StateFarm and accident benefits
- Thread starter BMC
- Start date
This is the reason insurance is so high in the GTA
+1
There is no need for $100,000 for a broken arm..... Unless you were hit by a celebrity and settle out of court
+1
There is no need for $100,000 for a broken arm..... Unless you were hit by a celebrity and settle out of court
Well he said for rehab . Depending on the nature of the injury some rehab might be needed. $100,000 seems on the high side at least it would be for most i would think.
I am not saying that all $100,000 is to be used on rehab. Clearly that's not how it works. However that's the entitlement. Just like a person with a Catastrophic Injury is entitled $1,000,000.00.
You have to understand that as a lawyer I have no choice but to sue for the maximum amount possible.
example:
I think a case is worth $30,000 for a final settlement.
When talking with an adjuster I know that the Adjuster was told not to settle for over $30,000.
If I offer $30,000 to settle right away. The adjuster will give me a big fat "**** you" and say $10,000. So I have to calculate from say...$60,000 in order to get $30,000 as the final settlement.
Whoever here thinks that adjusters are working in the best interest of a client are pretty gullible. Just as those that believe that the insurance companies are suffering. None of this is true.
Insurance companies now have bought out the assessment Centers that are supposed to do "Independent Medical Examinations". These IME centers...at least two of the biggest ones, have now been bought out by two Insurance Companies. The people of Ontario simply don't understand how badly the Insurance companies are raping them on the daily basis.
You have to understand that as a lawyer I have no choice but to sue for the maximum amount possible.
example:
I think a case is worth $30,000 for a final settlement.
When talking with an adjuster I know that the Adjuster was told not to settle for over $30,000.
If I offer $30,000 to settle right away. The adjuster will give me a big fat "**** you" and say $10,000. So I have to calculate from say...$60,000 in order to get $30,000 as the final settlement.
Whoever here thinks that adjusters are working in the best interest of a client are pretty gullible. Just as those that believe that the insurance companies are suffering. None of this is true.
Insurance companies now have bought out the assessment Centers that are supposed to do "Independent Medical Examinations". These IME centers...at least two of the biggest ones, have now been bought out by two Insurance Companies. The people of Ontario simply don't understand how badly the Insurance companies are raping them on the daily basis.
I dont think anyone thinks thats I think everyone has a good idea of what an adjuster has to do. The trouble is i dont think anyone realy thinks your working in you clients best interest. Either. Of the $30,000 G settlement what does your client get to take home and what do you keep?
As for the insurance industry not suffering... well they have to be profitable. They are mandated by the government to be...but they defiantly are making much on a per claim basis as per Viffers chart he posted
Problems a big circle of Greed thats why prices are so high.
Greedy people hire Greedy Lawyers to fight Greedy companies.
I wont even begin to get onto the Gready fake clinics places that due cash a cut stuff
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Lets see... Of the $30,000 the client gets to keep $19757. 25% My commission + HST. I hate the HST but I can't do anything about it.
Greedy fake clinics? They aren't all that popular not to mention that they don't have that many clients. I've been to a few of those and when I do find any clinic that I think even remotely is a fake clinic or over charges the insurance company I let the company know so they can conduct an investigation.
Insurance Companies made over $1B this past year. While they were screaming bloody murder and wanted the change that came into place on September 1, 2010 there is something no one realizes.
Back in 2003 Insurance Companies said that they wanted a deductible on the 3rd party claims to raise. At the time the deductible was $15,000. So lets say you won $30,000. You'd have to apply the $15,000 to it...get it? Ok. The reason the $15,000 deductible was put in place was because Insurance Companies paid out ON AVERAGE paid out around $15,000 in treatment. I don't usually see the rehab earning more than $20,000 unless it is a very serious case where a lot of treatment needs to be done, however on average, the average claim is around $15,000 in medical rehabilitation. When the law came into power in 2003 and the deductible was raised to $30,000 the Insurance Companies were yelling that they were losing too much money therefore the change was needed. That year, they saved over $1B each on claims. So that's great right? Not Really. The precurser to that whole fiasco was that they promised to lower insurance rates, instead ontario drivers got a big fat **** you.
