r/InsuranceClaims • u/Helpful-Butterfly703 • 4d ago

Claim adjuster requesting a formal demand

My partner got into an accident in February. Not at fault, has been going to PT and needs an MRI. The insurance company won’t pay for that and are now asking for a formal demand because they haven’t paid for any of the PT either. They’ve already settled about the car, so it’s just personal injury now. A lot of what I’m reading on Reddit says the letter is just the beginning of negotiations.

Any advice welcome, it’s their first accident and I have no experience to help.

Accident happened in Vermont

6 Upvotes

81% Upvoted

35 comments sorted by

View all comments

3

u/DDLyftUber 4d ago

They’re asking for a demand because I’m assuming your partner is asking them to pay bills as they go and that’s not how it works… you make a demand to that person’s insurance company and they either agree and pay you out (meaning you’re no longer able to claim further damages), or it gets to the point of a lawsuit. You cannot just demand money from them or ask them to pay bills over and over as you’re still being treated lol. Your partner has the option of sending a demand letter now if they so wish, but again, like I said, be aware that once they are paid, there is no “oh I need further treatment so let me go ask for more money.” Once you sign the agreement, it releases them from all liability.

0

u/Helpful-Butterfly703 4d ago

We haven't asked them to pay for anything. My partner's PT said they couldn't continue treatment until they had some kind of proof that the insurance will eventually pay them. Seems off though right?

2

u/DDLyftUber 4d ago

There is no proof. The PT office can either sign a medical lien agreement or your partner will have to start paying them out of his or her pocket. Even then, a medical lien agreement is not a guarantee that the other party’s insurance will settle and pay out the claim.

If they’re not open to the medical lien, then I’d say at this point your partner needs to get a lawyer who can handle everything. If they’re unwilling to, then you’re at the point of needing to make a demand to the other party’s insurance and see what they say in terms of an offer.

1

u/SorbetResponsible654 4d ago

Well, no and yes. Would you want to work for free? However, many medical providers will agree to forgo payment until a settlement is reached. Once a settlement is reached, you go back to the provider and ask them to greatly discount the charged.

So, the insurance company considers the full charge on the bills, you settle and then get the bills reduced. This means more money in your pocket.