Greg Herrman and Jordan Jacksondiscuss a little bit of Jackson's background and the different insurance coverages that you need in Texas.
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Greg Herrman: Well hello everybody, welcome to frequently asked questions Friday!
It's Friday, February 9th, I'm Greg Herman and I have with me today Jordan Jackson, one of the attorneys that work for Herrman & Herrman, do you want to say hi?
Jordan Jackson: Hi, I'm Jordan Jackson, I'm one of the associate attorneys here at Herrman & Herrman's San Antonio office.
Greg: Do you want to tell us a little bit about yourself Jordan?
Jordan: I'm originally from San Antonio, Texas. I went to high school in Converse at Judson, I went to Baylor for undergrad, go bears! I went to St. Mary's in San Antonio for law school. Ever since I got passed the bar in 2013, I've been doing personal injury work and I feel like this is kind of home for me.
Greg: I assume all your family is in San Antonio Austin for the most part?
Jordan: For the most part all my family is in San Antonio, a little bit from outside of skiing area and then everybody else from Chicago or DC.
Greg: How long have been over here at Herrman & Herrman?
Jordan: Since August 2017.
Greg: I understand the topic you wanted to talk about today was insurance coverages, right? Very exciting, well not, but I know you're going to make it exciting for us!
Jordan: Sure, since I've been doing this type of work, the one statement I constantly get from new clients is after they've been involved in an accident as we try to walk through the steps with them is 'but I have full coverage.' Well, that's great, now we can get your car fixed. But what does that mean? and most people don't. I didn't know what it means until I worked at USAA and they go through coverages with you. They explain to you full coverage means you have comprehensive and collision coverage. Comprehensive is for example if you hit a guardrail or a deer runs out you can get your car fixed. Collision is kind of self-explanatory, you get in a car accident, regardless of fault, you can get your car fixed. But what do you do if you're injured?
Greg: Right, and full coverage would also mean you have liability coverage, so if you hurt somebody else your policy will pay them and if you get sued the insurance member will defend you.
Jordan: Yes, but what do you do if you get hit and you're injured?
Greg: So let's stop for a second, so we just gotta acknowledge that you did work for the dark side there for a while. When you work for USAA you're on the insurance company's side.
Greg: What advantages do you think that gave you, the fact that you worked at for an insurance company first?
Jordan: So, I wasn't an adjuster so I don't want my clients to be upset about that. Basically, I was the person telling you about your coverages, so I was kind of like your agent so basically I let you know 'this is how much coverage you have, this is how much liability coverage you have, do you think maybe you need to protect yourself a little bit more?' but the one thing that I found out through working there is that you need to have underinsured, uninsured, and PIP. Preferably PIP over medpay. In that instance, if you do get hit by someone that doesn't have car insurance, you're protected with your uninsured. Or if you get hit by someone and you are drastically injured and they don't have enough coverage, you have underinsured to protect yourself as well. Also you might have questions about 'well I had to miss work right away,' that's kind of where your Personal Injury Protection steps in for your lost wages in the beginning and for your initial hospital bills or EMS bills.
Greg: So let's just kind of go back through those again. Now, what if somebody has health insurance, would they need all these coverages?
Jordan: I would still recommend having those coverages because your health insurance could say 'sorry, that person that hit you is responsible and we're secondary,' we hear that a lot. 'We're the secondary people to pay' Also they could pay your initial hospital bill then they want their money back.
Greg: Right, they have a right to subrogation, which we'll get to. I know some insurance companies used to say 'you know, look, we just exclude car wrecks, we just don't pay for it because everybody is supposed to have insurance.' Humana used to do that, I had a secretary that was hurt pretty bad one time in a car accident and she tried to use her Humana health insurance, now this was years ago, I'm not sure what they do now but they just said 'it's excluded from the policy, we read your policy, we just don't cover it, sorry.'
Jordan: That's not uncommon. I've heard that a lot, I've heard that some doctors don't want to see their patients because 'you were involved in an auto accident' Why not? A number of reasons, one of the myriad of reasons is that your health insurance isn't gonna pay for it, so they're fearful about them getting paid.
Greg: Okay so let's just go one by one, the first one is an uninsured motorist, so define exactly what is an uninsured motorist.
Jordan: Uninsured motorist is when you get hit by someone who does not have car insurance, your car insurance will step in and provide bodily injury coverage for you in the event you are injured in an accident.