Now to the issue at hand: Minor Injury Guideline states that only $3,500 is necessary for treatment. So doesn't that mean that the deductible for a tort claim should be $3,500.00 which is the amount spent on the medical claim? Nope, you still have to go by the 2003 law and still have a deductible of $30,000.
I couldn't tell you how many times I see people saying "oh you are an ambulance chaser.. I TRUST my insurance company. I've been with them for 20 years etc..." Then in half a year I get a call "HELP, THEY DIDN'T PAY FOR ANYTHING. I HAVE NO MONEY, I AM IN PAIN, I CAN'T WORK"
What I am trying to say is this: Sure both sides are biased. And yes, as a lawyer I am looking to make a profit. I have never hidden that from my clients and told them that the more money I win for them the better it is for me. HOWEVER unlike the Insurance Companies, I fight for my client's rights to be upheld and not destroyed like what State Farm, All State, Wawanesa, Aviva and all those other disgusting insurance companies are doing.
and if recovery const is $30000 they are 10 g's out of pocket still
Popular enough to be a problem. Just look up Ragu on this board. Insurance fraud is a massive issue in Canada. Both exaggerated claims and pre-med
Good My stocks did well. BTW how much would be appropriate for them to make?
So seems to me this is a bit of a misrepresentation of what a third part claim is. I aint no fancy pant Lawyer now but I do have google and to quote from the Ontario.ca website
Now correct me if im wrong but it only applies to when you are Sue'd. So its not if you win you pay the first $30,000. Its if Dont win
Im sure in some cases when the injuries and nature of the incident is complicated then its quite a good idea to retain council now tell me how many cases you have seen were injuries were exaggerated or were as a result of pre-meditated actions?
Look I’m not stupid. I know insurance companies don’t have your best interest at heart they will say what they can to get you take a **** settlement and in some cases it’s probably a great idea to retain council. However it’s not like lawyers have your best interest at heart either (You might be an expectation I can’t make that judgment). The reason the deductible of third party was raised is because so many people Lawyering up in some cases when it wasn’t even necessary.
Where in this quote does it say that the deductible applies when you lose? o.0
There are over 8000 registered rehab centres in ontario, 300 have been accused of any sort of fraud. That's less then the amount of corrupt body shops.
I think people have been scarred by the ****** paralegals in this industry a bit too much and can no longer differentiate between lawyers and paralegals. Lawyers always have your best interest in mind. Your interest = Winning.. Lawyer = Winning.
Majority of cases require a lawyer. Especially now that adjusters actually call people involved in accidents and advise them to NOT go see their family doctor but go to one of their facilities.
Well I will take advice and if I ever need to I will stick with my family doctor. However on the third party question. And I admit I'm a layman so give me an example of how it works cause what I'm reading is that if you sued by a third party when you are at fault you are covered by insurance for court awards with 30g deductible so if you loose and have to pay 100000 then insurance pays 70 u pay the first 30 plus your legal fees I assume are not covered by insurance. If you don't have to pay anything as a result of the suit then insurance pays 0 you pay your legal fees?
ABadjusterrider_5
Well-known member
1) Yes, I'll give you that.
2) A broken arm automatically bounces him from the MIG, nice try.... PS If his accident was after September the 1st 2010 it's 50,000.00
3) That's complete BS. I've settled claims with non rep'd clients all the time.
4) I'm not even going to respond to that.
5) Unless you know the adjusters personally, don't talk smack about them.
6) That's actually true.
7) So's that.
I never said anything about after September 1st 2010. I mentioned prior to September 1 2010, they were growing broke fighting insurance fraud. The changes finally gave them some reprieve from the sum 300 clinics in the GTA drowning the adjusters in paperwork to get "deemed approve" assessments that were completely useless and not in the best interests of so called "clients" I can name names if you prefere and provide examples of the useless shi!t they would submit for.
ABadjusterrider_5
Well-known member
It would depend on a few things wether or not he's entitled to housekeeping.
1) When the accident occured
2) When his policy renewed
3) If his policy renewed after sept 1, did he opt for that benefit.
As for attendant care, it would depend on who's providing. You know that. Stop making a scarecrow out of the insurance companies.
You are wrong. If you are at fault and are being sued then the Insurance Company has to protect you. The deductible is applied to the amount for which the claim settles. The at fault party doesn't have to pay anything.
