QuestionQUESTION: I have finished all my treatments for the soft tissue injuries from the car accident. The at fault car insurance requests the medical bills and reports. I am going to submit them along with my demanding (I do not want the insurance make the offer first because it must be low). There is a calculation of pain and suffering. Is it reasonable to start demanding the pain and suffering in the soft tissue injuries 3-5 times of the medical bills, wage loss and mileage reimbursement for the treatments? Thank you for your answer.
ANSWER: Hello once again, Ruo,
Forgive me if I misspelled your name inasmuch as last time it appeared as Rou. Anyway, I am happy to hear that you have pretty much recovered. As for valuation, you are on the right track, but take a look at some of the factors that go into the valuation of the claim pick out two of these that are in your favor and build some words around them.
Be sure to give the adjuster a full set of records and billings. You can go ahead and send them now if you wish and then work up your demand letter in the coming week.
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There are two additional things I want you to think about. These are not essential, but they might help in presenting your claim. These two ideas are (1) using a narrative report or letter; and (2) using a witness or two.
Narrative reports can settle personal injury claims
Here is another idea, Rou, to make your medical record into an asset for settlement. Get a narrative report from your doctors regarding your HISTORY and treatment and prognosis and FUTURE medical care. CONSIDER USING A DOCTOR'S NARRATIVE REPORT to assist in settling your insurance claim.
If you have only written notes as evidence of the seriousness of your injuries, then maybe the records she is using to value your claim are not all that good. Have you seen any of the doctors' records that have gone to the insurance adjuster? If not, it is easy enough to get a copy so you can make sure that everything of importance you discussed is included therein IN READABLE FASHION.
Cryptic medical notes may be medically significant, but why make the insurance adjuster struggle to figure out the significance of the injuries? A narrative report or letter spells things out so the adjuster can see, read, and understand the doctor's diagnosis and prognosis and her record of the problems and pain and suffering you have endured.
Plus, narrative letters can tie together the trauma and its after-effects in a way that is authoritative.
For the best insurance claim settlements, Www.SettlementCentral.Com recommends that insurance claimants almost always include some type of typewritten medical information to accompany to computer coded medical records and/or handwritten records. That is the first clue as to when to use the narrative report: if you are asking the adjuster to evaluate your claim on the basis of handwritten records and/or computer coded records that indicate diagnosis and treatment codes, then you need to supplement the record with a narrative report.
We have a lot of free legal tips on insurance claims settlements using doctor narrative reports http://www.settlementcentral.com/page8003.htm settle personal injury insurance clams. You can get information there as to how to ask for a narrative letter and what it might cost. Talk to the doctor's office manager about it.
Make darn sure your doctor does have updated full information in her records, or the adjuster may not give you credit for what you have been through. For example, if you just ask for a narrative letter now, three months after your last appointment, then you best go in for another appointment first and document for the doctor examples of pain. While I have no idea of your current condition, it is not unreasonable that you would still have a lot of residual pains. Maybe such things as nagging signs of soft tissue injuries you are noticing following a full day of sitting at your computer or doing physical activities. Personal Injury Medical Records http://www.settlementcentral.com/page0114.htm
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Get a witness statement if possible.
Will your demand letter include a lot of information as to how your pain and suffering impacted your life-home and work? If so, then give some thought to using lay witness statements from family, friends, and co-workers. Some of these people do have relevant evidence to document what you went through. List those things that you still cannot do. And be sure to include those things that you CAN do, but for which you will suffer a dull ache that night or for the next few days. Witness Statements Settle Personal Injury Insurance Claims http://www.settlementcentral.com/page0196.htm for maximum insurance awards.
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Here are some TIPS ON VALUATION—these are loose guidelines only, since we are prohibited from giving valuation on big cases in light of the exposure to a malpractice claim.
How does one figure out what to ask for? Quick Answer: get as much as you can. Figure out what would make you happy, and increase that amount by at least 50%! The value is what you and the adjuster agree it will be. Well, if that is not scientific enough for you, let’s learn a bit more about valuation of personal injury claims.
Valuation is not like going to a drive-in for a fast food meal. It takes time and study of many factors, including liability and medical records. Plus, one would like to meet the claimant to see how he will “sell” to the other side and to the jury. Those online sources that mention a "rule of thumb" is just that: a gross estimate.
SHORT ANSWER: A common theme among those who still think a “rule of thumb” formula will put you in the valuation ballpark is to multiply the medical specials times a number from ONE to FIVE (depending upon factors, some of which I will give you later—or all of which are fully discussed in the members' side of my website, dealing with insurance settlements www.SettlementCentral.Com ). Then that figure is the total value of the personal injury portion of the claim. Of course there is a long list of factors to consider for adding or deducting from the total.
Let's take a look just one factor that puts the lie to the general use of this rule of thumb. A not so obvious, but very important factor that shows how inaccurate a “rule of thumb” formula can be is just plain location of the trial. Let's start with geography. Values differ from state to state, and within each state. City values are often different than rural values on claims, especially if the economy is tenuous in small towns. And the differences can be HUGE between these areas, even if only 20 miles apart.
