MEDICAL MALPRACTICE AND PERSONAL INJURY LAW BLOG

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Should I Give a Statement to an Insurance Company for a Medical Malpractice Case?

After a medical injury, you may get a call from your insurance company. Since your medical insurance provider is responsible for covering your medical bills, it only seems natural to cooperate and give them the information requested. Before you talk to the insurance company, it is important to remember that the insurance provider is a business and they may be more interested in their bottom line than your health and well-being. 

You do not have to talk to anyone at the insurance company before you have an opportunity to speak with your attorney. Your lawyer can help protect you from answering questions that may not be in your best interests. Before saying something that could hurt your chance to recover medical malpractice damages, talk to your attorney. 

A medical malpractice case can be complicated and stressful. Having the right legal team on your side can go a long way to giving you confidence and help you avoid any unnecessary complications in your recovery. If you were the victim of a medical accident, contact Gilman & Bedigian today online or by phone at 800-529-6162.  

Do You Have to Talk to the Insurance Company?

Talking to the insurance company can be complicated. On the one hand, you may have to talk to the insurance representative in order for them to cover your medical expenses. On the other hand, you don’t want to say anything that will hurt your malpractice claim. After you get a call or letter from the insurance company, you may not even be sure which insurance company you are dealing with. 

There are a lot of insurance companies involved in a medical malpractice claim. In many cases, you will be at a disadvantage when dealing with the insurance company because their whole business is based around one area of practice and you only have to deal with the insurance company when there is a problem or things go wrong. 

You do not have to provide a statement to the insurance company but the insurance company may say they “require” you to provide a statement. It may feel like a false choice where you are “damned if you do and damned if you don’t.” However, in most cases, you will have the opportunity to talk to your attorney before providing a statement or responding to the insurance company’s questions

Your Insurance Company vs. Their Insurance Company

Dealing with the insurance company is a necessary part of any medical malpractice claim. Most medical injury victims have an insurance company that provides coverage for their medical care. However, there are a number of other insurers involved in your medical injury. Your own insurance company may have re-insurers. Reinsurance provides insurance for insurance companies, for example, to cover very high claims. You may know your insurance company but have no control over which insurance companies insure your insurance company. 

Insurance is a complex issue and something most people want to avoid talking about. Let’s look at the insurance companies that can be involved in a medical malpractice insurance claim. 

  • Medical insurance provider
  • Automobile insurance company
  • Medicare/Medicaid
  • Medical malpractice insurance company
  • Hospital malpractice insurance
  • Pharmaceutical insurance companies
  • Life insurance companies
  • Long-term care insurance
  • Reinsurance companies

Medical Malpractice Insurance Providers

The biggest insurance “elephant” in the room will generally be the company that covers malpractice liability of the doctors, hospitals, and nurses involved in your care. When a doctor makes a mistake, the medical malpractice insurance company steps in to deal with any claims of liability. The insurance company will generally handle the legal claims for the doctor, including their legal defense and settlement negotiations

Even if you think the lawyers for the doctor represent the doctor, they may just be the insurance company representatives. If a doctor really wants to be defended against any claims that they made a mistake, they may have to hire their own lawyer, even though the insurance company is offering their legal team to handle the liability claim. This is because the insurance company representative represents the insurance company first. 

Insurance companies provide liability coverage for doctors when someone alleges medical malpractice. Under the terms of the insurance, the insurance company will step in and take over the malpractice claim defense, trying to get the claim dismissed. If the insurance company cannot get the claim dismissed or defeated, they may try and offer a settlement. The settlement is based on the insurance company trying to calculate the risks and benefits of taking the case to trial. 

There are a lot of unknown risks in a medical malpractice trial so most cases are settled before they get to trial. An insurance company has adjusters and economists who develop their own algorithms and calculations to come up with settlement ranges that fit their predictions. Dealing with the insurance company might as well be like dealing with a robot instead of a human being because their world is ruled by numbers and dollar values instead of treating each individual case around a human being. 

What Will the Medical Malpractice Insurance Rep Say?

In most cases, you will have a medical malpractice attorney on your side before you have to deal with the medical malpractice insurance representative. Once you file your claim, most of the contact between the medical malpractice insurance company and you will be through your lawyer. If you get a phone call or a letter from the insurance company, you can refer it directly to your attorney. One of the greatest benefits of having an experienced malpractice team on your side is that they will deal with the insurance company so you don’t have to. 

The first time you will have to deal with the medical malpractice attorney may be to respond to discovery requests. Discovery is the fact-finding part of the legal claim, where both parties request documents, official statements, and information about the case. This includes interrogatories and depositions. 

