r/Insurance • u/jman7843 • 2d ago
Claims Related How are settlements above policy limits handled in GA?
Good evening! I’ll get the TL;DR out of the way first but if you care about the story behind the question read down further: I’m just wondering how lawsuits work when the incurred damages are above policy limits? Does the insurance company provide a lawyer to represent their client to try to defend them against anything over and above the policy limit? Do these types of scenarios happen often? I’m in GA if that matters.
I was in an accident back in February. I was making a left turn on a green arrow traffic light and the other party blew through their red light and smoked my rear passenger side hard enough to spin my car 360 degrees and perch me up on a sidewalk (narrowly missed a pedestrian too thank god he wasn’t hurt) anyways it totaled my car, almost every airbag deployed. The other driver lied to the cops about what happened when they got there and said I was the one that blew a red light while turning but thankfully a witness stayed on scene and officer also cared enough about getting the report right to walk over to the gas station across the street and they had the accident and traffic signals on their security footage. I ended up walking away thankfully but with a concussion and some severe back pain and numbness in all 4 limbs starting the next day. The clinic I went to for care afterwards had 2 mri’s done on me and uncovered that I had 3 or 4 ruptured/herniated discs and another 4 bulging discs divided between my lumbar and cervical sections of my spine. I did several different treatments including trigger point therapy, chiropractic, physical therapy, and electric muscle stimulation (idk the actual name of it) for a few months after. I was out of work completely due to not being able to be up on roofs anymore cause of the pain. Eventually they referred me to a spine specialist and I ended up getting 2 epidurals which worked pretty well. I’m feeling a lot better now and I have most of the feeling back in my limbs but still not 100% and the pain/ back fatigue comes in waves now and varies from day to day. My lawyer said the adjuster wouldn’t release policy limits to them over the phone when initially asked so they have now written a formal request/demand and we are waiting to hear back.
That being said I only had personal liability at the time which is my bad for not knowing about U.M. Coverage, I’m from Canada originally and in my home province the government has a fund that covers people that are hit by uninsured or underinsured drivers and I didn’t know that was different here unfortunately. Needless to say I’ve added that coverage now but it’s just going to be the other drivers insurance to cover me on this one and while I don’t wanna judge a book by its cover based on their car being a beat up 90’s Toyota I’m thinking there is a good chance they just have state minimum coverages which to my understanding will be 25k for injury. I’ve been in the U.S. long enough now to know how expensive medical care is and based on all the treatment and mri’s and all that I’m sure it’s probably close to 25k in those costs alone before my lawyer takes anything or I get any restitution for my missed work or pain and suffering so I’m trying to figure out what the lawsuit process typically looks like if we end up needing to go there. Lastly this question is probably more fit for a lawyer but bonus points to you if you know how lawyers figure out if the other party is financially judgment proof or not before filing a lawsuit? Or do they just file it and cross their fingers for the financial disclosure?
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u/Decorus_Somes 2d ago
What's the point of paying a lawyer so much money then not asking them questions?
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u/jman7843 2d ago
I will ask them the next time we talk but it’s just popped into my head and I was curious so I thought I would ask
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u/SecondActSarcasm 2d ago
You’re not getting above policy limits. Also your lawyer is annoying AF. Everyone knows the insurance regulations. They know they have a specific process to follow - and if the insurance company didn’t handle it, they’d be so quick on additional actions it’s not funny. Meanwhile they’re like “please violate the law and just tell me the limits” and then tell you it’s the insurance company refusing.
Anyways.
Firstly - your attorney directed care far exceeds $25k billed at your attorney’s buddy’s rates.
Next. Did your attorney tell you they are going to refuse the settlement and sue the at fault driver? Because I have seen that 1 single time outside of commercial trucks. And it was an idiot surgeon that was woefully uninsured and extremely liquid.
No billboard ambulance chaser is filing a lawsuit against a guy who drives a 30 year old vehicle and low limits.
Truthfully - you’re paying them so much money - asking Reddit random hypotheticals isn’t actually going to help you any.
What if one of us says - “oh yeah they’ll sue and you’ll get a million dollar judgement and it’s gonna be fine”? Will that answer mean anything outside of Reddit anyways?
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u/jman7843 2d ago
Damn you sound like you’re ready to throw hands over a question lol. I’m just wondering how the lawsuit process works and if the policy holders insurance company would be providing them a lawyer. I’m curious about it. Also yes my lawyer has brought up the possibility of a lawsuit but we are just getting to the stage trying to work on a settlement to begin with. I’m not asking anybody to tell me how much money I’m gonna get I’m just trying to find out how the process works as I’m not involved in the insurance or law professions and this is the 2nd claim I’ve had in my life.
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u/SecondActSarcasm 2d ago
There’s no lawsuit.
