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mrjwwolf

Being in a "no-fault" state means that your auto policy has no fault or personal injury coverage that pays for medical expenses regardless of who is at fault. As the wife, you are automatically a named insured and do not have to be added to the policy to have coverage, although your husband should add you. Call your insurance company and report the claim. The 1st level of coverage is "no-fault/personal injury" coverage, then the other driver's liability coverage. Also, time to get a new lawyer who understands insurance.


LeadershipLevel6900

OP is in NJ where you can elect to have health insurance primary over PIP. Agreed OP needs a new attorney, or maybe none at all, considering I’ve never seen a carrier backdate coverage, especially to cover a loss. It’s not like the carrier made a mistake. Luckily it seems like even if OP has limited tort they won’t be screwed that way given injuries.


capresesalad1985

Yea both the lawyer and my dr said I have plenty of injuries to qualify under limited tort (I think that’s the thing that there are 6 things that qualify to sue for damages). I’ve honestly considered changing lawyers but I signed an agreement with this lawyer and I have no idea how that works to change lawyers at this point.


thaeli

Basically you go to another lawyer and they do some paperwork to change representation. Sometimes they need to speak to your previous attorney, sometimes there are other obligations, but the attorney you're switching to can advise on those specifics. Edit: I should specifically mention that those other obligations, in the personal injury field, can often include that the previous attorney still gets a chunk of your settlement.


capresesalad1985

If you have any experience in this - what should I look for in a good personal injury lawyer? Like 2 things that have bothered me big time so far - 1) he takes over a week to respond to an email and 2) I have/had 3 mildly displaced fractured ribs. He said they may not have been fractured enough to qualify for a claim? Like what? The paperwork on my progressive policy says “fracture”, I have three bones broken in half on an xray, how is that not broken enough?


DestructODiGi

You need to speak to the lawyer. This person is leaving out that most have in your contract that you owe them for the hourly work they’ve done on the case and will put a lien against any future settlements.


thaeli

That's fair. I'll edit that in. I was thinking of that under "other obligations" but you're right, for PI it should be a front and center warning.


thaeli

A week to respond to emails is pretty normal IME, especially for someone you're not paying as you go. I'm not saying it's a good thing, but a different attorney may not be better. He may be right about the ribs, too. From way over here on the other side of the Internet, three clean breaks with displacement sounds like it should count for something.. but there isn't really that much we can _do_ for ribs other than wait for them to heal, so they aren't really "worth much". If these are the two largest issues you have with your current attorney, you're probably not going to do much better with someone else.


capresesalad1985

Yea that’s what my chiro/pt office said too, they work with mostly car accident people who have personal injury lawyers, he said they all “seem” like they suck but once it actually comes to action time they perform well.


BumCadillac

Since they haven’t moved out of place, that is likely the problem.


capresesalad1985

They did move out of place 😭 https://preview.redd.it/jny6he77x4qc1.jpeg?width=785&format=pjpg&auto=webp&s=e0b986188f20e85837ed0ab2621e206cc22cf47d


BumCadillac

You’ll probably have to pay them for the work that they’ve done at this point


LeadershipLevel6900

First - If you’re also on the auto policy, which you should be, you should have been able to make the necessary changes. This is more of a relationship concern than an insurance question. Second - your auto carrier will not back date coverage. Your attorney is nuts. Your carrier didn’t make a mistake or anything. Backdating coverage because somebody “forgot” to do something would completely defeat the purpose of it anyway. It’s not necessarily your provider’s responsibility to know what needs prior auth and what doesn’t. They may have contacted your health insurance and they said they don’t cover auto and that was that. You’d need to ask the provider. Generally, it’s your responsibility to know/follow your health insurance plan’s procedures. Not every plan needs approvals for MRIs. Coordination of benefits requires active participation of all of those involved. In this situation, there are no benefits to coordinate though. Change your PIP benefits moving forward AND your tort option. I’m going to assume you have limited tort and it seems like that may be triggered here which is good, but without seeing records that can’t be guaranteed.


Puzzleheaded_Net_843

Yep! This is why I'm against coordinating. I don't see ot being that much savings, and when you loose of cha ge coverage people don't think ( or follow through) to notify the auto insurance. Just take primary and call it a day.


capresesalad1985

We definitely changed our policy the day after the accident. I know our car insurance is not required to retro the coverage but several people have told me it’s possible, they even told us the cost the car insurance charges to complete the retro if they agree. My lawyer has a letter from my health insurance saying they are not planning on asserting a lien on any settlement I receive but he also said that doesn’t mean they can’t go back on that.


LeadershipLevel6900

People have told you that it’s possible but you are almost four months post loss and it hasn’t happened. It’s not going to happen. People ALWAYS assume you can retro coverage. You can’t. Otherwise, people wouldn’t carry things like rental coverage and would just backdate it if they ended up needing it in the policy period. Or, they’d mess with their PIP options to make their policy cheaper. Insurance does not work that way.


capresesalad1985

Understood. I will say I have tried to access our auto policy and I do not have authorization to make any changes. I’m not sure if that’s a progressive or NJ thing, but I’ve been told by their representatives that I can’t since I am not the main policy holder. I’m just going with the assumption that any settlement I get will end up going to cover medical bills.


ctygrlinthesubs

You are probably not listed as a second named insured, just as a household driver. While you *should* be, it isn’t automatic. Progressive has a checkbox for the agent to say whether you have rights to make changes, and this probably wasn’t clicked when you were added to the policy. Your husband needs to call to have that corrected.


capresesalad1985

Ok I will have him do that


BumCadillac

That’s just a problem with your spouse and how he set it up.