Greg: Then what is underinsured insurance?
Jordan: Underinsured motorist is in the event you were involved in an accident and your injuries max out the amount of liability coverage that the person that hit you has.
Greg: All right, and what is Personal Injury Protection or PIP?
Jordan: Personal Injury Protection is something that in Texas you have to opt-out of so, theoretically we all have it and we make the decision to not have it, but it's basically either twenty-five hundred or five thousand, it kind of comes in those tiers and it's no-fault coverage that covers the first round of your medical expenses up to those limits.
Greg: What is med pay?
Jordan: Med pay is something that you can have that works similar to PIP, it's no-fault coverage, but, if you recover from another source you have to reimburse your insurance company the medical payments they issued out. Med pay is short for medical payments.
Greg: What does that other source that you recover from? Is it your own uninsured or underinsured motorist coverage?
Jordan: You can negotiate with your insurance company for them to allow you to keep your medical payments or your med pay but they have to evaluate your claim or your injuries in excess of the amount that they've given.
Greg: So, in other words, they get like credit or something for the med pay?
Jordan An offset is the word they use?
Greg: Alright and then lastly we mentioned subrogation, now that's a big word and sounds like it's gonna be really confusing but can you make the concept of subrogation simple for everybody?
Jordan: It's kind of like we're in a law school exam but, so your health insurance along with another number of other things could have what's called a subrogation interest in your claim. That basically means that they are inserting themselves that they have to be repaid in the event that you recover, in smaller terms.
Greg: Are there any defenses to this right of subrogation of theirs?
Jordan: There's a couple, you can get into the weeds of it if you have an ERISA plan, employment funded plan, or health insurance you could make the argument that if employee funds weren't used to pay for your medical treatment, if they have a policy or an insurance policy to insure against that insurance then, you can argue you're not entitled to reimbursement automatically because you didn't use the Employee Retirement Fund in order to pay for this. The reason we repay ERISA is because employee funds were used to pay your insurance, but if you didn't use it, that's why it's so protected, if we didn't do that then you don't have that level of protection. That's a lot of paperwork, that's a lot of reading, that's a that's going in depth and that's a lot of fights you're escalating that up the chain
Greg: So it may be worth it on bigger cases?
Jordan: Yes, the reason I've gotten into the weeds of this is because I have had somebody who had millions of dollars worth of injuries and we were trying to get further surgeries and we were trying to get more money in her pocket for those future surgeries. You can fight a subrogation lien going all the way up to the Federal Supreme Court saying whether or not there's any remedy for you not paying a subrogation lien, or somebody's interest in your claim. The Supreme Court kind of says there's no remedy in that so if you don't pay it it's kind of out there but it's whether or not you want to err on the side of caution. Sometimes you should probably pay it especially if it's very nominal but if you have something with Medicare and Medicaid that's protected, tax dollars are being used we have to reimburse them.
Greg: So Medicare and Medicaid have essentially a lien?
Jordan: Yes, they have a lien, not a subrogation interest. The subrogation interest is something that is contractually written into your health insurance policy that no one reads when they sign up for open enrollment or their health insurance. a lien is something that especially with Medicare it's automatically in place there's also such things as hospital liens so if you go for treatment within 72 hours of your auto accident the hospital could theoretically file a lien against your claim that protects their interest and ensuring that they're repaid if Medicare or Medicaid pace can you still negotiate with them of the amount of their subrogation or only you can that's always a possibility you can say you could argue about certain things that they pay for for instance if you got into an accident you also went in and said hey I had a cold and they ran some type of flu test which is very common down here in South Texas right now guess what we don't have to remember the flu test you can also make an argument that you know I don't if it's a very big Hospital or a very big Medicare leave you can say this is how much I have available in funds as far as recovery in the instance that my client my clients insurance agent didn't explain uninsured and underinsured motors to them and now they have a big bill Medicare has a big bill or a big lien you got to take a third you know it's kind of one of the things we come to them with you have to reduce your medical bill you have to reduce this lien down so we can try to pay everyone else um what about if an insurance company claims their arrest so can you make them improve it yes you can ask for the it's certain documents that they have to produce in order to to prove up that they are an ERISA plan have you ever seen one be able to prove that an ERISA plan yes yes I've never seen 30 years and I've been asking for proof for 30 years and they sent me a bunch of stuff but it's not the right stuff going off I was told the same thing the same acts a memorable car accident I represented a minor for I thought the same thing I was like there's no way they can prove up that this is an ERISA plan we asked for the documents and normally they send you stacks and stacks of pages oh this was two pages they sent over so that let me