What it is

Comparative Liability is a term that insurance companies use when both drivers in an accident have some degree of fault, but neither party is completely responsible. It should be simple enough, but confusion arises while trying to figure out how much money will come out of your pocket, and how it will affect your future rates.

Example

The easiest way to understand this type of insurance claim is to take an example, and follow it to conclusion. A really common example is when two people back into each other in a parking lot.

Agreement

First things first, there should be some agreement that there is comparative liability. If both drivers agreed that they were both backing up and didn’t see each other, or they both thought the other driver was going to stop, and both drivers were honest and level headed, able to take responsibility for this particular mistake, and willing to admit that they were partially at fault, then this would be an easy to resolve, simple 50 / 50 accident.

I’ll explain in a minute how this is resolved, but first you should know that it hardly ever goes down like this.

Usually both parties think the other party is at fault, and blame the other person. Both drivers usually claim that they backed out first, and accuse the other driver of lying.

Keep in mind that just because they were both backing, doesn’t mean it is automatically comparative liability, but there are usually no witnesses, and no way to prove anything.

Sometimes the damage on the vehicles will support the claim that one driver had “taken possession” of the isle, and had the right of way. For example, if one driver’s damage was in the middle of the back bumper, and the other driver’s damage was on the passenger side door, it would support the claim that the driver with door damage had backed all of the way out, taken possession of the isle, and had the right-of- way

For this example, since I’m explaining comparative liability, let’s assume that neither driver can prove he has the right of way, and both drivers are equally at fault and assigned 50% of the blame. In this example both drivers’ insurance adjusters agree to settle the claim as a 50 / 50.

Out-of–pocket

This is the way your expense would break down:

If you went through your own insurance, you would pay a percentage of your deductible equal to your liability. So for a 50 / 50 accident you would pay 50% of your deductible.

You would pay the deductible at the body shop after your car was repaired. Your own insurance would cover the other half of the deductible, as well as the entire amount of the remaining cost of repair, because collision coverage covers the cost of repair, less the deductible, regardless of who was at fault. Your insurance is going to collect the other 50% of your deductible from the other driver’s insurance.

Your insurance would later send a copy of the repair estimate to the other insurance company, and be reimbursed for 50% of the repair of your car. They are simply being reimbursed for the amount of the repair that wasn’t your fault. Your insurance company will also write a check to pay for half of the other driver’s repair.

No Collision Coverage?

If you don’t have collision coverage, you will be forced to go through the other insurance company for your repair. Since you are going through the other insurance, there is no coverage for the percentage of the accident that was your fault. The other driver’s insurance company will estimate the cost of repair, and send you a check for 50% of the repair.

You will only be paid for the portion of the repair that was the other driver’s fault, which in this example is 50%. It would break down as follows:

Disagreements

Now that we have covered the very basics, there is something else you should know.

You should know that the insurance adjusters do not have to agree to do comparative liability. Your insurance could call it a 50 / 50, and the other driver’s insurance could decide you were 100% at fault. The good news is that your insurance company might still pay the percentage of your deductible based on their own liability determination, independent of the other insurance company’s liability position.

On the other hand, they may remind you that you are responsible for your deductible, in which case you will have to try to collect it from the other driver’s insurance. Considering they are not agreeing to comparative liability, you chances of collecting are zero, but you may get reimbursed if your insurance wins in arbitration. (discussed below)

Future Rates

Your future rates are based on your insurance company’s liability determination, independent of the other insurance company’s liability determination. Typically, no matter what amount is paid on a claim, the accident will not count against you unless you were more than 50% at fault, so a 50 / 50 should not affect you negatively. Obviously I cannot speak for every insurance company, so you should verify this with your adjuster.

Arbitration

It should also be noted that if the insurance companies do not agree on comparative liability percentages, the claim will eventually end up in arbitration. In this example, your insurance company would be arguing it was 50 / 50, and the other arguing that you were 100% at fault. If the final determination after arbitration is that you were more than 50% at fault, it may affect your record adversely. In other words, you would have an “at fault” accident on your record that could make future insurance rates higher.

