QuestionHi,
I have a question on how should I proceed next with my insurance claim.
I've been involved in an accident last May (not at fault). My car was in shop for 4 months and the total for the repairs was $11,500. This was already paid by the insurance company.
I have also had back, neck and shoulder injuries and I finished medical and chiropractic treatment in February. The total for my medical treatment was $4,900. To note that I was in big pain only after about 3-4 months after the accident. My doctor gave me some muscle relaxers and pain killers right after the accident, but after about 3-4 months I wasn't even able to sit on a chair. That's when I started chiropractic treatment. I feel ok now, but I wonder for how long.
I also lost wages in the amount of $1,500. For 4 months I was driving a rental car. That came to a total of $2,500.
The insurance company already paid the bills (some of medical, the rental car). They preferred to pay the bills as I got them and make me a settlement offer at the end.
From reading on various websites, I figured out my settlement somewhere around $30,000. The insurance offered me $3,800.
What do you recommend as a next step for me?
Is my demand to high?
Thanks you,
Adrian
AnswerDear Adrian,
First and foremost, do not become discouraged with the difference between the adjuster’s first offer and what other Internet sites told you about the value of your claim. You can make a good comeback with solid work and documentation of your injuries. And second, stay away from those sites that tell you a value for your claim: they are bad for your health! Truly, those sites rely upon the bogus B.A.S.E. “secret” formula, a scam to sell something that was once perhaps useful, but has been outdated for years.
In direct answer to your question: “on how should I proceed next with my insurance claim”,
I suggest that you either get an attorney now, or, if you can read and follow instructions, then you can make your own do it yourself personal injury insurance claim. But in order to do that, you will have to:
1. Learn about the personal injury insurance claim system.
2. Learn about what elements of damages you can and should make a claim for.
3. Learn about some of the topics for valuation.
4. Get a neurologist involved if your pain continues.
5. Use a narrative report
6. Take the initiative and DO NOT LET THE ADJUSTER DICTATE THE SIZE OF THE BALLPARK you are going to play in: Get your demand letter out there.
7. Establish a firm and professional relationship with the adjuster: communicate only in writing.
Ready? Here we go!
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First, though, here is a brief GENERAL INTRODUCTION to motives of insurance adjusters and to the Dan Baldyga scam: “secret BASE formula” of Dan Baldyga is worthless in today’s insurance adjusting world.
I FIRST want to introduce the topic of the personal injury insurance claims system with two comments. The first is that the adjuster is NOT INTERESTED in making you a fair settlement. All she wants is to get rid of your claim for as little payout as possible.
Thus, if you continue on the path you have apparently taken, the “kind of settlement you could expect” is the bare minimum the adjuster can get away with, and one that makes your adjuster a hero in his own office.
The reason I say that is because you asked about valuation, but neglected to mention anything that is important to valuation: diagnosis and prognosis for your injuries. That would tell me (and the adjuster) that you are not informed about such claims, and thus you are a good target for a minimum settlement.
One GOOD THING, however, is that you have taken the time to research your topic a bit by looking at other websites and by asking at this website, and hence that might give you a bit of additional information.
The SECOND introductory topic is that what you read about the value of your personal injury claim being $30,000 IS ABSOLUTELY BOGUS, unless of course, that person who gave that opinion had a chance to review your medical records and to interview you.
But instead, I suspect that you ran into some kind of “formula” approach to value. This was a scam perpetrated by Dan Baldyga—outdated, based upon the claims practice ten to forty years ago. We have the case of Dan Baldyga, long-ago retired adjuster, who is no doubt a very nice man, but who also is way out of touch with the way insurance claims are handled in the many years since he was in the business.
If you want a fun and somewhat helpful read, you can buy Dan Baldyga’s book, Auto Accident Personal Injury Claim. It is very easy to read and to understand, and thus helpful so far as it goes. Plus he does have good stories of how to relate with adjusters, but as fun as those are to read, THEY ARE MOSTLY OUTDATED since the advent of computer-generated valuations had dominated the relationship among supervisor, adjuster, and claimant.
As an adjunct to this topic of your valuation figures from the Internet, could you please share with me the sites where you did find such formulas? We need to warn folks that they can be misled by such a simple solution to valuation. You may write to me at my website, below. Just mention where we met and put down the URLs of those pages that offered simple valuation advice, and we will review them in order to warn others who may try to rely upon such theories.
Finally, as an introduction topic, while I do want you to become informed about the process of self-help personal injury insurance claims (and to have a little insight on how to proceed), I also want you to think about an attorney. You might want to consider the advantages of hiring an attorney instead of doing a self help personal injury claim.
Many people do not have the time to present their own claim. Nor do they like to get involved with negotiations with an insurance adjuster. And, of course, if their claim involves any significant legal issues, most people would prefer to hire an attorney, and we advise that they do so.
Likewise, if there are significant injuries, which will translate into significant personal injury damages, then we recommend that the claimant get professional advice or representation from a competent personal injury attorney.
Otherwise, most people with medium ($50,000) and less claims can and do settle their own claims, and they do a good job of it. I suspect that you fit into this category, so maybe you will try to do this yourself first.
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1. Learn about the personal injury insurance claim system before you go too much further.