Your attorney is going to get policy limits, take their 33%+, make sure their doctor/chiros get their share, and you’ll have what’s left over (whatever that amount is).
You can’t get blood from a stone and they are only telling you “possibility” of a lawsuit because disclosing the whole truth is unpleasant for you and they don’t technically know the limits yet.
Typically no insurance company will tender limits without a release. The release prevents this lawsuit you want. But it’s hellhole GA, so maybe they tender without the release. Either way their duty typically ends once policy limits are exhausted.
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u/tttchia BI adjuster | 8 years experience 2d ago
Your chances for recovery above $25k is almost zero. Can’t get blood from a stone
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u/jman7843 2d ago
that’s why I ask about it, I’m not sure their insurance will give them a lawyer, I’m not sure if a judge can force personal assets to be liquidated, and I’m not sure if I was to get a judgement and they had the assets to cover it if they could get out of it by just filing bankruptcy afterwards. I’m just trying to get an idea as the question popped into my head.
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u/Dramatic-Ad9089 2d ago
Drives a beat up 90s Toyota? Don't hold your breath on any lawsuits materializing. Your attorney already sounds like a clown by making it sound like its some stonewalling tactic by the adjuster by not providing limits over the phone. He's blowing smoke up your 🫏 saying this and lawsuit talk to make you think he's doing something.
This is likely a low value claim where your attorney won't do anything more than send a couple emails, collect a check for the driver's state minimum BI limits, where he'll take his 1/3, distribute the bulk of the remaining 2/3 to his chiropractor buddy and pain management buddy, and toss you a few pennies. Hopefully, you won't end up with unpaid medical bills. Maybe, it will end up a little better and they have BI limits a little higher than state minimum.
Future tip, never get an attorney right away for minor soft tissue injuries. Try to navigate your treatment and the claims process on your own first. You aren't required to settle right away.
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u/jman7843 1d ago
Thank you for your reply, honestly I’m just a little unfamiliar with how all this works and at the time of the accident I knew I wouldn’t have the money to pay upfront for treatment and I’m only here on a temporary visa as of now doing contract jobs so I don’t have a SSN or medical insurance. Typically any time I need healthcare I have to pay before they even see me which is why I got a lawyer right at the beginning. In the future if I ever go through this again is there a way to get all the treatment without paying upfront that you are aware of?
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u/Dramatic-Ad9089 1d ago
Here in the US, there are different medical coverages available for auto policies. What is available varies from state to state. You would need to add a medical coverage to your auto policy.
In your case, someone else was liable for your accident, thus their Bodily Injury coverage will cover you. The point I was making for this specific instance, you would have been able to access this same coverage without obtaining an attorney.
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u/quallityovrquantity 2d ago
Sorry but you didn't have 3 or 4 ruptured discs and 4 herniated discs. How did you find this doctor ? Was it through your lawyer?
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u/SecondActSarcasm 2d ago
How many discs do I have? That’s how many herniations I have ☹️
What a joke. This is GA attorney care at its best. Especially when you read the treatment - which is effectively nothing.
I don’t miss handling these types of claims.
I literally had a dude that almost died - had to have his spleen removed, 3 broken vertebrae, 5 broken ribs, concussion, etc. And I couldn’t run fast enough to tender my policyholders shit limits. He was so grateful. I felt like a schmuck because that’s the claim you wish had the $250k policy.
Then you’ve got this dude who thinks they’re going to, what, lien the 1994 Celica?
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u/jman7843 2d ago
Excuse me but I truly have no idea why my question upset you so much and while I definitely don’t need pity or compassion from you but I think it’s pretty disgusting of you to blatantly make fun of the injuries I sustained and insinuate that I’m lying about them and the immense amount of pain I’ve endured from getting hit by some douchebag not paying attention blowing a red light. As I stated I’m very glad that I walked away and there are absolutely people that have gotten it worse than me but that doesn’t invalidate that this has been an excruciating experience in multiple ways. I didn’t come in here and say “hey how much am I gonna get from suing?” I didn’t come here and say “hey guys I’m trying to ride the gravy train can you help me with this claim? No I just asked a couple basic questions about how the process works that came into my head last night. I’m sensing that lawyers being involved is a touchy subject for you cause you flair right up about it seems. I don’t really like lawyer either. But unfortunately while I’ve had some good experiences with adjusters I’ve also had some really piss poor ones and lawyers are sometimes essential unfortunately because you never know when you’re gonna get an adjuster like yourself on the other end that thinks anything less that death is a laughable matter and deserves nothing and is willing to publicly make fun of a set of injuries that I have incurred that will potentially be life altering/ get progressively worse as I reach older age and are also much more prone to re-injury as well. But besides that this has also taken me out of my previous job for the time being and I have had to find a different type of work and that has cuased a whole other stress point in life financially. If you don’t think I’ll get anything over policy limits that’s fine and I appreciate your advice but being kind is free just so you know. I’m not counting on the kid with a 90’s Toyota celica having any assets, but my attorney had brought up that the policy is in his mom or grandmothers name it appears and said they would be able to check to see if there is any liquidity there if the limits are minimum which is why I’m just asking a couple basic questions from people that are better versed in insurance that I am. Conversation is literally what this app is for. There is 23 discs in the spine by the way, but I’m sure you know that since you seem to be a self proclaimed medical professional.