Here is a listing of factors that will affect both the multiplier you will use, as well as the value of the claim inasmuch as they will increase or decrease the product of your multiplication. As I suggest, pick out two of these factors and expound upon them in your letter.
1. LIABILITY DISPUTE
This is a big one because it most dramatically affects value. You should NOT ACCEPT any reduction in value for fault.
2. Trauma suffered
The value of your claim increases with a bigger crash, and decreases with a low damage tripping wherein one catches himself. Why? Just human nature.
3. Medical special damages
Cost of medical and related health care expenses; higher costs usually equate to an increase in value (excepting, of course, cases of gross overtreatment).
4. Type of injury
Where does the injury fall within the insurance industry's "hierarchy list" of valuing injuries? Irrespective of which injury may cause more pain, injuries are valued according to seriousness, tendency to be persistent or permanent, and whether or not they need objective proof to be believed (e.g. a broken bone versus soft tissue strain).
5. Type of medical care
Where does the medical care fall within the insurance industry's "hierarchy list" of valuing medical care? Orthopedists at the top, chiropractors near the bottom.
6. Prognosis- future care—permanency of injury or pain and suffering—does your doctor recommend 6 months of care, or were you done treating 4 months ago? Even if you are done treating, will the doctor predict future problems?
7. Your medical and claims history, prior accidents, prior injuries or treatment of the same area of the body.
8. Impairment of quality of life. Emotional distress fits in here.
9. Quality and persistence of pain suffered.
10. Duties under duress: this is a factor in the software valuation programs used by many insurers. Hence, one would want to list here the work duties and home chores that were done under pain.
11. Activities you cannot do without pain. Notice we did NOT say merely activities you "cannot do", since those would be very few. But for most injured victims, they CAN DO many activities, except that they will pay for it at night or the next day with pain. The pains can be sharp, but more often they appear as just a dull ache that will not go away.
12.. Quality and thoroughness of her medical records.
13. Lost wages.
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OK, Rou, I want you to go back over that first answer I sent you for any tips in making the letter. Also, I want once again to remind you about doing your business in writing.
Learn how to communicate with the insurance adjuster: FINAL TOPIC—COMMUNICATE IN WRITING AND "DEMAND" NOT "ASK"
FINAL TOPIC: Effective communication with insurance claims adjusters. Establish Firm, Professional, and Positive Relationships With the Insurance Injury Claims Adjuster http://www.settlementcentral.com/page0059.htm
Always communicate with the adjuster in writing, showing your own analysis of value. It is OK I guess to have one call or so, but no more. Always have your information and ammunition in writing to give to the adjuster.
Let him know that you are FIRM IN YOUR RESOLVE to get what you are demanding (NOT "asking", since that invites a counter-offer, but instead "demanding" as fair and reasonable compensation) by asking him what the options are to resolve the matter fairly should he not agree to a reasonable claim value. In other words, let him know that you will go through with a court filing if need be.
Remember these tips, do your homework, print out your evidence, show resolve to get your fair settlement, and you will DO JUST FINE.
I trust that my time here has produced some information that has been of value to you, and thus I would respectfully request that you take the time to locate the FEEDBACK FORM on this site and leave some feedback for me.
Best Wishes,
Dr. Settlement, J.D. (Juris Doctor)
http://www.SettlementCentral.Com
---------- FOLLOW-UP ----------
QUESTION: I checked my medical bills with my medical insurance. One of hospital bill about $1,800 actually was paid 20% by my medical insurance because the hospital wrote off the rest of amounts due to it is in the insurance network system (has contract with the insurance). Should I claim the full billing ($1800) or the actual payment (20%) with the auto insurance company? This is regarding to the claim process. I prefer a direct answer to the question. Thank you.
AnswerI say that you include the entire bill of $1,800. That is your "direct answer" you asked for. If you want to know more read on.
Thanks for letting me know that you "prefer a direct answer to the question." Otherwise I might beat around the bush a bit?? In fact, THERE IS NO DIRECT ANSWER to your question in many states.
This involves the "collateral source rule". In some states, the defendant gets to deduct the 80% by letting the jury know that part of your bills have been paid. In most states, the fact that a "collateral source" paid the bill is NOT admissible evidence. Hence, the claimant gets to show the entire $1,800 as medical costs.
What I would do is to show the entire $1,800, but be prepared to fight should the adjuster try to diminish the total costs. One way to do this is to ask the hospital for a billing showing JUST the total bill as incurred, with no payment made.
By the way, if you are trying to use that multiple as the basis for valuation, you DO want to count the entire $1,800 even if your state does not support the collateral source rule.
You could also look up "collateral source rule" in your state via Google and see what the status is there. Put down in a Word document some of the arguments made in support of the collateral source rule so you can be prepared to fight the adjuster on this.
I trust that my time here has produced some information that has been of value to you, and thus I would respectfully request that you take the time to locate the FEEDBACK FORM on this site and leave some feedback for me.
Best Wishes,
Dr. Settlement, J.D. (Juris Doctor)
http://www.SettlementCentral.Com
