For many years defendants in medical malpractice cases have routinely insisted on confidentiality of the terms of any settlement, especially (but not limited to) the amount paid to settle the patient’s claim. For this reason, the Tom Riley Law Firm ordinarily cannot identify the amount of any individual medical malpractice settlement, and no press coverage follows the settlement of a medical malpractice case (as opposed to a trial and verdict, which are public).
Our areas of practice include personal injury, medical malpractice, workers’ compensation, civil rights, discrimination and business and contract law. In addition, we have a large staff of highly trained, knowledgeable and experienced legal assistants, secretaries and firm personnel to support our lawyers and provide you with exceptional service.
For many years defendants in medical malpractice cases have routinely insisted on confidentiality of the terms of any settlement, especially (but not limited to) the amount paid to settle the patient's claim. For this reason, the Tom Riley Law Firm ordinarily cannot identify the amount of any individual medical malpractice settlement, and no press coverage follows the settlement of a medical malpractice case (as opposed to a trial and verdict, which are public). Consequently, even though we have settled medical malpractice cases for four and five million dollars, we are prevented from identifying the defendants or otherwise describing the circumstances under which such settlements were paid because of the confidentiality clauses the defendants require as a condition of settlement.
Yes, and it can range anywhere from four months to ten years from when you suffered injury or damages. The length of the deadline will depend on a number of factors such as: whether the injured party is a minor (under age 18 years) or not; the type of lawsuit or the legal theory relied on to seek a recovery (general negligence, dram shop against a bar or restaurant, medical malpractice, product liability, legal malpractice, oral contract, written contract, among others); the identity of the defendant (is it a government entity, a person who has died since causing your injury, an insurance company based on its underinsured/ uninsured motorist coverage, to name just a few); where the accident or injury occurred (inside or outside the state of Iowa).
If the insurance adjuster for the party at fault calls me and asks to take a recorded statement from me, should I let him?
Ordinarily, no. Insurance adjusters may try to persuade you they are your friend and just want to settle the claim in a fair way for all concerned, but think about it. He or she is employed to settle a claim for as little as possible or, if a settlement is not reached, to gain admissions and other evidence from you that will make it easier for the defense attorney to defeat or minimize your recovery of compensation.
Insurance adjusters are trained to obtain information that might later be used against you. This is information which, while you are answering a question, seems relatively innocent or even helpful to you. Often times it is not. Unless you know what to look out for and how to avoid various traps set by an adjuster, you are at a distinct disadvantage when giving such a statement. Moreover, once you give a statement, you will never be able to “unring the bell” or “take back” what you said of your own free will to the adjuster, at least with any degree of persuasiveness in the eyes of most jurors.
If the insurance company wants me to give them a medical waiver to verify my injuries, why shouldn’t I do so?
The medical waiver the insurance company will want is an unlimited waiver. It will allow the insurance company to look into all aspects of any medical care or counseling you have ever had. It will include treatment not just for the injuries you suffered in the accident that forms your claim, it will also include all previous injuries and any sessions with a psychologist or psychiatrist. At some point in your case, even if you have an attorney, you may have to give some kind of medical waiver. You should not do so before it is absolutely necessary, however. And you should not do so unless and until you are fully informed of the consequences of doing so, whether some limitations should be placed on the insurance company’s ability to gather or disseminate the collected information. Furthermore, the waiver you sign for your adversary’s insurance company (without benefit of representation) allows the insurance company not just to collect records but to speak with any of your doctors. This is something the insurance company or its lawyers will never be able to do without your attorney present, even if it is ultimately necessary to provide the opposing party with a medical waiver in the future.
Is there a “rule of thumb” used to decide what a case is worth by multiplying the medical bills by a certain number?
No. There is no rule of thumb for determining the value of a case in such a manner. There are literally dozens of factors that go into deciding what your case is worth. Moreover, many of these factors will not be apparent until several months or more than a year after your injuries or damages first appear.
Let’s look at just one factor that greatly affects the value of your case: trying to assess the likelihood of a full recovery or the extent of a partial recovery from your injuries. Physicians are understandably unwilling to guess how long your symptoms will last early on in their treatment. For this reason, it would be foolish to settle a case -- whether you are represented by an attorney or not -- while you are still undergoing treatment and there is any question concerning how long your symptoms will persist or how well you will respond to current or future therapies. Furthermore, while keeping a positive attitude and hoping for a good outcome to your treatment can be quite helpful from a therapeutic standpoint, one should not settle his or her case based on hope or wishing for a particular medical outcome, unless there is a sound professional basis for believing such an outcome is likely.