Questions

Hopefully this post was helpful explaining comparative liability, and how it affects your wallet. Keep in mind that if I covered every possible scenario it would be a book, not a post, but I’m happy to answer questions.

If you have any questions please send me an email, or just ask your question in the comments section below. I’ll try to get back to you the same day.

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If you were involved in a car accident, and you were injured, the more quickly the inflammation and swelling can be reduced, the better off you will be.

If you think you have been seriously injured, you should begin with the hospital Emergency Room to rule out fracture and dislocation. This is especially important in the spine, as a fracture or dislocation could lead to permanent injury of the spinal cord or nerve roots, and possibly lead to paralysis or death. The emergency doctors will also check your vital signs and perform other tests like recording your blood pressure and heart rate, which may be altered in the case of internal injuries. They will refer you to emergency surgery if needed.

If you are fortunate enough to avoid surgery, then you will probably be given a prescription for pain killers and muscle relaxers, and then sent home.

It will be up to you to decide if you want follow up treatment. You will likely have many symptoms that are not resolved with pills, but not major enough for surgery. These symptoms include things like painful muscles and joints that make it difficult to move, and difficulty with daily activities like walking the dog, playing with your children or even putting on your shoes and socks.

If you do decide to see a chiropractor for treatment of your injuries, there are a number of things that you should look for. The most important, in my opinion, is a chiropractor who uses active rehabilitation as part of your recovery. You see, the body goes through different stages of healing during your recovery. The first is the corrective stage, where the treatment is focused on symptom relief. The goal is to reduce pain, inflammation and swelling as quickly as possible. This allows you to get back to your normal life.

The second stage is focused on helping the body to heal properly. When muscles, tendons and ligaments are damaged, they heal themselves by laying down scar tissue. Unfortunately, the body does a sloppy job with this. The chiropractor can help to make sure all of your joints are lined up properly and that those joints continue to remain free and mobile during this healing stage. This will help to insure that you don’t lose your joint movement from your body’s healing process.

The third stage is the rehab stage. When a person is injured, muscles contract and spasm to protect damaged tissues. Some of these tissues remain short and contracted, not allowing for proper movement, and leave the potential for chronic pain and future re-injury.

Other muscles will become weak over time because you won’t be using them. It will hurt to move, so you will avoid movement. It’s similar to someone who breaks an arm, and wears a cast for 8 weeks. When the cast is removed, the arm doesn’t look like the other. It is weak and skinny. This same process happens to the muscles that protect and stabilize your neck and back. If active rehab is not part of your overall treatment plan, then you are setting yourself up for chronic problems, and future re-injury.

There is a whole other level of care beyond the typical pain killers and hot pads. Without a proper treatment plan specifically designed for you, and designed to correct specific problems of weakness, instability, or other faulty movement patterns after the initial pain has been removed, you are not getting the complete care available to you. This leaves you vulnerable to chronic injury, and makes it more likely that you will re-injure the same area in the future.

Chiropractors are not the same. They take completely different approaches to patient care. Don’t take a chance. Our office takes this complete approach to care, and can take you through all three stages of treatment leading to a pain free, strong, flexible, complete recovery.

As a Citrus Heights Chiropractor, I have been helping people with car accident treatment for years.  If you think you need car accident treatment in Citrus Height, please call us as soon as possible so that we can complete your consultation, and determine if treatment at this clinic would be appropriate in your case.

Furthermore, we can handle your insurance needs, paperwork and help you find excellent legal representation.

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The Basics:

If you were injured in an accident, and the other driver is at fault, there are two injury related coverages that apply to you.

Med-Pay coverage:

This is a coverage that is on your own personal automobile policy, if you elected to take it. It is not a mandatory coverage in the state of California, but if you did decide to pay for this coverage as part of your insurance policy, it will cover your car accident treatment regardless of who is at fault, up to the policy limit. The most common limit is $5000, but your insurance adjuster will be able to answer that specifically. If you were not at fault for the accident, your insurance company will collect the amount paid under this coverage from the at-fault driver’s insurance company after they have paid your medical bills.

