I was told by Nationwide Inusurance (the person responsible for the accident insurance company) they have denied my claim because the damage to my friend's car who I was riding with is less than $500. The car who hit us damage was greater than $500 because he was driving a small car. We were driving a SUV. Is this legal for them to deny my claim for my hospital visit just because they don't feel I should have went to the hospital based on the damage to the vehicle? Do I have a case?
Nationwide can deny any claim brought to it so long as they have a good faith basis to do so. Nationwide denies cases on the basis of property damage all the time. They realize that in doing so a certain percentage of claimants will simply go away and will not file a lawsuit. Those that do file a lawsuit, a certain percentage will meet with the jury that doesn't believe someone can be hurt a car accident unless there is a lot of damage. Some cases will win in front of a jury and they will pay the claim.
From a business perspective it makes a lot of sense. Deny all the claims and pay only that fraction of claimants who go the distance and fight. Unfortunately it's become harder and harder to pursue these types of claims.
As you know most if not all personal injury attorneys work on a contingency fee. The fees usually one third of the total amount recovered. A big part of your recovery would be the amount of medical bills. As of 2011 the law changed in North Carolina limiting the amount you can recover for medical expenses i to the amount necessary to satisfy the bills. It's commonly referred to as paid versus incurred. This means that if you have any health insurance, Medicaid or Medicare is reduced your liability for the bill, you can only recover what is is necessary to pay back the lien and any outstanding balance. So for example if your medical bills were $1500 at the hospital and your health insurance is reduced your liability by $1000 through their discounts, you can only recover $500 for your bills. Obviously no attorney wants to go to court to collect the third of a $500 bill.
Prior to 2011, it was possible for an attorney who is successful on behalf of a small case plaintiff to seek attorneys fees from the insurance company for their time in addition to the recovery. The law changed however to require an "unwarranted refusal to negotiate in good faith" on behalf of the insurance company. There was also limits placed on the amount of attorney's fees that could be recovered.
If you're getting the impression that the deck has been unfairly stacked in favor of Nationwide you would be correct. In my 20+ years of practice I've never seen a greater or more successful effort to protect the profits of liability insurance companies over the rights of injured people. I believe it will take some time to amass enough people who have had your experience to affect a change with our state legislature.
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