Sorry living in the past. Yes $50,000 if it's after Sept 1, 2010 however it does bounce him from the MIG. I would love for you to look a person in the eyes and tell him "You broke your arm? Great, you are in the Minor Injury Guideline."
You forgot to mention that you've settled them for much less then you would have settled with a lawyer.
Don't know them personally? I am not saying adjusters are bad people. Hell my girlfriend's father is an underwriter for an Insurance Company. However the people at the top are bad. The people that instruct you to put every single file in MIG. People that tell my clients "Oh you are throwing up, passing out, can't sleep at night, can't work? Lol, let me check if I care" those are the people that I dislike.
I'd love to know how many people actually knew that their benefits were going to be taken away not to mention the fact that Insurance companies promised lower rates as a counter balance and didn't deliver on the promise.
Now let me ask you a question ABadjuster.
How many times do you send people to an IE and get a response of "It's reasonable and necessary"
Specially from IME centers such as Sibley and Associates and Riverfront?
The reason I ask is that I use s.42 assessment centers for assessments for my clients. Why? Because they are used to being on the Insurance side so they give a more realistic report then doctors that always do s.24. That, is also a double edged sword as I've had assessors tell me that certain ICs won't give them business if they do s.24s.
Stop making a scarecrow out of insurance companies?
Just a few days ago I had an adjuster contact a service provider in order to confirm that the service provider did work at the house. The adjuster yelled at the provider and threatened him with court sanctions and things that generally would scare someone ignorant of the law. That situation is actually quite minor in comparison with some of the other **** adjusters try to pull. Maybe you are different, you never know, however as a rule, I wouldn't trust most adjusters, granted there are some good ones out there. Though so far, I've found maybe 5/6 adjusters that actually even KNEW SABS.
I wonder why you are so jaded about lawyersFixed it
.
I wonder why you are so jaded about lawyers
Its just that everyone is looking out for themselves first.
Insurance companies want to settle for the least amount possible as it will make them more money.
Lawyers want to settle for the most amount possible as it will make them more money.
I don't care what anyone says, the money will almost always come before the victims best interest from all sides.
Its not that I am jaded about either side I am just saying almost every comment from both sides are biased, Its just the way of life. (I do it with my job as well
)Its just that everyone is looking out for themselves first.
Insurance companies want to settle for the least amount possible as it will make them more money.
Lawyers want to settle for the most amount possible as it will make them more money.
I don't care what anyone says, the money will almost always come before the victims best interest from all sides.
Its not that I am jaded about either side I am just saying almost every comment from both sides are biased, Its just the way of life. (I do it with my job as well
I have to agree with you on that. However at the same time, and yes I argue because it's kinda my nature
... At least unlike the Insurance companies we actually care about our clients.If you forgive me for using this cliche statement. To me the client is more then just a number. Aside from the insurance litigation work that I do I provide my clients with free services from dealing with their debt collectors to any other legal problems completely free of charge because I know how hard it is to go without work and be injured and harassed.
ABadjusterrider_5
Well-known member
Inslaw.
I would never put someone into the MIG with a busted arm. That's just not cool. Or a broken anything for that manner.
You're right, typically when I settle claims it's for a lesser amount. I'll be honest and fair about it. It's typically less. However when dealing with a lawyer; When settling we have to consider the cost of mediation (300.00) arbitration ($3,000.00) defense counsel ($10,000 + + +) and on-going handling of the file (Assessments etc) while the legal process is taking place. Stacking that against what your firm is proposing for settlement. Sometimes it's just cheaper to settle with your firm regardless of how injured your firm or the Insurance company thinks.
So on a open forum, without providing detail (up until now) for the world to read. You would paint every single adjuster with the same brush. So does that mean every rider on this forum should think I am corrupt adjuster and slam me for denying people their benefits? (Yes I know this is a bit over the top, but you attacked my post first and made me look like arsehole who didn't know what he's talking about)
By the way, most adjusters are instructed to use their heads. At least at the companies I worked for. (I split from one company to go to anther after the big change)
I'm with you on getting premiums lowered. I'd love to see my preimums lowered. The government, the media and insurance companies themselves launched a huge awareness campaign and advised people what was going to happen. Most of the guys here talked about it when it was happening too. I don't think it was right, but something had to happen to combat those who abused the system.