Bodily Injury Coverage:

This coverage is mandatory in the State of California. If you were injured in an accident, and the other driver was at fault, you will make a claim under the at-fault driver’s Bodily Injury Coverage. Keep in mind that this claim will be with the other driver’s insurance, not yours. You did not pay for this coverage. The other driver paid for this coverage to keep him or her out of financial trouble in the case that they hurt someone else, and in this case, the person they hurt is you.

This coverage does not pay your medical bills directly, so you will want to have your bills sent to your insurance company if you have Med-Pay coverage (from above). If you don’t have Med-Pay on your auto policy, don’t worry. Many clinics (this one included) will still be able to give you all of the care that you need to recover from your car accident without you having to pay any money up front or out-of-pocket.

Once all of your medical treatment is complete, and you are ready to settle your claim, the at-fault driver’s insurance company will review the medical records and billings, and offer to settle your claim. When the insurance company makes the offer to settle, they are attempting to settle your claims for the following:

• Special Damages
  1. Medical Bills
  2. Lost Wages
• General Damages
  1. Pain and Suffering

It is important that you understand that the settlement offer is being made in exchange for a release of all claims. Once you sign the release in exchange for your settlement check, you will no longer have any claim against the other driver. It is very important that you know what you are doing when settling your claim. You may wish to have an attorney represent you in this matter.

Other Insurance Coverage

The two coverages above are the most common that apply to an auto accident, but there are additional insurance coverages that may apply to your specific situation, such as Un-insured Motorist Bodily Injury coverage and Under-insured Motorist Bodily Injury coverage. These coverages have some interesting rules that make them both unique and complicated, but they won’t fit into this post. Both of these will be covered in a later post.

The post Understanding Car Insurance – Part 1 appeared first on Citrus Heights Chiropractor.

If the other driver was at fault for the accident, you will have a choice. You can go through your own insurance for repair, or use the other driver’s insurance company. If you need help deciding which one, see this other blog post. It should make that decision easy, and it’s probably not the answer you think.

Either way, when you go to set up the repair with the adjuster, he or she will ask you if you would like to use one of their “approved” or “direct” repair facilities. Most peoples’ first reaction is to say “no way!” People are concerned that using the approved repair facility will result in poor quality work and low quality parts because the body shop will cut corners for the insurance company.

You should understand that no matter where you have your car repaired, the insurance company is going to send an insurance company appraiser to physically inspect your vehicle. Any estimate from any body shop will have to be approved by the insurance company’s appraiser if you want the insurance company to pay for it.

In my experience, (which includes years of setting up, reviewing the estimates and writing the checks for the repairs) the insurance companies just want to make sure that they are not paying for things that weren’t caused by the accident, and confirm that “like kind and quality” parts are used to replace the damaged parts. There was never a case of an appraiser or body shop trying to put used or inferior parts on a vehicle that I was ever aware of.

Radio commercials would have you think that the bigger shops in town will do better work. But in reality, it’s not like the most impressive body shop in town is going to put upgraded parts on your car. If they tried to give you upgraded parts the appraiser would deny it, and if you chose to get them anyway you would pay the difference out of your own pocket. It’s just marketing. The parts are coming from the same places.

If you have a shop that you really want to use, go ahead and use them, but if not, don’t be so quick to dismiss the approved shop. The repair will definitely be completed more quickly, since the appraiser never has to physically inspect the car. The body shop will take digital pictures, complete an estimate, and email it to the insurance company. After a quick approval, they’ll be able to get started with the repair.

One of the biggest advantages of the approved shop is that the insurance company will stand behind the work of that particular shop. If you get the car back and the paint doesn’t match, you’re covered. You’ll still be in your rental car, and the body shop and insurance company can fight over who’s paying for the continued rental while they get the paint right, but bottom line is that it won’t be you paying.