As noted above, there are a large number of considerations or factors that affect the value of your case. The amount of your medical bills is just one piece of a very complicated puzzle. Moreover, if an adjuster tells you that some multiplier times your past medical bills (or anything else) is a fair statement of the value of your case, you can bet he has already done the math and he and his company are quite happy to get by with paying you whatever results from using his formula. (Perhaps not so mysteriously, but when accident victims have relatively large medical bills as a result of sophisticated and expensive diagnostic techniques -- such as CT scans or MRIs -- but little objective evidence of an injury caused by the accident, adjusters are quick to forget the magical formula they would use on someone who had only $200 in medical bills.) In short, if there were a practical formula for determining the value of your case, someone would have put it in print and sold it to the public by now.
Can you tell me what my case is worth after the initial consultation?
It is entirely understandable that a client would believe that if he or she gives the lawyer a fairly accurate description of how they have been injured or (in a non personal injury case) how they have been damaged, the lawyer should be able to use his or her experience and training to assess the dollar value of the case at that time. Unfortunately, with rare exception, the lawyer will not be able to tell you what your case is worth with any measure of accuracy until he or she has spent several months ordering documents (e.g., medical records, accident reports, employment records, etc.), interviewing witnesses and speaking with your treating physician(s) where necessary, and taking depositions of uncooperative witnesses and the person(s) opposing you in the litigation. Furthermore, as noted in answer to the preceding question, frequently nothing but the passage of time will provide an adequate opportunity to assess the extent you will heal from your injuries. To tell you what your case is worth without considering all of the important facts is a disservice to the client and more likely to mislead than inform him or her. No one is served well by a speculative answer that may be off by a factor of 500% (either high or low) because the lawyer did not have adequate information to assess all aspects of the case at the time he or she offered an opinion as to its value.
Should I submit my medical bills for the treatment I receive to my own health insurance company or wait to collect it from the auto insurer for the person who hit me?
It depends. In most instances you should submit your medical bills to your health insurance company first, but there are exceptions. Satisfy yourself that the hospital where you are treated submits your bills to your health insurer, if that is what you believe is in your best interest. Many hospitals do not do so because they get paid much higher fees when it comes from the auto insurer for the person who injured you. This is because Blue Cross Blue Shield and other health insurers frequently have contracts with hospitals that greatly reduce what hospitals can charge health care insurers. (Similarly, Medicare and Medicaid do not pay “full price” or the “walk-in rate” for medical services.) Auto insurers, on the other hand, ordinarily have no such agreements with the hospitals. Thus, if you pay your own hospital bills out of the proceeds from your settlement with the other driver’s insurance company, you hurt yourself financially in two ways. First of all, the car insurance company that is ultimately responsible to pay you for all of your damages caused by their driver’s negligence will be paying much more to the hospital or other health care provider than would your health insurer in many instances. What this means is that the opposing auto insurance company is paying more of (what will be) your money to a health care provider than is necessary. For example, if you have work done at a hospital that Blue Cross or another health insurer would only pay $10,000 for, but the hospital’s “walk-in” rate is $30,000, by not turning in your treatment to your health insurer, the hospital is getting $20,000 more than it otherwise would. This extra $20,000 is essentially coming out of your pocket because the opposing auto insurance carrier is only going to pay so much for your injuries, and the more that goes to various health care providers means just so much less that is available to pay you for your pain and suffering, future disability, future health care, etc.
There is a second way you can be deprived of the full amount of your settlement by not having your health care bills paid for initially by your own health insurance. Almost all health insurance policies have a section on “subrogation.” Subrogation is just a legal principle that means that if an insurer (e.g., Blue Cross) pays for some of the damages you suffered in an accident (medical bills) caused by the wrongful conduct of a third party, and you collect from that third party (or his insurance company) for the injuries or damages you have suffered (which would include your medical bills, lost wages, pain and suffering, etc.), you have an obligation to pay back to your health insurer for the bills that the health insurer paid on your behalf because of the wrongdoer’s (i.e., the other driver in a motor vehicle accident case) negligence. But Iowa law also provides that if you incur collection costs in seeking compensation for your injuries (i.e., attorney fees and litigation costs), you may deduct a pro rata share of these amounts from what you have to pay back to your health insurer -- but not to the hospital if it just files a lien and waits for you to settle your case!
