QuestionMy mother was invloved in a hit and run accident with a drunk driver, he was charged, is insured in New York State, as is my mother. She had medical bills of about $6000, as she suffered a fractured sternum and 2nd degree burns to her arm, hospitalized for 3 days. She was doing childcare, earning $300/wk, the doctor disabled her for 4 months. Total loss of income was $4800.00. Auto damage was $9000. Her sternum fracture will take a full 6 months to heal, and may not heal correctly, due to the fact that she is a senior. What can she expect as an award for pain and suffering ? What would be a reasonable offer to accept ? Insurance adjuster is going to be making an offer this week. This accident occured in New York state as well. Thank You.
AnswerHi Greg,
I am sorry to hear of the injuries to your mother. They sound painful and may stay with her for awhile. We hope that she is restored to good health, BUT you hit on a key point: at her age, the injuries are likely to bring continuing problems.
That is why I want you to think long and hard about settling too soon. What if you settle now, but in a year she is having pains again? I know from handling injury cases for seniors that there is a REAL RISK of suffering from those injuries for years after the accident. What is the hurry? Is there a statute of limitations problem, or is the adjuster trying to get rid of the case before it becomes obvious that your mother is in for a long term problem?
I know that you just wanted to know about valuation, but I am here to look out for the injured victims, and as such, it is my duty to make a full disclosure and warning about the insurance industry tactic of securing early settlements.
DO NOT SETTLE YOUR MOHTER’S CLAIM UNLESS BOTH OF YOU ARE ABSOLUTELY CERTAIN THAT HER FRACTURE AND HER SOFT TISSUE INJURIES WILL NOT REAPPEAR ONCE SHE STRESSES HER BODY WITH PHYSICAL ACTIVITIES OR JUST DAILY LIVING AND WORKING. That Plays Right Into an Insurance Tactic Regarding Inducing Early Settlement of Injury Claims.
Let's just finish up this topic of early settlements so you get the full picture of the advantage to them and the risks to your mother. Insurance companies like to settle early because the general damages—claims for pain and suffering—are always minimal, but continue to grow with continued medical/therapeutic care over the months. Therefore, the insurance adjuster will try to settle before the claim merits a larger pain and suffering element. This makes good sense for the insurance company. A claim that is still active after 12 months, with an injured claimant still undergoing treatment, will settle for a lot more pain and suffering money than a claim that is settled after two or three months of treatment.
Your mother's body suffered a VERY LARGE TRAUMA, AND IT IMPACTED her sternum and her soft tissue connections in ways we do not yet even know. OK, maybe for YOU these injuries do not amount to a long term deal. But in the case where we have age as a factor, then what you have described to me is serious. And in serious fracture and soft tissue cases such as this, the full extent of most injuries is not known immediately after finishing early rounds of treatment, because the injured person has to undergo some of the wear and tear of everyday life, including the pounding her body will receive from a day's work. Even jobs that appear not to be physically demanding can be hard on an injured body, as your mother learned with her work.
For example, have you ever stood all day with few breaks, as a store checkout clerk or a jewelry salesperson does? Or sat all day at a computer, as a secretary or phone service center employee does? Many jobs will interfere with healing, and you have no way to know how your mother's body will respond until she has experienced sufficient physical exposure to load-test the scar tissue as she heals.
Plus, who will pay for your mother’s medical care incurred AFTER you settle? What if she were to settle now and nine months later when she is suffering at work and the pain starts to become too much, and she goes to a doctor only to discover that she can expect a course of treatment that will cost a lot of money? After you settle your mother’s claim, all further treatment is HER responsibility. Except in specific, unusual situations, you cannot go back and re-open a settlement: when you cash the check, you agree to close your claim in all aspects. Check with your mother’s no-fault PIP adjuster to find out whether they will pay anything once she closes the claim against the tortfeasor.
Here is another page from my website that shows in detail why you should never make an early personal injury insurance claims settlement http://www.settlementcentral.com/page0211.htm
And, of course, once you settle, THAT IS IT: your mother will never see another dime in pain and suffering money. By the way, did you know that getting an early settlement is a favorite trick of the insurance adjusters? Please see my website wherein we show Insurance Claim Adjuster Secret Tactics http://www.settlementcentral.com/page0092.htm
I know that you think this is going on too far with this one topic, but I HAVE TO TELL YOU that this is a REAL danger that I have seen many times. So just have patience a bit longer and commit yourself to convey the following to your mother and make her follow it. Tell her this:
There may be a dull ache at night following a day at work or some physical activity or pain the next morning. DO NOT LET LITTLE PAINS GO UNATTENDED SINCE YOU DO NOT KNOW WHETHER THEY WILL CONTINUE OR GO AWAY. We all hope and believe that such little pains will disappear soon. But on the other hand, we have no way of knowing since this is the way serious fractures and soft tissue injuries can behave.