I'll be fair about your section 44 (again, living in the past bro. 42 is dead and gone) question. It's about 75/25. 75% coming back denied, 25% reasonable and necessary. However; for those actually reading this post, it's a sheer numbers game. I deal with literally thousands of applications for assessments and medical therapies a year. THOUSANDS.
If you wanna name names, and play that game. How much BS was generated by clinics like Assessment direct, century diagnostic, and the crap they would submit for. Their cookie cutter reports where they often forgot to review their reports before submitting them to the insurance companies to get paid. Leaving the previous clients name in, forgetting to change a him/her.
I can't speak for that specific adjuster, or their actions. Obviously we don't have their story, or their evidence to justify their actions. However; I will remind you about what justifies an incurred expense and proof of payment.
At this point, I think we can both agree that I know the SABS. I don't trust most Paralegals quite frankly. However there are some out there that I do. They're fair, honest and easy to get along with. I love visiting their office and catching up.
I think the insurance industry needs to have one big paintball tournament. Adjusters vs paralegals vs clinics and just let them have 'atter. Get all that pent up aggression out and afterwards sit down and have BBQ with beer.
I would never put someone into the MIG with a busted arm. That's just not cool. Or a broken anything for that manner.
You're right, typically when I settle claims it's for a lesser amount. I'll be honest and fair about it. It's typically less. However when dealing with a lawyer; When settling we have to consider the cost of mediation (300.00) arbitration ($3,000.00) defense counsel ($10,000 + + +) and on-going handling of the file (Assessments etc) while the legal process is taking place. Stacking that against what your firm is proposing for settlement. Sometimes it's just cheaper to settle with your firm regardless of how injured your firm or the Insurance company thinks.
So on a open forum, without providing detail (up until now) for the world to read. You would paint every single adjuster with the same brush. So does that mean every rider on this forum should think I am corrupt adjuster and slam me for denying people their benefits? (Yes I know this is a bit over the top, but you attacked my post first and made me look like arsehole who didn't know what he's talking about)
By the way, most adjusters are instructed to use their heads. At least at the companies I worked for. (I split from one company to go to anther after the big change)
I'm with you on getting premiums lowered. I'd love to see my preimums lowered. The government, the media and insurance companies themselves launched a huge awareness campaign and advised people what was going to happen. Most of the guys here talked about it when it was happening too. I don't think it was right, but something had to happen to combat those who abused the system.
I'll be fair about your section 44 (again, living in the past bro. 42 is dead and gone) question. It's about 75/25. 75% coming back denied, 25% reasonable and necessary. However; for those actually reading this post, it's a sheer numbers game. I deal with literally thousands of applications for assessments and medical therapies a year. THOUSANDS.
If you wanna name names, and play that game. How much BS was generated by clinics like Assessment direct, century diagnostic, and the crap they would submit for. Their cookie cutter reports where they often forgot to review their reports before submitting them to the insurance companies to get paid. Leaving the previous clients name in, forgetting to change a him/her.
I can't speak for that specific adjuster, or their actions. Obviously we don't have their story, or their evidence to justify their actions. However; I will remind you about what justifies an incurred expense and proof of payment.
At this point, I think we can both agree that I know the SABS. I don't trust most Paralegals quite frankly. However there are some out there that I do. They're fair, honest and easy to get along with. I love visiting their office and catching up.
I think the insurance industry needs to have one big paintball tournament. Adjusters vs paralegals vs clinics and just let them have 'atter. Get all that pent up aggression out and afterwards sit down and have BBQ with beer.
I wish there were more adjusters like you out there.
you have to understand that due to the fact that I deal with primarily the ****** adjusters that want nothing more then to determine my Cat clients as mig or non Cat, I am dealing with some of the most idiotic adjusters out there. I agree that places like Assessment Direct are disgusting. I am happy when I see ******** going to prison for scamming insurance companies...case and point: http://www.citytv.com/toronto/citynews/news/local/article/180593.
With that said, I would never use services of places like Universal Rehabilitation Injury Center or Assessment Direct. I know they are the scum of the earth. However it's quite funny. that one clinic was able to destroy the entire legitimacy of the business.
I did some research and you seem to be a good guy, at least from the advice I've seen you give.
However I am sure you can understand my skepticism.
