If you are involved in an accident or collision that is not your fault, New Mexico law clearly states that you are entitled to be paid your medical expenses from the at-fault driver or its insurance company. Since you didn’t cause the accident, it is reasonable for you to expect that they would pay for all of your medical expenses. The question I am most oftern asked as an Albuquerque Personal Injury Attorney is, “What types of medical care will be covered?“ This is the topic of today’s blog by Mark Caruso, Personal Injury and Wrongful Death Attorney.
Let’s look at the actual law according to the New Mexico Statutes. For this we turn to the NM Jury Instuctions 13-1804. This is the law that the judge reads to the jury, and is the law that is applicable to before trial and during settlement as well. The law states, You are entitled to “The reasonable expense of necessary medical care, treatment and services received and the present cash value of the reasonable expenses of medical care, treatment and services certain to be received in the future.” Also, 13-1802 states that the injury must have resulted from the negligence of the other person. Taken together, and in layman’s terms, the law is this…You are entitled to reasonable medical expenses you need as a result of the negligence of the other driver.
Clearly transport by ambulance and ER care meet this criteria. But questions are always raised by insurance companies about follow up care with your primary care doctors, medications, physical therapy, chiropractice care, medical massage therapy and other medical care. Note that the law does not limit the care to anything except two words…..(1) result and (2) reasonable. The law doesn’t say that you don’t get reimbursed for chiropractic care or medical massage therapy or limit you in advance of the type of medical care from your accident.
Auto insurance company claims adjusters try to limit your medical care or scare you into believing that certain medical care will not be paid for. These are interpretations, restrictions and limitations wrongly placed on NM law by greedy insurance companies trying to save money for their shareholders. You shouldn’t let claims adjusters from State Farm, Farmers, Allstate, Geico, Progressive, USAA, Fred Loya, Travelers, Hartford, Nevada General and other insurance companies decide the medical care you should get. They are not doctors, they are just claims adjusters! Only your doctor and health care providers should decide your medical care.
In order to prove that the medical care from your wreck should be paid to you, you merely need to be able to show the following:
A. You gave your doctor or health care provider an honest history or your prior medical condition and what happened in the wreck?
History of Prior Injuries: It is extremely important to tell your doctor about prior problems, symptoms and medical care to the part of the body that you are currently claiming was injured as a result of the wreck. Clearly, he cannot state that you suffered an injury from the current wreck unless he knows about prior problems. Your doctor may be able to state that you aggravated your prior condition in the current wreck if your symptoms are now worse than before the wreck.
History of Current Wreck: It is also important to tell your doctor exactly how the wreck happened, the speed of impact, the location of the impact and the amount of damages to your vehicle, if known. The doctor needs an accurate history of the wreck to determine whether you sustained a significant impact to cause the injuries you are now claiming were from this same wreck.
B. Your doctor or health care provider examined you.
The doctor needs to perform an actual examination of your injuries. The doctor will normally check your range of motion and areas of sensitivity and pain. Make sure to report all of your symptoms to your doctor so that your doctor can examine each area of your body that is painful.
C. Your doctor performed diagnostic tests such as x-rays.
Don’t be surprised if your doctor asks your permission to perform diagnostic tests such as x-rays to help the doctor determine the extent of injuries. X-rays are important to determine broken bones but are also useful in determining the effects of a soft tissue injury on your spine.
D. Your doctor reached a diagnosis that your injuries were a result of the accident.
Once your doctor takes your history, completes your examination and reviews the diagnostic reports he/she will reach a diagnosis of your injuries. The diagnosis will tell you the injury that you suffered and will also state the cause of the injury. An example would be that you suffered a broken leg as a result of the wreck or that you suffered a whiplash as a result of the wreck.
E. Your doctor will recommend and prescribe treatment or medications for your injuries.
Now that you have been told that your injuries are a result of the wreck, the doctor’s job is to try and fix those injuries. Some doctors will give you drugs and send you home. Better doctors will make a referral for physical therapy, chiropractic care and perhaps medical massage therapy. At the conclusion of your care, the doctor will state that that care that has been provided is reasonable. Usually, the doctor’s final report lays out all of the doctor’s findings about history, examination, diagnostic tests, diagnosis and treatment. It is extremely important that you doctor create this final report, because you will need it for the insurance company and perhaps even for litigation.