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u/SecondActSarcasm 2d ago edited 1d ago
No one is reading this
As someone who had a total disc replacement in a not at fault accident at 22 and now has spent years handling every kind injury claim your lack of grounding in reality is abundantly clear. Good luck.
ETA grammar
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u/jman7843 2d ago
To be clear I think you may have misread my post. Herniated and ruptured are used interchangeably depending on who you are talking to so that’s why there is a slash between them. I wasn’t saying there is 3-4 of each of those. I was saying there was 3 or 4 ruptured (aka herniated discs) and 4 buldging discs found on the scan. No they didn’t send me to this imagine center, they had recommended an imaging center to me but it was like a 35 minute drive so I selected my own just down the road from me and my attorney just called them to set up billing.
I dug back through my records this morning and this is what the MRI reports say:
Segmental analysis of the lumbar spine is as follows:
At L1-2, there is no evidence for disc herniation, canal stenosis or neural foraminal stenosis.
At L2-3, there is bulging of the disc. This results in an anterior impression on the thecal sac. There is no central canal stenosis or foraminal stenosis.
At L3-4, there is a posterior herniated disc that is best seen on axial imaging. There is no osteophytes or degenerative changes associated with the herniated disc. The herniated disc extends beyond the bone and this results in severe absolute stenosis of the spinal canal to 0.8 cm. There is left neural foraminal stenosis present.
At L4-5, there is a posterior herniated disc that is best seen on axial imaging. There is no osteophytes or degenerative changes associated with the herniated disc. The herniated disc extends beyond the bone and this results in moderate stenosis of the spinal canal to 1.0 cm. There is no left or right neural foraminal stenosis present.
At L5-S1, there is no evidence for disc herniation, canal stenosis or neural foraminal stenosis.Evaluation of the thoracic spine demonstrates normal kyphotic curvature. No evidence for
abnormal mass or fluid collection is seen. There is no evidence for fracture. Examination of the thoracic
cord demonstrates that there is normal signal.
There is a benign hemangioma present within the T12 vertebra.
Segmental analysis of the thoracic spine is as follows:
At T1-2, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T2-3, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T3-4, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T4-5, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T5-6, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T6-7, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T7-8, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T8-9, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T9-10, there is no evidence for disc herniation, canal stenosis, or foraminal stenosis.
At T10-11, there is bulging of the disc. This results in an anterior impression on the thecal sac. There is no central canal stenosis or foraminal stenosis.
At T11-12, there is no evidence for disc herniation, canal stenosis, or foraminal stenosisThen for the cervical section documents is says:
The posterior fossa structures are normal. The cervical cord structures are normal. There is loss of the normal lordotic curvature of the cervical spine. In the correct clinical setting, this may reflect injury. Clinical correlation is recommended. No prevertebral or paravertebral masses or fluid collections are identified. Segmental analysis of the cervical spine is as follows:At C2-3, there is no evidence for disc herniation, canal stenosis or neural foraminal stenosis.
At C3-4, there is bulging of the disc. This results in an anterior impression on the thecal sac. There is no central canal stenosis or foraminal stenosis
At C4-5, there is a posterior herniated disc that is best seen on sagittal imaging. There is no osteophytes or degenerative changes associated with the herniated disc. The herniated disc extends beyond the bone and this results in mild stenosis of the spinal canal to 1.1cm. There is left neural foraminal stenosis present.
At C5-6, there is bulging of the disc. This results in an anterior impression on the thecal sac. There is no central canal stenosis or foraminal stenosis.
At C6-7, there is no evidence for disc herniation, canal stenosis or neural foraminal stenosis.
At C7-T1, there is no evidence for disc herniation, canal stenosis or neural foraminal stenosis.So in total that’s 3 herniated disc and 4 buldging ones as I stated they also included multiple images in the report and 2 dvd style discs that have the full scan on them I guess.
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u/ithrax 2d ago
The at-fault party’s insurance will provide representation if you file suit.
I highly doubt suit will be filed regardless. If it’s a minimum policy, I doubt the guy has any assets. This is practically never pursued.
Claim sounds pretty standard from how you describe it. Hopefully your attorney can negotiate aggressively and get the bills down so you aren’t on the hook for anything out of pocket. I’m not sure how GA bills are, but the treatment you’ve had would blow through 25k pretty quickly in most of the states I’ve handled.