The truth is, the adjuster really doesn’t care if you use their approved shop or not. As a matter of fact, some adjusters would prefer that you didn’t. I knew adjusters who would intentionally “forget” to mention it as an option, since it had the potential to make more work for them.

No insurance adjuster wants to have to mediate a disagreement between a body shop and a customer. You see, insurance companies don’t repair cars. Insurance companies simply write checks. It would be much easier for the adjuster to tell a customer the check was written for the amount of the estimate, and if there is a problem with the actual work, then they need to take it up directly with the body shop they chose to do the repair.

Understand that a good body shop will to whatever they need to do to make sure you are a happy and satisfied customer. If there is a problem with the initial repair, they should stand behind their work. The problem is that what they should do and what theyactually do are sometime two different things. So choose wisely.

As an auto accident chiropractor in Sacramento, I can tell you that there are many other insurance issues that need explaining, and we’ll get to them in later posts. Car accident injuries and car accident treatment will also be discussed.

The post Should I Use the Body Shop that the Insurance Company Recommends? appeared first on Citrus Heights Chiropractor.

I believe this type of thinking has more to do with “principle” than actual knowledge of how insurance claims are handled. People tend to think that since it was the other guys fault, then the other guys insurance should be the one to pay. They are also afraid their rates might go up if they use their own insurance.

My recommendation is always to use your own auto insurance for the repairs, and for the medical bills. There a so many reasons for this that it’s hard to know where to start.

For one, you pay premiums to your own insurance company, and have an actual contract with them. Because of this they are required to act in your best interest, and act in good faith. The other insurance company does not have to act in your best interest, and because you have no contract with them, bad faith does not apply.

Customer service is also an issue. You insurance company recognizes you as a paying customer, and understands that a certain level of customer service is rightfully expected. The other insurance company sees you as a “third party claimant” who is making a run at them for money. Customer service isn’t an issue, because you are not a customer. If you call them up with an issue with your rental car, or a problem with the auto repair, your own insurance company is much more likely to attempt to help you out and make you happy.

One concern I have heard is that people know they will have to pay their collision deductible if they go through their own insurance company. This is true, but keep in mind you can call the at fault insurance company and ask them to pay the deductible. If their driver is at fault, and there is no dispute, all they need to do is verify your deductible with your insurance company and they can send you a check. They can even send it directly to the body shop if that’s what you would prefer.

You see, after your insurance company pays the body shop for the repair of your car, your insurance is going to send the bill to the other insurance company anyway. The other insurance will reimburse your insurance for the cost of the repair, so it makes no difference to them if they pay your deductible directly to you instead. You just need to make sure there is no liability dispute (disagreement about who was at fault), and that they are willing to do it (I have never heard of a case where they were not willing to do it.)

You could even ask the other insurance company before deciding who to use for repair. Call them up and say “I was going to go through my own insurance for repair, but I have a $500 deductible. Will you send me a check for $500?” This happens all the time. The adjuster is happy to do this because it is less work for him. Now he just has to sit back and wait for the bill to arrive from your insurance company.

When it comes to medical bills, it’s really not even a question. The other insurance company will not pay any of your medical bills directly. They will tell you that they will “review” your claim for medical bills after you have completed all of your treatment and are ready to discuss a “possible” settlement.

Some people hear this and read too much into it. If you listen to them carefully, you will notice that they are not agreeing to pay for anything. They are only agreeing to “review” your bills and records for “possible” settlement. It is very common for them to wait until you are completely done with treatment, and then tell you that they are denying your injury claim.

If you have Med Pay on your auto policy, you health care provider has a place where he or she can send the bills for actual payment. You insurance company will attempt to recover any payments made for your car accident treatment from the other insurance company down the road. We’ll get more into Med Pay in another post.

As an auto accident chiropractor in Sacramento, I can tell you that there are many other insurance issues that need explaining, and we’ll get to them in later posts.

