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

Tuesday, May 10, 2016

Seattle Bike Accident Overview

Seattle Bicycle Accidents: No Presumptive Liability for Drivers

Bicyclists Hit by a Motor Vehicle have the Initial Burden of Proving Liability

In personal injury cases, such as when a driver of a motor vehicle is injured by another driver, the plaintiff normally has the initial burden of proving that: (1) the defendant was negligent; (2) the plaintiff was injured; and (3) that negligence of the defendant was a proximate cause of injury to the plaintiff. The plaintiff must prove these facts by a ‘preponderance of the evidence,’ which equates to a more-likely-than-not standard.

The law provides certain exceptions to this initial burden, however, such as when a following vehicle collides with the vehicle in front of it, in which case negligence on the part of the following driver will be presumed. Interestingly, the law provides no exception for this burden of proof in the case of collisions between bicyclists and motor vehicles. Subject to only narrow exceptions, bicyclists who are hit by a motor vehicle still have to meet this initial burden of proving liability on the part of the motor vehicle driver.

Washington statute provides the default rule that bicyclists are subject to the same laws as motor vehicles, explaining that:

Every person riding a bicycle upon a roadway shall be granted all of the rights and shall be subject to all of the duties applicable to the driver of a vehicle… except as to special regulations of this chapter… and except as those provisions of this chapter which by their nature can have no application.

RCW 46.61.755. One notable case-law exception to this general rule is that a bicyclist in a crosswalk is not subject to general traffic rules and is entitled instead to the protections of a pedestrian.[1]

Should the Law Create a Presumption of Liability for Drivers?

While the plaintiff’s initial burden of proof is likely appropriate in the context of a collision between two motor vehicle drivers, some commentars  argue that this burden is inappropriate for collisions between cyclists and motor vehicles. The Washington Bike Law organization, for example, argues that, by presuming liability of motor vehicle drivers who collide with cyclists, the law would:
·                (a) take into consideration the power imbalance between motor vehicles and bicycles;
·                (b) increase bicycle ridership; and
·                (c) account for the fact that many bicyclists suffer memory loss because of head injuries and have difficulty meeting their burden of proof.[2]

Lobbyists are pursuing efforts to sponsor legislation that creates presumptive liability for motor vehicle drivers who collide with bicyclists or pedestrians.

Presumptive liability for motor vehicle drivers is not a concept unique to the United States. On the contrary, several European countries have adopted legal systems where motor vehicle drivers are presumed liable in collisions with pedestrians or bicyclists, including the Netherlands, Spain, Sweden, Germany, Belgium and France.

Opponents of imposing presumptive liability on drivers argue that our legal system is based upon the presumption of innocence, and that presumptive liability violates this basic principle. Furthermore, opponents highlight the fact that Personal Injury Protection (PIP) is fairly common in Washington, and provides no-fault injury coverage for medical treatment, thereby avoiding injustice while the injured bicyclist or pedestrian argues his/her case.

Conclusion: Be Aware of Your Rights and Responsibilities

This concept of presumptive liability will likely be debated in the future, as urban cities shift towards alternative modes of transportation to adjust for growing populations and limited space. With no change to the law apparent in the near future, however, it is important the bicyclists involved in a collision with a motor vehicle understand that they have the same general rights and responsibilities as motor vehicle drivers. This means that an injured bicyclist, much like an injured motor vehicle driver, will have the initial burden of proving liability.

The same common recommendations for injured motor vehicle drivers therefore apply to injured bicyclists:
e    1) exchange information with the other party;
·           2) talk to witnesses and get their contact information;
·           3) take pictures if possible;
·            4) keep track of any medical treatments received after the collision.

If you are injured in a Bike Accident, consider contacting a Seattle Bike Attorney

Our Firm

520 Kirkland Way, Ste 103
Kirkland, WA 98033

Tuesday, March 29, 2016

PIP Coverage in Washington State

Many of our clients encounter the concept of ‘Personal Injury Protection’ (“PIP”) if they are in a car accident and need immediate medical care. We’d like to explain exactly what it is, how it works and why its an important part of every insurance plan.

What is PIP?  
PIP is a part of your insurance policy that covers (up to certain limits) medical expenses, wage loss, loss of services, and funeral services and it applies no matter who is at fault.