To illustrate this legal principle, let’s refer to the example we used before: If you had your doctor and hospital bills submitted to your own health insurance company, and your health insurance company paid $10,000 for the treatment you received, you would not have to pay back $10,000 to the hospital if you retained an attorney (usually on a one-third contingent fee basis) to maximize your settlement or verdict. Iowa law states that the hospital would have to help you pay your attorney by only collecting two-thirds of its bill, and the money for the other one-third of its bill would be kept by you to reimburse you for some of the attorney fees you paid to obtain the settlement or verdict. You would also get a credit for the hospital’s pro rata share of any other litigation expenses beyond attorney fees that you incurred in obtaining the settlement (e.g., filing fees, witness fees, court reporter expenses for depositions, etc.). So in the hypothetical set forth above, if you did not turn your hospital and medical bills into your health insurer, $30,000 of your settlement would go to your medical creditors before you saw one dime. If you had turned your medical bills into your health insurer, however, you would only owe two-thirds of $10,000 or $6,666.66 because your own health insurer would have to help you pay its fair share of the attorney fees you incurred. In fact, as noted above, your health insurer would actually have to pay somewhat more than this because it would also have to reimburse you for its fair share of any litigation costs your attorney advanced or incurred in prosecuting your lawsuit.
We have had clients who did not submit their bills to their health insurance company (or erroneously believed the hospital had done so), and by the time they came to our office, it was too late to submit their health care bills to their health insurer. Most health insurance policies include deadlines for submitting bills for services rendered. If you intentionally or mistakenly fail to have the hospital’s bill submitted to your health insurer within the deadline provided in your contract, your health insurer will deny the claim.
Do I need a lawyer to represent me for the injuries or damages I suffered?
If you are in a car accident (or otherwise injured because of someone else’s negligence) and whatever pain or limitations you suffered were short lived and gone within one week of the accident, you probably do not need an attorney. Assuming the opposing auto insurance company is prepared to pay you to fix your car and give you some amount for the short-term discomfort you suffered and any lost wages or medical bills you incurred, it probably would not be worthwhile to hire an attorney. Bear in mind, too, that if the insurance company does not pay you what you feel your claim is worth, you can still sue the other driver and owner of the vehicle in small claims court. Small claims court is available for ordinary citizens to present a claim to a judge, who will then render a decision based on any documents or testimony that is given at the small claims court. No juries are allowed to decide cases in small claims court. The judge is authorized to make awards up to $5,000.
Small claims forms and information sheets are available at the Palmer Building, 123 Fifth Street SE, Cedar Rapids, Iowa. (Be sure to ask for the information sheet.) The documents can be picked up between 8:00 a.m. and 4:30 p.m., although it is best to get there by 4:00 p.m. This is also the building where you will present your small claims case.
Do I need a lawyer for my workers’ compensation case?
Under the Iowa workers’ compensation law, an injured worker is entitled to certain benefits for an on-the-job injury regardless of fault. The benefits include full payment of medical expenses (including prescriptions and travel expenses for attending medical appointments), temporary disability benefits (weekly benefits paid while a worker is completely or partially off work), and permanent disability benefits (weekly benefits to compensate the injured worker for a permanent injury). In many instances, the workers’ compensation insurance carrier pays the injured worker certain benefits without too much of a struggle. However, there comes a time in almost every workers’ compensation claim when the workers’ compensation insurance carrier believes they have “paid enough,” and at that point the injured worker should contact a qualified and experienced attorney to protect the injured worker’s interests. Even if the workers’ compensation insurance carrier is continuing to pay benefits, and all seems well, it is a good idea to consult with an attorney to make sure that the injured worker is, indeed, receiving all of the benefits to which he or she is entitled. Failing to contact an attorney, preferably early on, may leave the injured worker wondering “did I receive everything to which I was entitled?” for the rest of his or her life. Do not hesitate. Contact an attorney early on to make sure you receive all of the benefits to which you are entitled under the law. Ordinarily, if the attorney cannot help you increase your benefits, there will not be a charge for the attorney’s services.