So, when this happens, even if a couple months or more post-treatment, do not hesitate to SEE A DOCTOR AND ATTRIBUTE THE PAIN TO THE ACCIDENT WITHOUT EQUIVOCATION. It is NEVER TOO LATE TO REPORT PERSONAL INJURIES FROM A CAR ACCIDENT http://www.settlementcentral.com/page0104.htm
Managing Medical Care After Auto Accident: http://www.settlementcentral.com/page0203.htm
"No medicine: no money"; medical costs increase worth of personal injury insurance claims http://www.settlementcentral.com/page0045.htm
OK Greg, this is your question since the next topic is the range of VALUATION. I would be way out of line to make any guess. First thing to note is that valuation for settlement purposes can surely depend upon the quality of your mother’s medical reports. My guess is that her doctor is just a general practitioner. They mean well, but we have found that a better route might be to try a narrative letter or narrative report. The reason I say that is many general practitioners still use hand written notes on a chart. What you are looking for in terms of a medical record it something that an adjuster can READ AND UNDERSTAND, not a bunch of hen scratches on a medical chart. Narrative reports http://www.settlementcentral.com/page8003.htm make insurance claim settlements easier. Let the doctor explain things so that the FUTURE RISKS OF PAIN are firmly set forth.
Here is a list of topics that affect valuation.
VALUATION COMPUTATION AND FACTORS THAT INFLUENCE VALUATION
Valuation is not like going to a drive-in for a fast food meal. It takes time and study of many factors, including of course liability and medical records, but also an evaluation of the plaintiff—what kind of person will she present to the jury is a most important consideration (i.e. is she credible, does she elicit empathy, etc.).
So, I have a short answer and a longer more detailed answer for you.
SHORT ANSWER: A common theme among those who still think a 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 listed in the members' side of my website, 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.
LONGER ANSWER:
Here are some of those factors (as set forth in MORE DETAIL IN the members' section of http://www.SettlementCentral.Com - Dr. Settlement's website):
There are changes in the formula approach, DEPENDING UPON SERIOUSNESS OF INJURIES.
The typical formula approach mentioned to determine the value of general damages, i.e. pain and suffering, permanent disability and emotional damages, is to multiply the amount of the MEDICAL specials by a factor between 0.5 and 3 if the injuries are relatively minor or continue less than one year, or by a factor of 4, 5, or more when the injuries are very painful, serious, long-lasting or permanent. You have mentioned the lost income component, so it is added on at the end. That is, you get the total here, and add on transportation expenses (48.5 cents per mile) and lost wages.
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.
1. LIABILITY DISPUTE & comparative negligence
This is a big one because it most dramatically affects value: minus if you have any fault. This is a positive for your mother.
2. Trauma suffered
The value of the claim increases with a bigger crash, and decreases with a low damage fender bender. Why? Just human nature.
Therefore, the total value of the property damage (e.g. cost to repair or replace a motor vehicle) becomes significant. Here again, this is a plus for your mother inasmuch as she was in a BIG CRASH
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).
This is again a positive for your mother. Her injuries were nothing short of horrific and terrifying to go through. Ask a member of a jury how much would it take for them to agree to be injured with the painful fracture and the burning. This is a BIG nudge for increased value.
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—or was she done treating 4 months ago?
Her claim value gets a boost if her doctor specifies that she will need some future medical care.
7. Her medical and claims history, prior accidents, prior injuries or treatment of the same area of the body.
8. Impairment of quality of life. I would think that you and friends could really develop some good information here. Your mother’s claim should be well-supported in this aspect.
9. Quality and persistence of pain suffered.
10. Quality and thoroughness of your medical records.
11. Lost wages.
Here is where I prove to you that such formulae are not all that worthwhile. What is NOT included in that list above, but will make a BIG difference in valuation? Answer: (1) DUI and (2) Hit and Run. Those are two “social factors” that need to be accounted for because a jury is surely going to want to punish the tortfeasor for his despicable actions that caused such serious injury to an innocent older lady. People DO NOT like that kind of stuff, so we have to go way off the chart to guess at a figure, assuming (as I believe is going to be the case) that evidence of same gets before the jury. I would add no less than $7,500 to $10,000 to the valuation just for this issue.
WHERE DO YOU GO FROM HERE? Given all that above, I would think that what you are now missing is a good solid narrative report to tie things together and to get your mother some future medical costs added in at this time. But, that is not going to happen with the present condition of your treatment.
Thus, I would simply tell the adjuster that you want to go thru a few more months to see how your mother’s healing holds up. That is a reasonable stance, and I think that by January you will thank me for not letting you settle so early.
POLICY LIMITS
Take a look at the auto insurance policy limits http://www.settlementcentral.com/page0451.htm claims settlement information. If the tortfeasor does have minimal limits for your state (which I believe to be $25,000), then they need to fork over that amount with no further proof or arguing. Surely all of the special damages (i.e. medical costs) and general damages (i.e. pain and suffering and loss of enjoyment of life) would surely far exceed the minimal policy limits of $25,000 and thus you need to write a sentence to that effect in your demand letter. Something along the line of agreeing to settle the case with their insured in exchange for payment of their policy limits, SUBJECT, of course, to your mother’s UIM carrier interposing no objection to the settlement.
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 extra 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
