Auto Insurance Claims: Help with my claim, puncture wound, demand letter

Question
Dear Mr. Nussbaum:

I was rear-ended when my car was stopped for a red traffic signal and as a result, I sustained minor injuries to my right hand, neck and back.  The puncture wound to my right hand developed an infection that put me in the hospital for eleven days, and undergone six surgeries and multiple skin grafts.  I lost my good job due to my right hand disability.  

I just received a response to my demand letter from the at-fault adjuster. The letter states, “Based on the findings of the specialist in Infectious Disease, it appears that the infection was unlikely to have been cause by the accident.”  The specialist letter states, “Although it is possible that this infection was related to (my) car accident, I do not think it is likely.  There is no clear evidence from the review of records that this infection was causally linked to her MVA, and in my opinion as a specialist in Infectious Diseases, based in the nature of this infection and its timing, I believe this to be unlikely.”

I talked to my primary doctor about the response to my demand letter and her letter states, “The wound {I} sustained in the MVA could have been a precipitating cause of infection as it is in exactly the same place of the infection so it is most likely a contributing factor.”

Shall I send a response to the adjuster and attach my doctor’s letter or it’s better to hire an attorney now. I was thinking of answering it myself and if I do not get a fair response to my demand, I will an attorney and go to trial. I am demanding an excess of the maximum amount of policy limits available under the insured’s policy. I was offered $5,000 instead.  

Thank you in advance for your help.  HAPPY HOLIDAYS!

Answer
Violet,

I am not sure what state you are in so I can not say with absolute certainty what to do. However, the significance of the claimed injury and hospitalization for 11 days does warrant further pressing of the matter. I would retain an attorney and file suit on this one.

I practice law in Florida. The standard of evidence to be submitted to a jury is based upon a preponderance of the evidence. In other words, is it more likely then not that this accident caused or contributed to the claimed injuries. Its not a beyond a reasonable doubt standard like it is in criminal cases. Its a lower standard.

Any infection in the same location as the injury caused by the accident seems to be an infection incurred as a result of the accident. Further, the insurance company's "expert" is equivocal and admits its possible the injury is related to the accident. This will be a battle of the experts.

I would not send in the note from your primary just yet. I don't know what policy limits are in your case but if they are significantly higher then the $5,000 offered, that letter is not going to change their minds but an attorney might.

Best of Luck.

Marc B. Nussbaum, Esquire