QuestionQUESTION: My son was a passenger on a city bus in which the driver entered an intersection on a yellow/red light in the path of another vehicle. While attempting to quickly stop with the brakes my son was ejected from his seat and landed about 10-12ft away. The bus did hit the other vehicle. The other driver did not sustain any serious injury. My son recevied treatment and those services cost $4550.00. My son was willing to resolve/close the matter for $15,000. The Claim adjuster counter=offered 8500.00 and appears unwilling to reconsider claiming the medical evaluation of injuries and future treatment over the next year is subjective. My son re-considered and is willing to resolve/close for $13,500 and the claim adjuster is still unwilling to resolve stating the same. No attorney is involved at the moment. Can you give some insight on the matter and how to proceed? Thank you in advance.
ANSWER: Hi Ken,
I'm sorry to learn of your son's injury and glad to hear that he is on the road to recovery.
You did not mention any broken or fractured bones or any cuts that would leave scars, so I am assuming that his injuries consisted of 'soft tissue' injury.
If your son treated with a Medical Doctor who prescribed treatment by a licensed physical therapist and the total if all his bills and round trip mileage for each visit of $0.43 per mile is $4,550.00, then your son has every right to expect a settlement in the area of $11,375-$12,285.
If the majority or all of his treatment was Chiropractic,
Then the offer of $8,500 is over generous.
Your statement "unwilling to reconsider claiming the medical evaluation of injuries and future treatment over the next year is subjective" leads me to feel that his a Chiropractor. This is a 'tag' line that seems to be added by every Chiropractor in the US, and is considered a worthless statement by the insurance industry.
The entire insurance industry is extremely anti chiropractor.
The majority of Health Insurance policies have a clause that only allows $1,500 Chiropractic treatment per year, and Medi-Care has mandated that clause in their policy.
When negotiating a personal injury settlement against an insurance company, you can expect to negotiate a settlement of 2.5 - to 2.7 times your medical bills if all treatment was provided by medical doctors and prescribed physical therapy. In cases where the majority or all of the treatment was chiropractic, the amount of recovery drops to
1.5 - 1.7 times the bills, or in this case, $6,825-$7,735.
That's the reason I have stated that $8,500 is over generous.
I am presently trying to assist a person whose wife was injured in an auto accident. Her bills were all Chiropractic and slightly exceeded $11,000. He hired an Attorney that was only able to receive a settlement of $15,500. Now the attorney gets 1/3 of the settlement and the injured party is left with an amount that is actually less than her medical bil, and since her health insurance requires full reimbursement if she recovers from a 3rd party, she is going to wind up with absolutely $0.00.
If my assumptions have been correct, I recommend that your son accept the offered settlement.
If your son secures an attorney, this offer immediately is null and void and can never be mentioned by the attorney in any correspondence with the insurance company nor in court. Of course, no attorney would ever take a "soft tissue" injury to trial.
In 90% of the questions such as yours, I have to try to read between the lines and make assumptions. Many times, my assumptions are 100% wrong.
If I have made wrong assumptions, please write me a follow up and provide very specific detail of his injuries and treatment.
I Trust this has been of help.
Your feedback by rating my answer will be appreciated.
Sincerely,
Bennie
San Francisco Bay Area 12-08-07 1:29 PM PST
---------- FOLLOW-UP ----------
QUESTION: So, if my son's last written response indicated that he would seek out the legal process and legal opinions. Does this preclude him from demanding the $8500 to $9,800 which is less than the 1.5 to 1.7 times the medical expense of $4,550?
AnswerHi Ken,
The offer of $8,500 doesn't come 'off the table' until he actually secures an attorney.
With medicals of $4,550, 1.5 times that amount = $6,825 and
1.7 times that amount = $7,735.
That's why I made the statement that I consider an offer of $8,500 as being over generous This statement was made based on my knowledge of industry standards and my 43 years of experience in the Property & Casualty Insurance field.
Because the offer is already larger than could be expected, I see nothing that would cause the insurance company to increase it by any amount.
All your son needs to do is make a polite telephone call to the claims adjustor, state that he has reconsidered the situation and decided against going through all the legal hassles and time delays that would be caused by securing an attorney, and is willing to settle the claim for the offer of $8,500. This should enable him to have a check within 7-10 days.
I truly feel that my first answer was informative enough to secure a rate of 10-10-10-10-Y.
Perhaps you will feel able to apply such a rate to this follow up answer.
Sincerely,
Bennie
12-08-07 6:35 PM PST