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It’s important to understand that most people who have osteoporosis won’t ever know it before fracturing a bone. Not even an x-ray done at your doctor’s office is helpful, since a person would need to lose 30-50% of their bone density before it could be detected with a normal x-ray.

The test that is used to check your bone density, and determine if you are at risk for fracture, is called a DEXA. It stands for Dual Energy X-ray Absortiomety. The test will produce two scores that are used to determine your risk.

DEXA scores can be confusing, but they don’t have to be. If you do an internet search asking how to interpret them you’ll end up reading about complicated mathematical formulas, conversions and units of density. In this post I am going to break it down very simply, and no math knowledge is needed. More importantly, I will explain what the sores actually mean, and why you should care.

The test will give you 2 scores. They are called the “T-Score” and the “Z-Score”. Both scores are important, but for completely different reasons.

The T-Score:

The T-score compares your bone density to the average density of a 30 year old person of the same sex. The score will be a positive number, or a negative number. A positive numbers means your density is greater than the average 30 year old (good). A negative score means your bone density is less than the average 30 year old (bad). A score with a negative number less than -1 but greater than -2.5 means you have osteopenia, which is a level of bone density lower than normal, but not low enough to be classified as osteoporosis. A score of -2.5 or lower is classified as Osteoporosis. In other words, this test answers the question: Do you have osteoporosis, yes or no.

What you probably don’t realize is that this information (do you have osteoporosis, yes or no) isn’t enough information for your doctor to make a clinical decision. For many people osteoporosis is a natural part of aging, so more information is needed before making any treatment decisions. Specifically, is it something that needs to be investigated further? Is there some sinister cause for this osteoporosis, or is it “normal?” This is where the Z-Score comes in.

The Z-Score:

The Z-Score compares your bone density to the average density of someone your same age and sex. It compares you to your peers. You see, there are things other than aging that cause osteoporosis. Very serious conditions such as certain types of cancer, alcoholism, hemolytic anemia, hyperthyroidism, etc., can cause a decrease in bone density that could be confused with the normal aging process. By comparing you to your peers it can be determined that your lack of bone density is average, which means it is probably due to aging, or it is more than average, which means it may be a symptom of some other condition or disease.

This is why there are 2 scores. This way your doctor can say:

“Yes, you have a significant reduction in bone density (T-Score), and an increased chance for fracture, but it is average for your age and sex.”(Z-Score)

OR

“Yes, you have a significant reduction in bone density (T-Score), and an increased chance of fracture, and the reduction in bone density is significantly greater than average for your age and sex (Z-Score), and more tests need to be done to find out what is causing it.”

There are 2 things that I want you to learn from this post.

• If someone asks you if you have osteoporosis, and you have never had a DEXA, the correct answer would be “I don’t know.”
• Understand how to read the scores, and what they mean, so you can ask your doctor the correct questions. You should know when you should be concerned, because your health is your responsibility.

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Our President said “Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.” In my opinion, he’s right on. John McCain agreed with him, and said that by emphasizing prevention we can cut health care costs.

The problem is that this idea of legislating preventative medicine in order to reduce health care costs and improve the health of Americans is a complete fantasy. First of all, you need to understand that what they were talking about was national health care reform, and what we got when it was all said and done is now called the “Patient Protection and Affordability Act,” also known as the PPACA.

People should understand that the PPACA is not about health care at all. It’s about health insurance. There’s a difference. Furthermore, there is no health care model currently run by any insurance company that has anything to do with preventative medicine. Preventative medicine does not currently exist in any form that can be provided by an insurance company, hospital or government.

Kaiser is currently trying to be the insurance company that is associated with prevention, but what do they actually do? They saturate the airwaves with commercials where Peggy Bundy talks about blueberries and yoga, but when was the last time Kaiser made you eat a blueberry, or forced you to do yoga? It makes for a great, feel-good PR campaign, but how will these commercials for something that can’t be provided by an insurance company improve the health of Americans or cut health care costs like the politicians described when designing health care reform?

