Jessica’s Story

Why are these insurance issues so important?

Please take a look at my explanation of insurance coverage here and how insurance companies save you money here. This set of facts happened. I just changed the names to protect confidentiality. My client, let’s call her Jessica, just turned 17. She got her driver’s license, and her parents bought her a 2015 Honda Accord. Jessica was an athlete. She played basketball at her high school as well as on a competitive travel team. She was not going to play basketball at the Division 1 level but had a chance to continue playing basketball at a Division 3 or maybe even a Division 2 school. She was very good.

Her parents added her to the insurance policy. While on the insurance company website, Jessica’s parents changed coverages based on suggestions from the insurance company. The parents kept their $250,000/$500,000 bodily injury limit but reduced their PIP from $250,000.00 to $75,000.00. The parents reduced their UM/UIM coverage from $250,000/$500,000 to $50,000/$100,000. They saved just under $500 for the year.

Jessica was driving home from a friend’s house one afternoon. An uninsured vehicle came into her lane and hit her vehicle head on. She was seriously injured. She was admitted to the hospital. Jessica and her parents were terrified when the surgical consultation led to a surgical recommendation. The surgeon looked and Jessica and her parents and reassured them. For the first time since the accident, Jessica felt safe. The operation was successful, and Jessica was discharged home. The hospital bill was over $80,000.00, which exhausted her PIP coverage. Jessica needed ongoing treatment, and in the end her bills exceeded $100,000.00. Additionally, her surgeon felt she would benefit from a second surgery that would cost roughly $75,000.00. Unfortunately, the surgeon that made Jessica feel safe did not take her health insurance. He was out of network. If she had more PIP, he could do the surgery, but if she wanted to proceed with the second surgery under her health insurance, she would have to find someone else.

The worst part for Jessica was the injury ended her basketball career. She could not play anymore due to the injuries. She tried. The pain and lack of mobility proved too much. Her high school coach loved her and missed her leadership on the court. He made her an assistant coach for the season. She never played competitive basketball again. I remember the day after this became clear, Jessica and her parents came to my office for a client meeting. Jessica held it together when we went through the medical treatment and the need for surgery. She fell apart when we talked about basketball. She played basketball with her dad when she was little, and her dad coached her until she began to play on more competitive teams. She explained to me how much basketball meant to her. She really wanted the chance to play in college and now she knew that would never happen.

As the person responsible for the accident was uninsured, Jessica made a claim under the revised insurance policy discussed above. She had over $20,000.00 in unpaid bills and future medical bills of at least $75,000. She had $50,000.00 in coverage. The insurance company would not offer their full $50,000.00 as at that time, they would never be responsible for more than $50,000.00. There have been some changes in insurance law that may have made her situation a little better but not much. I’ll link to another post explaining that change.

In the end, the insurance company refused to offer more than $47,500.00. It would cost more than $5,000.00 to continue the case with the possibility of recovering only $2,500.00 more. Jessica and her parents felt trapped. Between counsel fees and costs and medical bills, Jessica stood to recover around $8,000.00 for her severe injuries, her future surgery, and her loss of basketball. I reduced my fee to help her, but unfortunately, she walked away with only $18,000.00. She ended up having the future surgery under her health insurance. The surgeon in network had very poor bed side manor. She was scared. While the surgery helped a little, it did not help as much as she hoped. She was left with the belief that her first doctor would have done better.

Had Jessica’s parents kept their PIP policy at $250,000.00, she could have proceeded with the surgery with the doctor she trusted. Had Jessica’s parents kept their UM/UIM policy at $250,000.00/$500,000.00, Jessica would have recovered much more for her pain and suffering.

The risk is not worth the savings offered by the insurance company. Please make sure you follow our advice. Keep your UM/UIM at the same level as your bodily injury coverage and keep your PIP at $250,000.00 PIP Primary.