries sustained as the result of some automobile accidents and you can seek compensation for these sorts of damages.

This kind of claim is referred to as a negligent infliction of emotional distress claim. Sounds complicated, but it’s not. If you have suffered this sort of trauma, the main thing you should know about NC law in this context is that in order to make a successful claim, you HAVE to get a diagnosis from a health care provider. You can’t just say your feelings were hurt. You have to get a diagnosis. And this is for the best, right? With a diagnosis from a provider, you can also get treatment recommendations, and in the end, getting better is the most important thing, regardless of the claims process.

If you have a negligent infliction of emotional distress claim from an auto accident in North Carolina, call me at 919-929-2992

If you have Medicare and you’re involved in a personal injury claim in North Carolina, that fact WILL have an impact on the resolution of your claim.

Medicare would like to not pay for treatment that someone else is paying for, but in a liability state like NC, liability coverage doesn’t pay for treatment as you go, which means there’s a dispute as to payment and there is no coverage when the bill is incurred so Medicare CAN AND WILL pay for your injury related treatment.

https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Attorney-Services/Attorney-Services

BUT, they are going to want their money back! The details of how we go about that process are for another post, but suffice it to say that if Medicare paid for any treatment related to your claim – PCP, Urgent Care, Emergency Department, etc. – then we HAVE to ask Medicare what they want back and we have to go through that process.

This is not the end of the world! It’s really not that onerous. Now, their system is in some ways backwards, but it is something that we can work through and resolve over time. The main things that you need to take away from this is that a) If Medicare even might have been billed for accident related treatment, I HAVE to jump through their hoops – even if you don’t want me to, and b) it will add a bit of time to your injury claim process. As to how much time it might add, I can’t say for sure, but generally we’re talking weeks, not months, so it’s really not that big of a deal.

So if you have Medicare and you are involved in a North Carolina personal injury claim, just know that we’re going to have to deal with Medicare and it’s going to take a little longer than you might hope, but if you have good representation, it should all be OK. Call me at 919-929-2992.

When you’re in an auto accident you are very likely to need some form of medical treatment. That might be some ibuprofen or it might be surgery. For most people, it’s PT and/or chiropractic care. For those folks, they almost always ask me this question: How long should my treatment last?

The short answer is I can’t say how long your treatment should last.

The long answer is that, of course, I’m not that kind of doctor so I really don’t have any business giving opinions as to the length or course of your treatment. Having said that, it is important to understand how the length of your treatment might impact your claim negotiation. On THAT topic I’m imminently qualified to opine.

Generally, if you’re in need of PT and/or chiropractic treatment following an accident, you’ve suffered some sort of soft tissue sprain/strain injury, normally to muscles around your spine. With those sorts of injuries we normally see clients improve within 3 to 6 months of the accident. Is that always the case? Certainly not. But is that the average? It certainly is. So how does that impact your case value?

That could be a very long answer, but I hate long blog posts. For the point of this post, let’s restrict the answer to one issue: Perception. When your treatment extends past the average time, it starts to raise red flags with the at-fault insurance company. Why isn’t this person getting better? There may be some very valid reasons. Or they might just be “malingering,” which is a term that insurance adjusters use to mean “you’re just pretending you’re hurt to make money.” That’s less than ideal. So how do you avoid it?

There really isn’t a way to avoid this scenario, per se. You can hope that your course of treatment will terminate in the average time so that you don’t run afoul of industry perceptions and you’re more likely to get the claim resolved easily. But if you start to linger past that time frame, it’s time to talk to your physician and your attorney to discuss what’s going on. It might be time to seek a second opinion.

All of this stuff is complicated. It’s probably a good idea to have an attorney. You should call one. Call me. 919-929-2992.

One of the topics I constantly discuss with clients is that of aggravation of pre-existing injuries. “What dat mean?” you might ask. Buckle up.

First, let’s talk about what it’s not. Let’s say you’re feeling fine and you get in a car accident and THEN your neck and back start hurting. You have no history of neck or back pain and no complaints prior to the accident. You have some neck and back pain after the accident and your doc supports the causation argument that the impact caused soft tissues injuries in and around your spine. THAT’S a new injury. And that’s great. It’s ALWAYS easier to convince a liability carrier to pay for new injuries. What’s not as easy to convincing a carrier that they should pay for aggravation of a pre-existing injury.

Let’s say you were in that accident above and had some neck and back issues. You were in treatment and still suffering from symptoms when BOOM! the gods of the highway curse you with ANOTHER accident. Your neck and back were in pain before, but NOT as bad as they are now after this second accident. What you have now is aggravation of a pre-existing injury, and that’s never easy to win.

When you’re arguing about aggravation of an old injury, how do you prove what percentage of the pain/suffering/etc. was caused by the second impact versus the first? This can be a very difficult thing to do, especially when you have a soft tissue injury that doesn’t really show up on diagnostic imaging. This can lead to a very complex causation discussion involving your treating physician and maybe other experts.

As with many things dealing with personal injury claims, it’s best to seek the help of a professional if you’re having these sorts of questions and concerns. Call an attorney. Call me at 919-929-2992.