Our firm asks the doctor to also state that the treatment was reasonable, necessary and customary. This means that the treatment was the type of treatment that would have been provided by other doctors of the same qualifications in the area for the same or similar price of other doctors in the area. It also means that the treatment was necessary to treat the injuries, not just optional treatment.
Often times, outside sources can be used to help prove that the injuries were reasonable and customary. Our firm utilizes two such sources for chiropractic injuries and treatment.
The first is the Croft Guidelines. These Guidelines have been accepted by the New Mexico Chiropractic Association as the guidelines for chiropractic care in our state. The Guidlines permit a specific number of treatments over a specific duration of time based on the findings of degrees of injuries. As long as the treatment of the chiropractor falls within these Guidelines, the treatment is deemed reasonable. It is important that your chiropractor limit treatment to that which is permitted by the Guidelines, or the insurance company will use the Guidelines to argue that the care was excessive. You should only use chiropractors who are familiar with the Guidelines and agree to treat you in accordance with the Guidelines.
The second is the PMIC. The PMIC is a national publication used by health care providers and insurance companies nationwide to determine the customary charges for a particular service or procedure. Each individual service or procedure done by a health care provider is designated a code, and each code is designated a customary price in the community. Compare your charges from your doctor with the average charged by other doctors to determine whether your doctor was charging a customary charge in the community. You will have problems getting the insurance compoany to pay or reimburse you for charges that exceed the customary charge in your community.
Under NM law you are entitled to reasonable medcial care to take care of your injuries from the collision. In communicating with all health care providers you must be honest in reporting your history and when cooperating with your doctor for the examination, the diagnostic tests and treatment. The doctor’s diagnosis will determine whether the insurance company will pay for these injuries provided the health care providers complies with Guidelines established by the doctor’s profession and PMIC.
Mark Caruso exclusively handles personal injuries and wrongful death as a result of accidents, collisions and wrecks from autos, trucks, motorcycles, buses, bicycles and pedestrians. We do our best to insure that the health care providers our clients see have done everything possible to prove that the injuries claimed by our clients were reasonable and a result of the accident. Sometimes that means pressuring the doctors to write reports, and other times it means arguing with a doctor why their charges are too high.
We fight for our clients not only with the insurance companies but also argue on their behalf to their health care providers. After all, we work for our clients-not the insurance companies or the health care providers.
Located in Albuquerque, Mark Caruso handles cases statewide throughout New Mexico. We have two locations in Albuquerque-Northeast Heights and Westside. Free consultations with an attorney can be scheduled by calling us at (505) 308-1556. You can also visit our web site at carusolaw.com Mark Caruso is a former insurance company attorney who now works against these same insurance companies to get his clients the most money possible. Licensed since 1982 our firm has represented tens of thousands of personal injury and wrongful death clients with vehicular accidents, malpractice, product injury and other negligence. Our firm handles injuries whiplash, spinal injuries, head trauma, PTSD, permanent injuries and wrongful death. Please contact our firm if we can help you in any way.
We are highly rated and ranked as one of the top New Mexico personal injury and wrongful death attorneys by www.AVVO.com as a 9.6 SUPERB. We have peer reviews by other attorneys and reviews by our clients at this site. We have received a Client Distinction Award and been rated a 4.5/5.0 by Martindale Hubbell ratings. We have an A+ rating by the New Mexico Better Business Bureau. We have been selected as a member of the Million Dollar Advocates Formum. We are members of the NM Trial Lawyers Association and the American Association for Justice. Also, as a Christian attorney, Mark Caruso believes in honesty and fairness in everything he does at the office and away from the office. We take care of our clients and it shows in these reviews. We continue to strive to receive the best reviews possible.
We offer a discounted 29% attorney fee on all cases that are settled prior to a lawsuit being filed. This discounted fee puts more money in your pocket when compared with other personal injury attorneys who charge the higher 33 1/3% fee to help pay for their expensive television, radio, billboard and bus advertising. We pass this savings directly to you. However, you still receive the same quality care by a firm which fights for its clients to get them the most money possible on their personal injury claim.
Watch this Blog for future topics by Mark Caruso about your right to money for Pain and Suffering, Lost Earnings, Permanent Injury, Punitive Damages under NM law.