Disease prevention has nothing to do with medicine or hospitals, and therefore nothing to do with health insurance, which is a misnomer in the first place, since insurance only pays when you are sick or injured, and really should be called sick insurance.

By the way, mammograms, prostate exams and other screening tests, although a good idea, are not preventative medicine. Mammograms do not prevent breast cancer any more than x-rays prevent broken ankles. Diagnosing a disease in its early stages will improve your treatment outcomes, but is not prevention, so why are we calling it that?

Prevention is about not having a disease or condition in the first place. Disease is prevented by a person’s lifestyle, and lifestyle is a choice. Don’t take my word for it. Almost every medical doctor agrees that more than 90% of Medicare costs are caused by just a handful of conditions that are preventable, and in some cases even reversible with proper choices in regards to nutrition and fitness. The government is not capable of legislating our choices, and therefore unable to legislate prevention.

I’m not trying to be a downer with this post. I just hope that people will take all this marketing by insurance companies and speech making by politicians, and see it for what it is. They are telling you the nice things that you want to hear because it makes them look good and you feel good, but they can’t deliver. If you are waiting for some change to health care that is going to make you wake up every morning feeling well rested, healthy and energetic, you are living in a fantasy world.

Health and fitness is like a college degree. Nobody can give it to you, and you can’t buy it. You have to earn it, and the payoff is huge. Disease prevention is just one of the many benefits.

If you are actually interested in prevention, and therefore health and fitness, here are some great resources. You can start here, at the Linus Pauling Institute, which is run by Oregon State University. Start by learning the “Rx for Health.” The website will provide you with all of the general rules, and is not designed to sell you anything.

There are plenty of good blogs out there that give actual recipes using the rules from the Rx for health, and I can give you some specific links if you send me an email. Also, gyms like Fitness 19, right here in Sacramento, have gym memberships for $15.00 per month, and sometimes less. If you’re looking for a personal trainer to get you started on a realistic and helpful workout plan, I’d be happy to recommend a good one in your area.

So give us a call and get started. It’ll change your life.

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Drug commercials are spending billions of dollars trying to sell you Viagra, Cialis, Lunesta, Ambien, Lipitor, Crestor and a list of others for the treatment of erectile dysfunction, high blood pressure, high triglycerides, high cholesterol, insomnia, diabetes, and other conditions that most Americans are likely to end up with sooner or later.

I say conditions because let’s face it, people don’t die from high blood pressure. They die from the heart attack, stroke and kidney failure caused by high blood pressure. Just as bad, the lucky folks who manage to not die from these diseases end up spending the second halves of their lives sitting around nursing homes after having their organs cut out, or sitting on the coutch watching tv because they are too overweight and out of shape to do anything fun.

That’s the bad news. The good news is you don’t have to fight to prevent all of these conditions separately.

Let’s say you are interested in preventing high blood pressure. You would start with your diet. One approach would be the DASH diet, which stands for Dietary Approaches to Stop Hypertension. It consists of eating lots of fruits and vegetables, whole grains, lean meats like turkey, chicken and fish, as well as nuts, seeds and legumes.

After diet you would start an exercise program designed to reduce stress and lose body fat. The most common would be to include some type of cardio training like a treadmill, exercise bike or elyptical machine, along with weight training.

The great thing is that this will also help to lower triglycerides and cholesterol, and help you reduce your risk for:

• diabetes
• heart attack
• heart disease
• stroke
• kidney failure
• cancer

It will also help you sleep better, increase your energy and strength, improve your immune system, and make you look better. How’s that for side effects?

In other words, in your attempt to eliminate the risk of one condition, you are simultaneously reducing your risk for almost every other condition. That’s the good news about disease.

If you have risk factors for any of the disease listed above, or are just interested in being healthy in general, I would recommend not going it alone. You have probably already tried that and didn’t get the results you expected. There are a number of health and wellness professionals in the Sacramento area that spend an extraordinary amount of time becoming experts at what they do. Use them. If you need a referral, just call me.

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