How Insurance Works

shutterstock_50485129There are many types of insurance that could be applicable to your claim and it can be confusing trying to figure it all out. When looking to the coverage(s) of the at-fault party for his/her negligence we are looking to LIABILITY INSURANCE. Everyone on the roadway, must have hit, however, there are citizens who operate vehicles without coverage. If you are injured by such a person, you still may have a claim for your injuries, however they must be paid through the contractual relationship you have with your company called UNINSURED MOTORIST COVERAGE (UM). All South Carolina auto policies have this coverage even if you just have liability coverage on your car. Other contractual coverages you may have with your insurance company are UNDERINSURED MOTORIST COVERAGE (UIM) and MEDPAY. Underinsured Motorist Coverage is optional, but you must be given a meaningful offer to have it. It protects you for any damages you have that exceed the coverage of the at-fault party. Medpay covers your out of pocket medical expenses up to the amount of coverage you have for you or any person in your car during the accident and it is redeemable even if you were at fault in the accident.

The following links provide detailed information to help you understand how insurance works:
Liability Insurance
Uninsured Motorist Coverage(UM)/Underinsured Motorist Coverage (UIM)
MedPay Benefits
Health Insurance

Liability Insurance
The simple definition is coverage from the insurance company of the person who is at fault. If you are injured in an accident as a result of someone else’s fault, you will be making a claim against their liability insurance coverage. You are entitled to be reimbursed for various things such as your property damage, medical treatment and bills, lost wages and pain and suffering to name a few.
Your liability coverage will cover you or any family member while using any automobile or trailer, and any person using your covered auto with your permission. In South Carolina, every vehicle is required to carry at least 25/50 in liability coverage. This means that if the at-fault driver has minimum coverage, $25,000 is the most any one person injured by a covered driver can receive even if their damages are more (this is why UIM is such an important coverage) or up to $50,000 for all injured parties combined, as a result of a single accident. Thus, is you have 3 people in your car and you all have $20,000.00 in bills, there is only $50,000.00 that you have to split. While 25/50 is the minimum required to be carried, you can also see limits in the amounts of $50,000/$100,000 and $100,000/300,000. The at-fault insurance company is not required to tell you exactly how much coverage their insured driver has to cover them. Having representation by an attorney can open up other avenues to determining whether the coverage is suitable or if you will have to analyze car insurance policies at your home to locate additional coverage.

What is UM or UIM?
An uninsured driver is someone who did not have any liability insurance at the time of the accident. A hit-and-run driver claim is also processed as uninsured if the vehicle is not identified prior to settlement of your claim. Your insurance company will look at your bodily injuries and pay the claim out just as an at-fault carrier would have done.
An underinsured driver is someone who had insurance, but the amount of the insurance was not high enough to pay for the personal injuries or damage caused by the accident. In these situations, UIM is paid out once you can prove damages exceeding the at-fault driver’s coverage. In order to protect your ability to get a UIM payout, do not sign a Release of Claims on the liability, you will need to execute another type titled document such as a Covenant not to Execute.
Additionally, uninsured and underinsured motorist coverages can pay for injuries to you or any household resident relative living (spouse, parents, children, siblings) even if your automobile was not involved in the accident. So if you have a family member who was in an accident and there is not enough coverage, the policies you have at your household may be of help. Your insurance company will need to know about the accident and begin its own investigation of the claim. This can be a complicated process – that’s why we’re here. Call Spann Wilder Law, LLC to begin the process of analyzing coverages in your claim. A legal claim is a job all by itself, while you work on healing and putting your life back together, we will deal with the insurance company and getting you all the money that is available to your claim. Call us at (843) 266-7792 or 1-800-866-3830.

Why Would You Want UIM or MedPay?
Simply put, you want to be protected. If you get into an accident with someone whose coverage isn’t enough to cover your damages. Once their insurance company provides their policy of coverage, you would have no other means of recovery. This will leave you with the injury and no full compensation. UIM coverage is usually affordable, especially considering the amount of protection it offers. It could pay your medical bills, lost wages, and pain and suffering. If someone hits you or your car and is legally responsible for the damages, you won’t get any money from them if they don’t have money to give you. Especially during times when people are struggling economically, many drivers either do not have insurance or do not have enough insurance. If you have UM/UIM, you can get money even if the other driver doesn’t have enough. Just like while driving you are charged with being aware and on the lookout for the other driver, you should do the same in way you plan out your insurance coverage. Ask your agent to run the numbers on these added coverages, for pennies on the dollar you could save yourself from significant financial loss if you were injured.