Interrogatories are written questions which must be answered as part of the lawsuit. Interrogatories may appear confrontational and confusing. Don’t worry…you don’t have to figure them out all on your own. Your attorney can help you with the interrogatories so you don’t accidentally say something that will hurt your case down the road. Interrogatories for the injury victim in a medical malpractice case could include questions like: 

  • State your full name, address, date of birth, and marital status.
  • Identify each person who claims personal knowledge of the alleged injury.
  • Identify each person you intend to call as an expert witness. 
  • Identify all hospitals and physicians that rendered medical treatment related to the injury claim. 

The next significant interaction you may have with the medical malpractice insurance company may be your deposition. A deposition is a sworn testimony that takes place outside the court. A deposition could be in your lawyer’s office, the insurance company’s lawyers’ office, or in another location. There will generally be attorneys from all sides present, as well as a court stenographer who records the testimony. 

During a deposition, the attorneys on the other side will be asking questions that you have to answer. In general, your attorney can object to a question that they have a problem with but you may still be able to answer the question. Don’t worry about the deposition because your attorney will be able to help you prepare for the experience so you know what kinds of questions will be asked and what the situation will be like. 

The next time you have to deal directly with the medical malpractice insurance company will generally be during the trial. Before the trial, your attorney will be the one dealing with the malpractice insurance company lawyers. However, if your case does not settle and goes to trial, you may have to end up in court for a few days or weeks, depending on the trial. Before you get to this point, your attorney should prepare you so that you know what to expect and can help you feel more comfortable for such a stressful and conflicted experience. 

Independent Medical Exam 

Another way you may have to interact with the insurance company is to get an independent medical examination (IME). An IME is a way to get a 3rd-party examination of the injury victim to evaluate their injuries and damages. An IME is supposed to be by a doctor who has no prior relationship with the injury victim to give an independent evaluation of the person’s health. The insurance company can require an IME as part of a medical malpractice lawsuit. 

You may be able to have your attorney with you for an IME in case you are concerned the examination will not be truly independent. However, IMEs are a routine part of medical malpractice lawsuits, similar to personal injury or workers’ comp claims. Talk to your attorney about the process of going through an independent medical exam as part of your malpractice claim. 

Medical Insurance Provider

Your insurance company may be less directly involved in your medical malpractice lawsuit. In general, the insurance company will be more interested in getting paid. If you recover damages for your injuries, your insurance company may try and get a portion of your award that was supposed to pay for your healthcare. Your insurance company may even file a lien against your case for reimbursement. If you have questions about insurance reimbursement and medical malpractice, talk to your attorney for advice. 

Insurance Company Tactics to Avoid Liability

Let’s not kid ourselves. The insurance company has little interest in your best interests. The insurance company is a company with their primary interest in making money and saving money. They will do whatever they can get away with to keep as much money in their own pockets, which generally means less money in your pocket. 

The entire industry is based on calculating risk and losses. You pay for insurance to cover your own medical expenses. In many cases, you end up paying more than you expected because the insurance company will deny some coverage, not pay for out-of-network care, or only kick in once you have met your deductible. Anytime there is a dispute with the insurance company, it is almost impossible to get someone on the phone to explain why your covered care has not been covered. 

The insurance company has a lot of tactics to avoid liability. Unfortunately, many of these schemes involve getting the injury victim to say something that can be used against them in court. This is why it is so important to talk to your medical malpractice injury attorney before talking to the insurance company. Your attorney is familiar with the insurance representative’s tactics and can help you avoid saying something that will hurt your case. 

The insurance company representatives try to appeal to your honest nature. When they call up and want to talk to you about your claim, they may sound sympathetic. They may even sound friendly and understanding. However, be aware of their questions and their wording when they try to get you to talk. For example, if you were injured because of a surgical error, they may try and get you to say something about knowing the risks of surgery even if the doctor never properly advised you of the risks and benefits beforehand. The insurance company may then later try and use this to counter your informed consent claim. 

Before Giving a Statement to the Insurance Company

It is unfortunate that your own insurance company is not on your side when you suffer a medical injury accident. However, you need to do what is necessary to protect yourself and your family. After a medical error injury, make sure you have someone on your side who understands how to deal with the insurance company so you don’t have to. An experienced medical malpractice attorney is familiar with the insurance industry tactics and will make sure you don’t get taken advantage of when just trying to protect your rights.

If you were injured because of a doctor’s mistake, talk to an experienced attorney about how to deal with the insurance company so you can recover the maximum award available for your losses. Contact Gilman & Bedigian online or at 800-529-6162 for a free consultation.

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