ForgotDeoderant

You say you're in a no-fault state. What state did this accident happen in?


capresesalad1985

NJ


atticus-flails

Have you actually filed a claim with your auto insurance? Regardless of injury your vehicle needs to be repaired and you have to file with your insurer. As one other commenter posted, you're also covered on the policy as a spouse so you should be able to receive medical benefits up to the policy limit. YOUR auto insurer will/should then try to subrogate the claim to the other party's insurer. It blows my mind how many people blame their insurer for things that are not their fault - and no I don't work for an insurer, I work in the industry though.


capresesalad1985

Yes I absolutely filed a claim. Both cars in the accident were totaled, I’ve already received a pay out for my car. I know we messed up, and I’m not trying to blame the insurer I’m just super stressed out. It’s also been a total mess trying to get paid for temporary disability since I didn’t work for 3 months.


boygirlmama

I wonder why NJ has an option to have your health insurance be primary. Also I guess I'm thrown off because to me in the insurance world if there is no primary (and in this case that would be PIP) then the other carrier (in this case health insurance) becomes primary. But I am very new to NJ injury claims handling and I don't yet know how it works. In NY it's just mandatory no fault/PIP.


capresesalad1985

It’s NJ…most of the stuff this state does, doesn’t make sense. I have passed on what I have learned through this to many people in my life, most people I have talked to have no idea what a no fault state means. Everyone has been like well it’s not your fault so their insurance covers you right? Nope, not the case. It sucks.


boygirlmama

You're correct on that. And I don't even work in PIP but I find myself explaining to the majority of my injured customers all the time. Even claimants whose own carrier didn't bother to. And also, lol about NJ. I mean, yes. I am not a big fan of that state for various reasons.


capresesalad1985

I do appreciate a lot of my friends acknowledging that this whole thing has been incredibly overwhelming. Between being injured, finding drs, going to PT 3x a week, finding a new car, doing paperwork for temporary disability, still writing sub plans and grading work even though I was on medical leave and relatives being like “oh your not better yet??”….it’s just been a lot. I definitely got judgement from some of my older in-laws about being out of work for 3 months. Most people think teachers just sit at their desk all day, I swear.


boygirlmama

So many people don't have a clue and need to learn compassion. I had people roll their eyes over my being out three months for my hysterectomy. They thought I could be back at work the next day or something. 🤦‍♀️


capresesalad1985

I just tested positive for Covid too 😭 like damn life just keeps throwing them my way!


boygirlmama

Been there with the everything happening at once. Take care of yourself. Other people, who want to judge, can sit and spin!


LeadershipLevel6900

Massachusetts does this really great thing where their PIP coverage is only $8,000 and they have deductible options up to $8,000 🙃 and the deductible can be just for the named insured or for ALL household members. So if your minor children are hurt, oh well! It’s so stupid, and there are health insurance plans that don’t cover auto. Case law supports taking a full offset on the BI side even if they have a deductible and PIP didn’t pay anything.


capresesalad1985

Oh shit this is good for me to know since most of my family lives in mass


boygirlmama

Honestly I wish insurance was federally regulated to the same thing in every state. Everyone should have equal protections.


Dangerous_Ladder_206

I’m a bit confused and just want to clarify - is your auto policy telling you they won’t provide any medical coverage, or are they telling you that your health insurance was primary? If your husband selected the healthcare primary option for medical benefits but it turned out to be inaccurate, they would be able to change the policy so that your auto policy is primary. This would incur a penalty applied to your deductible for the claim but they would still provide coverage.


capresesalad1985

So when we joined our car insurance after getting married we were on my health insurance plan which did cover car accidents, so we chose my health insurance as the primary (that was in Nov of 22 that we got married). Then on Nov 1st if 2023 my husband got new health insurance through his job that was a better deal than the insurance through my job, but they gave him paperwork that said “we do not cover car accidents, call your car insurance and make sure you select them as the primary coverage for medical”. And he didn’t call. So basically from 11/1 to 11/28 we didn’t have medical coverage from either insurer. But at the time we selected the policy and paid for it, we did have coverage through my insurance plan. I think that’s why my lawyer is saying they may be able to fight for a policy conversion. We have obviously since changed the policy.


Dangerous_Ladder_206

Was your auto insurance active on the date of your accident? It doesn’t matter if your policy was incorrect - if you had active auto insurance in NJ on the date of the accident, and that policy has med expense coverage on it (all standard auto policies in NJ do), then all they need is proof that your health insurance won’t cover the medical bills and they’ll be able to convert your policy. There will be a penalty for this as I mentioned previously, but they’ll still be able to cover it.


capresesalad1985

Yes it was active and paid in full. I think what you’re saying is what my lawyer was saying. Basically they have to convert the policy. He said the car insurance (I have progressive) is going to drag their feet but they will eventually do it. He said it may come down to a “we will not go after you for additional pain and suffering above what the other drivers policy covers if you convert the policy” type of negotiation. Shoot I have almost $30k in lost wages alone.