Medical Payments (medpay) is a coverage that may be available under your own auto insurance policy. This coverage will pay for reasonable expenses incurred for necessary medical and funeral services because of bodily injury caused by auto accidents and sustained by an insured. It is usually issued in amounts of $500, $1,000, $2,000, $5,000 or even higher. Individuals covered include:
1. You or any family member while occupying any automobile, or as a pedestrian when struck by a motor vehicle; or
2. Any other person while occupying your covered automobile or any vehicle driven by you or a family member.
The services are only reasonable and necessary if the treatment is rendered by a licensed medical provider within his practices and the charges are consistent with the usual charges within the geographical area for similar services. Medpay does not cover pain and suffering, scarring, permanent disability. Depending on how your policy is written, it may cover lost wages.
This coverage applies only in limited circumstances. First you must have been injured in the vehicle accident and you must have incurred medical expenses. The insurance coverage does not pay for future medical expenses; it only reimburses for medical expenses you have due to your injuries in the accident. Secondly, you must be an insured under the policy to receive the benefits of med pay coverage. An insured under the insurance policy is:
• The named insured on the policy (usually the one who owns the vehicle that is insured)
• The named insured’s resident spouse
• Any family member to the named insured which is any person related to you by blood marriage or adoption who is a resident of your household
• Anyone using the vehicle covered under the named insured’s policy
Insurance coverage follows the vehicle. If you are in a vehicle that has med pay coverage on its policy, you will likely be a covered insured under the med pay coverage of the policy. However, you may be a covered insured for med pay coverage under more than one policy. It is best to consult an attorney to be sure you know which policies may cover you under the medical payments coverage.
As is the case with most insurance policies, there are listed exclusions when the policy does not apply. The facts arising out of your automobile accident will bring rise to those factors. If it always a good idea to secure a copy of your policy to ensure that what you are being told is in fact what you have agreed to.
It is not required that you carry med pay coverage in South Carolina. Therefore, the coverage is only a supplemental coverage you can purchase on your policy. Typically the charge for this coverage is small compared to the benefit you can receive if you are ever in a vehicle accident. If you are injured and an insured under the med pay policy, then you are entitled to this benefit regardless of fault. I encourage you to ask your agent about adding this coverage to your policy today.
Redeeming your medpay coverage will not increase your premiums. Your insurance premiums can only be increased if you have a chargeable offense, or are involved in a chargeable accident. You are also entitled to be paid the full amount of your medical expenses (up to the limit of your medpay), not just the balance due after other insurance has paid. For example, if you have health insurance, and it paid 80% of your medical expenses, you could still claim the full amount of your bills for medpay reimbursement, not just the 20% balance owing.
NOTE: if there is more than one medpay benefits policy available, you are only entitled to collect up to the exact amount of the total medical expenses you incurred. You cannot submit the same bills for duplicate payment to more than one insurance company.

Health Insurance
If you are fortunate enough to have health insurance at the time you were injured in an accident, you should let your health insurance pay on their accident related expenses. Often we will hear, “Why should my insurance have to pay when the accident wasn’t my fault?” The answer is simple: Because the law allows you to do so and it will reduce the amount you are responsible to pay medical providers out of pocket before the case is settled. Once treatment is rendered, providers are not at all interested in waiting until your settlement for payment. You received the treatment so you are responsible for the bill and if payment is not received timely, they will turn your account to collection agencies.
If you’ve read our sections on liability and medpay, you know that you can recover from both of these insurance sources for injuries sustained as a result of someone else’s negligence. But you can also collect from your own health insurance company in addition to the liability and mepday benefits. Many hospitals will tell you that you cannot use your health insurance accident related care, this is not true. They just prefer to charge you at a full price rate versus the reduced rate they have agreed upon with your health insurance company. It is best to just present your health insurance card to the administrator processing your intake and not get into any lengthy conversation about which coverage you should use. If you have insurance, use it. Again, this person works for the hospital and is looking out for their bottom line. We work for you and have your interest at heart, they don’t!

Here is how it works:
You are in an accident as a result of someone else’s fault. You have three sources of potential insurance coverage to help pay your medical expenses:
• The at fault driver’s liability insurance
• Medpay benefits on your own automobile policy
• Health insurance benefits
Personal injury claims can often take months, sometimes years to settle. By using your health insurance, you will prevent harassing collection phone calls which is a stressor no one needs. If your insurance company sends you a questionnaire asking about what has happened, it is best to forward it on to us and allow us to begin the discussion with them about what is owed from your settlement claim. We will negotiate a fair settlement amount back to the insurance company and everyone wins – your bills were paid early, you got the benefit of a reduced balance out of pocket and the insurance company got some money back!

What is Subrogation?
Subrogation in its technical form is an insurer’s right to collect against a third party for reimbursement of benefits it has paid on behalf of its insured. In simpler terms, it is an insurance company’s right to get paid back. In the context of health insurance, your health insurance company may have a right to subrogation against your personal injury claim (right to be paid back) for benefits that they pay out on your medical expenses. This is something that we verify before we settle your case. Often we will work with your health insurance carrier to negotiate a lesser amount to be paid back equaling more money in your pocket. You may question why it is that they are entitled to be repaid since you pay insurance premiums already. Simply it is about equity – health insurance is deemed for health problems that just occur, not because someone caused it. So when a 3rd party has caused your damages and your insurance takes care it, they are entitled to get some portion of the money back that they spent.