Wednesday, September 28, 2016

Washington PIP denial by Insurance Carrier

In a Washington Personal Injury claim, every case prior to denying a claim for PIP (Personal Injury Protection) benefits, the insurance carrier must provide the a written explanation of coverage under the policy, and include a notice that the carrier may deny, limit or terminate benefits if the carrier determines that the medical or hospital services are to be covered.  

The PIP carrier can deny, limit or terminate PIP benefits if the treatment is considered:
1. Not reasonable;
2. Not necessary;
3. Not related to the accident; or
4. Not incurred within 3 years of the accident.
The PIP carrier’s decision to deny, limit, or terminate the claimant’s PIP benefits must be based on the review and opinion of a medical or healthcare professional. Note that a Independent Medicine examine ('IME') will likely be requested by the carrier. 
The term "medical or health care professional" does not include an insurance company's claim representatives, adjusters, or managers or any health care professional in the direct employ of the insurer. 
If the claimant is being treated by more than one health care professional, the review shall be completed by a professional licensed, certified, or registered to practice in the same health field or specialty as the principal prescribing or diagnosing provider, unless otherwise agreed to by the insured and the insurer. Please note this doesn't prohibit the insurer from providing additional reviews of other categories of professionals. 
The insurance company’s explanation for deny PIP benefits must be so that the claimant will not need to resort to additional research to understand the reason for the action. A simple statement, for example, that the services are "not reasonable or necessary" is not sufficient.
For more information as regarding your rights in a Seattle Personal Injury Accident, please consider contacting a Seattle Personal Injury Attorney
Our Firm: 
520 Kirkland Way, Ste 103
Kirkland, WA 98033
T: (425) 889-9300

Wednesday, June 15, 2016

Disputing (diminished) valuation of your vehicle after an Accident in Washington State

How to file a diminished value claim after an accident. 

Many of our clients who need assistance maximizing a Seattle Personal Injury Claim often find its not worth engaging an attorney fight for their auto claim because of the costs and expenses of litigation. That said, we thought we would share some helpful tips on what to do if you find yourself in disagreement over the valuation of your vehicle as well as some helpful tools:

What is diminished value?
Diminished value is the difference (if any) between the market value of your undamaged car before an accident and its market value after you have it repaired.
Who to file the claim against
In Washington, you’ll file a diminished value claim against the insurer of the at-fault party and not your own insurer.
What you need to do
If you decide to file a diminished value claim, you’ll need to prove your claim with supportive documentation. Some car owners file a claim on their own or hire a private company to document the lower value. Even then, an insurer may argue against it. Its important to have as much documentation as you can have including opinions from local dealerships as to the value of your vehicle pre-collision and post-collision (even with the repairs).

The insurer doesn't automatically pay you for diminished value. It's subject to proof that your car's market value decreased even after repairing it. If you plan to file a claim for diminished value, we recommend you talk to your claims adjuster.

Another helpful source in the Washington State Insurance Commissioner. Please see their link below on helpful contact information: 

For more information on your rights on your rights in a Seattle Auto Accident, consider contacting a Seattle Auto Accident Attorney.

Our Firm:

DC Legal, PLLC
520 Kirkland Way, Ste 103
Kirkland, WA 98033
T: (425) 889-9300

Washington Auto Accident Valuation Dispute Overview

Determining Car Replacement Value in Total Loss Claims

If you have ever been in an accident and had the insurance company low ball you, you know that this is a tough part of the law if you don't know how to effective argue these items.

In accidents that include personal injury claims, as well as auto claims, the two issues will typically involve two different negotiation processes. Here is an overview of what you need to know with the automobile valuation should you happen to disagree with the insurance company valuation.

How is the value of the car determined/disputed?

Governing Law: WAC 284-30-391

Unless insurance company and insured can agree on value, an insurer must settle the insured’s total loss claim by using one of following three methods:

1) Offering replacement with an available and comparable care in the insured’s area

Replacement vehicle must be a (1) comparable vehicle, (2) available for inspection within a reasonable distance from where the totaled vehicle is normally parked.

2) Cash Settlement Based on “Actual Value” of Comparable Cars in the insured’s area
The insurer must determine the “actual value” of a comparable vehicle, minus the deductible. The insurer must determine the actual cash value is by using one of the following methods:
a. The actual cash value of a comparable vehicle in area where loss vehicle is normally garaged.
b.       Using two or more licensed dealer quotations of a comparable vehicle by dealers located within 150 miles of area where loss vehicle normally garaged
c.        The actual cash value of two or more comparable vehicles advertised for sale within 150 miles of area where loss vehicle is normally garaged.
d.       A computerized source that must meet the criteria within WAC 284-30-391(2)(iv)
e.        If no methods in a-d provide an actual cash value, search area may be expanded in 25 mile increment, not to exceed 150 miles without permission of the claimant
f.        If the insurance policy has an appraisal provision, either party may invoke it to determine actual cash value

The insurer must add to the actual cash value any applicable taxes, license fees and other fees that would have been incurred by the insured if he had purchased the loss. (WAC 284-30-391). After the  actual  cash  value,  sales  tax  and  applicable pro-rated taxes and fees are added together, the insurance company deducts the  salvage value from the total amount.

Tip from the Office of the Insurance Commissioner: To find out if the amount the insurer offers you is a reasonable estimate of the retail market value, ask the insurer for a “total loss valuation report.” This report shows the comparable auto data the insurer used to calculate your vehicle’s value. Insurers aren’t required to provide it without being asked, so be sure you request a copy.

For more information on Seattle Auto Accident Help, consider contacting a Seattle Auto Accident Attorney

Our Firm: 

520 Kirkland Way, Ste 103
Kirkland, WA 98033
T: (425) 889-9300