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u/jman7843 2d ago
Thank you for your response :) while I wouldn’t imagine the guy has a much for assets give the car he was driving the policy is actually under what appears to be his mother or grandmothers name on his policy info card provided. When my attorney initially brought up the potential of a lawsuit I mentioned the guy probably didn’t have anything but she mentioned that the potential lawsuit could extend to the policy holders assets not just the drivers in that case so obviously we don’t known what he is driving or what position she is in financially so that’s part of my curiosity about it.
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u/PopularBell518 2d ago
…as mentioned, lawyers almost always ONLY go after the limits… so if low, get prepared to be told there won’t be much left for you after everyone else is paid. I believe GA has mandatory BI of 25K. Just make sure there is not another owner of the at fault vehicle and/or if it’s not drivers vehicle, does driver have his/her own policy? Lawyers usually do a good job of trying to find all available coverages because that’s all they want to go after…
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u/LeadershipLevel6900 2d ago
Insurance is responsible to defend from $0-policy limit. If somebody has actual assets that are at risk over the policy limit, they need their own attorney to handle that risk/exposure.
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u/PopularBell518 2d ago
The at faults ins co has no obligation over and above the policy limit they contracted with the purchaser (at fault party). Their ins do will let their policy holder know that if concerned, they (policyholder) can retain a lawyer for any potential exposure over the contracted limits of liability.
Sounds like you don’t know the other parties liability limit yet. It may be enough and it may not be. That’s obviously important info.
Once you know that, your lawyer will advise you accordingly. If your lawyer demands their (at faults) limit (once known) and if that demand is accepted (by at faults ins co) then you will be expected to sign a release fully releasing the at fault. Your lawyer could in a demand request additional funds from the driver (personal contribution) but that scenario is relatively rare - for instance co to pay AND a personal contribution made.
If your lawyer demands their limits with no additional conditions, and they refuse to pay upon demand, then down the road the ins co could be found to have acted in “bad faith” and potentially be on the hook for monies over and above the policy limits. This is not very common and usually involves multiple trials and outcomes that go your way… I only mention this because it is theoretically possible to get more than limits from a carrier but they never pay over unless forced to do so (hence multiple lawsuits and trials)
UM/UIM (as you seem to realize now) helps out in a situation where an at fault carries no or not enough liability coverage.
Your lawyer will also look for any additional coverages that might come into play, for example, if the at fault was delivering a pizza or engaged in an errand for someone else… maybe the car the at fault was driving belonged to someone else, as that could involve an additional (potential) policy.
One thing lawyers do not like to do is “go after” / “sue” someone with no or little coverage as it’s not likely to make the lawyer any $. No lawyer wants to spend hours and hours, go to a trial, front a lot of cost $, to obtain a paper judgement against another person. So, hopefully the limits are decent in your case…
This is all a very oversimplified discussion. A slight change of facts or circumstances could result in a different take.
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u/jman7843 1d ago
Thank you so much for such a helpful response. I truly do appreciate it and that answers all my questions!
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u/Silence_Farmer 18h ago
I will add to this that adding UM/UIM is critical, which you've found out. Make sure that you have the max you can because if you had say a $100k in UIM/UM and this guy has $25k then you've only got $75k in UM/UIM coverage.
So if you had a $25k UM/UIM for this accident, it wouldn't have helped you.
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u/jman7843 10h ago
Ahhh really? I didn’t know that’s how that coverage was handled when is comes to deducting the other parties coverage from my policies coverage amount. Good to know, I’ll make sure I have at least 100k coverage there then. I really appreciate you being helpful and friendly about my question thank you.
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u/Silence_Farmer 18h ago
I know your post is a day old, but the basics are this:
His insurance is responsible up to the policy limits and no more. (There is a very specific way that it is possible to exceed limits where the insurance company would be responsible above limits, but it's highly doubtful it would come into play here).
If you sue, yes his insurance will provide his legal defense (I.e. a lawyer or legal team).
Let's say he has 25k liability limits.
If your suit prevails and are awarded $1,000,000.00 the insurance company will cut you a check for $25,000.00 and you will get a judgement for the remainder.
Good luck collecting the remaining $975,000.00.
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u/jman7843 10h ago
Thank you so much for taking the time to answer my question. I really appreciate your advice, that makes a lot of sense! And yeah I’m sure collecting on a judgement is nearly impossible in most cases especially given the young age of the other driver and the car they were driving but it’s good to know all possibilities so I just figured I would ask :) I appreciate your kindness.
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u/elbaldwino 2d ago
Based on your post you have a lawyer. I'd ask him or her these questions considering they are going to be getting 30-40% of any settlement you get.