know first thing they knew exactly what I was talking about and then they sent me they sent me the stacks of paperwork and then they pointed me to the right direction of where we needed to be for for that and I had at several bosses review that because I didn't think that's not very common yeah I've never never seen be able to prove it yet they always they threatened to come down and they got to go to the hearing and they're gonna ask for attorneys fees and oh that then they call you at the last second ago uh you know what but anyway alright and on just regular subrogation if it's not IRISA and it's not Medicare and Medicaid do you have any defense to just a regular subrogation I would say to they put you on notice that's kind of where I stand did they let you know that you have to reimburse them the other thing that I talk to my clients about and this is for your client to make the decision and I always go and tell them this is what I would do and this is my legal advice but I have had situations where I've had clients say because if you don't repay your subrogation interest with your health insurance they could potentially pull coverage but how often are we during open enrollment getting new insurance companies occasionally you have one year you might have Humana the next year you might have United Healthcare and you might have Blue Cross Blue Shield so then the question becomes well if you got an accident 2017 and August of 2017 for instance and now it's December of 2017 do you have the same insurance company I know our open enrollment has happened during that portion during that portion of time do you want to reimburse them I've had clients tell me no because that's not my health insurance company anymore so there's no coverage for them to yank what about since they just have an equitable right of subrogation don't they have to prove that you've been made home before you get a reimbursement that's a good question you can make the argument that I still have future medical bills that need to be paid I still have future coverage I mean future future treatment that I'll need so I still need these funds for x y&z you the other thing is once you cut it off with treatment or once you cut it off with the the auto accident claim you can always take that step forward and then go back and continue treating through your health insurance as well and that subrogation interest has ended because you have resolved your property your personal injury claim okay all right we've probably exhausted this every day it's controversial around here yes all right any other issues on insurance if you want you are stuck well the only other thing I would say is make sure you have the amount of coverage that fits you I see a lot of times when we get our clients deck pages and they'll have $100,000 in coverage or you know they have an excessive amount of coverage they don't have anything that they're protecting but then they also aren't protecting themselves now a lot of times when you buy insurance it's if you want to have a hundred thousand dollars in um are you I am you I am then you need to have comparable coverage and liability but I've also seen you our clients are out here if they ever hit someone that person is protected but they're not protecting themselves no definitely need to protect yourself call your insurance company ask questions but if you're involved in an accident you don't have to go at this alone you can call us we're here to help you so so if you're not worth a hundred thousand dollars you probably don't need to be protected up to a hundred thousand and it doesn't matter whether somebody sees you for ten million dollars or nothing they're not going to get don't the worst thing it did is your policy closed what's your worth and if you're not worth a hundred thousand but you'd probably need a hundred but you may want to protect yourself up get hundred thousand or more in case somebody hurts you really bad and they only have like a thirty thousand dollar policy exactly state minimums in this in the state of Texas is thirty thousand it varies per state but you might get hit by somebody that only has a state minimum which is a strong majority of people so you want to make sure you protect yourself but at the same time if you hit someone what are you protecting yourself against the Homestead Act covers a lot they can't take your home they can't take your house we can't take people's homes we can't take their their cars can't take their retirement accounts so a lot of Texas protects a lot of the individuals personal sets so it's a question of what do you feel comfortable with in the event you're involved in an accident and making sure your coverages are comparable to protect yourself and then also your insurance agent or company might say then you need to have comparable coverage in order to do this that's just part of the part of their but better to worry about yourself for protecting you against other idiots then worrying about covering other people I would always say protect yourself because you could get hit by so many it doesn't have anything so they weren't looking out for you you need to look out for yourself so make sure you hide limit so I hear you and you're you I am and you're pepper yes yes get as much PIP as you can what I mean but if I hit someone personally they can have all of my student loan debt I'll share it with them all right I want you are you okay well that's okay thanks everybody for tuning in again and we'll see you next Friday if anybody has any questions about in this they can send me an email or send Jordan an email and we can answer any further questions about insurance or um pet medpay or I know your favorite subject is subrogation so any questions about ERISA subrogation notice letters then says an email or sends a question through through Facebook so John thanks again for coming to FAQ Friday and we'll see you guys next week same time same channel