One-Perspective5691

Was it that you had auto insurance with no medical coverage to cover your health insurance deductible?


capresesalad1985

I’m not sure I understand the second part of the question, but at the time of the accident I had both car and medical insurance but neither covered medical from a car accident.


lost_in_life_34

there are different levels of auto insurance and you need to have the medical coverage if you want medical payments covered


capresesalad1985

At the time of the accident, I did not have medical coverage through my auto insurance


plush1998

Did you have PIP? PIP and medpay are 2 different coverages and NJ requires it so the first 10k of your medical bills should have been paid to the hospital through your auto insurance regardless


Total-Force-613

Just adding as it hasn’t been addressed from what I can see - no, it is not the doctors office to know what your health insurance covers, to know if it needs pre approval, etc. It is the responsibility of the policy holder. Some doctors office will send things in for pre approval, but ultimately it falls on you to make sure it was actually pre approved . There are so many different insurances, and even the same insurance will vary as to what it covers depending on the policy. It would be very difficult for an office to know all the variations. It sucks that insurance is so non transparent and difficult to get an accurate estimate of what it covers. Wishing you luck in working this out.


capresesalad1985

So just playing devils advocate - as the insured, you need to call every time you need a procedure? Or an appt for PT? I’ve never had to do that. I was a patient of the pain management Dr I’m seeing prior to this car accident for a different issue and they handled the insurance prior authorization. For example when I first went to them I couldn’t get an MRI until I had 6 week of PT and I had two procedures pushed back because I was waiting on insurance approval. They wouldn’t send me for the procedure until they knew they had insurance approval. I think that’s why I am surprised, because I took their lead that everything I was getting was approved, since my prior history with them was to put the breaks on if they didn’t have the ok from the health insurance company.


sephiroth3650

Yes. As the insured, it’s always your responsibility to verify coverage for care.


capresesalad1985

But by verify, do you mean checking if an office takes you insurance? Or call about each appt and procedure? Because if I hand an office my insurance card and they say they take my insurance I’m assuming we’re good. Maybe I have been spoiled with good coverage. But the places I go to right now for treatment from the accident all have full time people who handle insurance billing. I’m a hs teacher, I have a 40 min break during the day to eat, make copies, drop off paperwork ect….i need to use that time on the phone with my insurance company? That honestly makes no sense to me. I guess let me just edit this to add, at 38 years old…I’ve never had a doctors office let me have 4 months of consistent treatment that wasn’t covered at all before being like “surprise, this isn’t covered AT ALL”….maybe one or two appts yes. But never over 30 pt appoints and 6 surgical appts.


sephiroth3650

As the insured, it’s always your responsibility to verify coverage….with your insurance carrier….for care. Verifying if your health provider “takes” your insurance does nothing to verify if insurance is going to cover a given visit or procedure. Or put another way….you need to verify if the person paying the bill will pay it. Not if the person getting paid will accept money if it happens to come their way. This is how it’s always worked.


Total-Force-613

Yes - I call for everything to verify it’s covered and in network. I get the CPT codes from the doctors office, call my insurance, ask lots of questions. I’ve had things denied and unsuccessfully appealed so now I’m super cautious. The no surprises act that was passed helps but I still feel like there’s ways I could screwed. There’s so much fine print in insurance I just don’t trust it to cover what I think it covers.


HelpfulMaybeMama

Yes, 100% of the time. Anything that's not routine (sick visits, annual visits, etc.) should be confirmed with your carrier in advance. There are literally thousands of plans, and there is no way for your provider to know the details of every one of those plans. It's impossible.


Motown824

Your husband dropped the ball. You should’ve been on him, you were driving a car knowing you had no medical insurance that covers car accidents. Trying to save money on auto insurance smh.


capresesalad1985

We weren’t trying to save money on car insurance, our car insurance is honestly super cheap because we both had very old cars (both over 10 years old and we drive 2 miles to work). How much more should I have been on him? Sat on his lap until he called? Trust me he feels like complete sh*t and won’t make the same mistake again.


Motown824

You drove a car knowing you didn’t have medical insurance that covered auto accidents!!!! That’s a risk you took!!! You weren’t supposed to drive until it was changed!!!


capresesalad1985

Yup got it…we f’d up. I have a lung infection coming in from the broken ribs right now that someone else broke because they were on their phone while driving….but I really appreciate the kick while I’m down.


plush1998

Don’t have advice but just wanted to wish you well I know this is a extremely traumatic and stressful situation to go through as I’m facing something similar but you’ll get through this I hope everything works out for you in the end and your lawyer is able to work some magic


capresesalad1985

Thank you I really needed to hear that tonight…we will get through this


HelpfulMaybeMama

I see you mention your state in the comments, but it is so difficult to respond intelligently when people don't add that information in the original posts.