Is PIP required?
PIP is not required, but Washington Law does require that your insurance offers it to you. If they do not offer it to you and receive a rejection in writing, your company must add it to your policy and charge you for it. Sometimes, even if its not a part o your policy the insurance company must honor it post - accident if they cannot provide something in writing that the coverage was waived.

How it works:
If you are a ‘named insured’ are injured, PIP coverage kicks in. It covers 1) persons named on the policy; household residents related by blood, marriage or adoption, as well as any non-family passenger and pedestrians involved in an accident.

Why its important.

Should you find yourself in an auto accident where injuries are incurred, PIP will pay for your medical care as you negotiate with a liable parties insurance company. If you don’t have it, you will have to pay these costs out of pocket thus potentially prohibiting the quality of care in your recovery.
For me information on your rights in a Seattle Auto Accident, please consider contacting a Seattle Personal Injury Attorney.

Our Firm:

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

Monday, March 28, 2016

Seattle Auto Accident Insurance Policy basics:

In assessing an insurance claim for a Washington Auto Accident, it’s important to know the various types of insurance that you may encounter.

Auto insurance coverage is typically broken down into separate components:
Liability coverage: This provides protection for claims made against an insured, where the use of an insured vehicle caused bodily injury or property damage to someone else

Medical payments coverage or personal injury protection (‘PIP’): This provides coverage for various medical expenses incurred by the insured and others as a result of an accident, regardless of negligence or liability on the part of the insured

Collision coverage: This provides coverage for losses that the insured suffers as a result of damage to his or her covered vehicle caused by a collision

Other-than-collision (also known as comprehensive) coverage: This provides coverage for losses that the insured suffers as a result of damage to or loss of a covered vehicle not caused by a collision (e.g., fire, theft, vandalism, falling objects, explosion, earthquake, flood, and civil commotion)

Uninsured motorist coverage: This provides coverage for losses that the insured and others sustain when injured through the negligence of an uninsured or unidentified hit-and-run motorist

Underinsured motorist coverage: This provides coverage for losses that the insured and others sustain when injured through the negligence of a motorist who has liability insurance, but the limit of that insurance is insufficient to pay for damages.

If you are injured by another party in an Seattle Auto Accident, the insurance that will pay for your damages is the other drivers Liability coverage. That said, your PIP coverage will pay your medical bills while the other claims are settled. 

If you are in need of a assistance, consider contacting a Kirkland Auto Accident Attorney

Our contact: 

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



Tuesday, March 1, 2016

How to value a Auto Accident Case in Washington State

Clients often ask us how to value personal injury cases, and the honest answer is that no cases are truly the same. That said, there are some parameters we consider in valuing claims for our clients. 
In personal injury cases, if an insurance adjuster is using a damages formula to value your claim (which is almost always the case), it's usually based on a multiplier of between one-and-a-half to five times medical costs. This is how the adjuster typically arrives at a base negotiating figure -- not including lost income. However, in some cases, certain factors line up so overwhelmingly  that the top multiplier of five is simply not high enough. In those claims, the multiplier might move up to six, seven, or even as high as ten times special damages (ie. medical and lost income). 
Here are some factors That Justify a High Personal Injury Multiplier
In order to realistically consider a multiplier of more than five, you must have had a serious injury, and most, if not all, of the following factors must be present:
  • 1) the other party’s fault/ liability for an accident must be obvious and almost total
  • 2) injuries must be unquestionably observed or detected by medical examination
  • 3) injuries must be patently painful and dramatic -- a fracture, or a wound, tear, or displacement that requires surgical treatment, or that cannot be successfully repaired
  • 4) diagnosis and treatment must come primarily from physicians and hospitals
  • 5) recovery must be prolonged (six months or more)
  • 6) suffering of some permanent issue -- pain, immobility, weakness, discomfort, scarring -- that is medically documented, and
  • 7) your physicians must clearly indicate that you will have recurring, degenerative, or future problems as a result of the injuries, even if they have stabilized for the time being.
If most or all of these factors are present in your case, larger multiples may be justified in seeking more than five times your medical costs. 
Unfortunately, the fact that you feel justified in initially seeking such an amount doesn’t mean that you will receive it. Please note that allowing yourself to get carried away with the unjustified hope of a high settlement when the facts of your case don’t support it will only delay an already process. 
For more information on your rights in a personal injury case, please consider contacting a Kirkland Personal Injury Attorney
Contact us today at: 
DC Legal, pllc
520 Kirkland Way, Ste 103
Kirkland, WA 98033
T: (425) 889-9300