Learn how to submit and settle your own personal injury insurance claims—DO IT YOURSELF SETTLEMENTS. Here is a series of pages that you can review. Take what makes sense to you and don't worry about the rest. Just get a flavor of how the system works without spending a ton of time right now.
Overview Tort Law Personal Injury Legal Claims http://www.settlementcentral.com/page3000.htm
Managing Medical Care After Auto Accident: http://www.settlementcentral.com/page0203.htm
Medical Care Documentation-the Key to Successful Personal Injury Insurance Claim Settlements http://www.settlementcentral.com/page0217.htm
Keys to a MAXIMUM INSURANCE INJURY CLAIM SETTLEMENT http://www.settlementcentral.com/page0089.htm
Use a Confidential Personal Injury Diary for TOP DOLLAR Insurance Claim Settlements http://www.settlementcentral.com/page0208.htm
Outline of questions to be expected from insurance claims adjuster http://www.settlementcentral.com/page0190.htm
Detailed listing of questions to be expected from insurance claims adjuster http://www.settlementcentral.com/page0207.htm
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
Responding to Settlement Offer From Insurance Claims Adjuster http://www.settlementcentral.com/page0244.htm
Do It Yourself Advantages, or do these claims need an attorney? As for an ATTORNEY, this does not seem to be a case that involves any legal issues in dispute nor any large or complex damages. Why should you pay someone one-third to do what you can do yourself? Do-It-Yourself Personal Injury Claims; Eliminate Personal Injury Attorneys' Fees; Save Thousands of Dollars Settling Your Own Insurance Claim http://www.settlementcentral.com/page3011.htm
Without having to join my website, I have given a lot of free information on handling insurance claims without having to join as a member. Read the module at "5 Easy Steps to Do-it-Yourself Insurance Claim Settlement" http://www.settlementcentral.com/page0102.htm
This stuff is not rocket science, but it will take some effort on your part to read and cut and paste letter examples and to communicate. But hundreds of people are doing it each day, and they are getting good results.
What if you get only two-thirds the way to your settlement goal? Well, you can get as big a settlement as you can and then turn it over to an attorney and save a lot of fees. Thus, you could go it alone just to get an insurance settlement offer, and then take that insurance settlement offer to a personal injury attorney, thus exempting the amount of the offer from her fees. Do It Yourself Personal Injury Settlement Offer Reduces Personal Injury Attorney Fees http://www.settlementcentral.com/page0109.htm
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2. Learn about what elements of damages you can and should make a claim for.
What are you entitled to, and can the insurance company reduce any of the payments?
ELEMENTS OF YOUR DAMAGES
We consider the damages in three categories: special damages, general damages, and future damages (which will be both special and general).
Special damages are things that are capable of ascertainment by calculation or documentation. These include such topics as medical and chiropractic expenses, appliances (crutch or dental appliance for a jaw joint claim), physical therapy, lost wages, transportation to and from medical appointments, hired chore and personal help, and the like.
General damages are for pain and suffering, loss of enjoyment of life, severe emotional distress, and the like.
Usually general damages are the “wild card” in the settlement, and that is where the negotiation centers. Assuming that they agree to the special damages, what is left is to argue about the value of the claim for the suffering that you have and will endure.
Your accident sounds like a pretty good hard crash (based upon the $11, 500 property damage), and thus you might have a settlement attempted by the adjuster NOW, but at the same time, a prognosis from your doctor of future problems. Future damages (which will be both special and general) will be paid ONLY UPON A FIRM COMMITMENT by the doctor. Your doctor cannot just state that you will need some additional care in the future. NO, he has to make it an unambiguous statement of need: a firm prediction that you will encounter problems in the future “on a more likely than not basis” (that latter being the standard of proof). This should be a SPECIAL paragraph or two in his prognosis.
You doctor does not need to give a firm statement of costs if he is not comfortable in doing so. But maybe he can tell what a course of treatment would be. For example, it is easy to know future costs if there is an additional course of physical therapy treatment estimate; and one could estimate the costs of various surgeries; and one can make an estimated requirement for additional chiropractic care.
Thus, in future damages, you will include both the estimated cost of a course of treatment AND the pain and suffering and loss of enjoyment of life that will be experienced by the predicted condition cited in your doctor’s prognosis.
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3. What about valuation of your claim? How does one figure out what to ask for? Answer: get as much as you can. Figure out what would make you happy, and increase that amount by at least 50%!
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. The "rule of thumb" is just that: a gross estimate.
So, I have a short answer and I promise to give you the full longer more detailed answer if you ask me later, when you are ready to settle.
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.
This is the so-called “secret BASE formula" of Dan Baldyga. He has a website from which he sells his book, and he writes articles touting his "secret" B.A.S.E. "formula" for settling claims. Maybe he has some other ideas of merit in his book, but this BASE thing is NOT among them. Once it became apparent to everyone on the Internet that this was NO REAL “SECRET”, inasmuch as anyone in the business knew that years ago it was somewhat relevant, Dan stopped using that “SECRET” adjective as a sales tactic and actually put it out in articles he has written.
Here is a link to his website, where you can try out the so-called formula and buy his book if you wish: http://www.autoaccidentclaims.com/index.asp
Let's take a look just two factors that put the lie to the general use of this BASE. An obvious one is that you are left with the records of a chiropractor to support a claim that might have some value, but not as much as if your records were from an orthopedic surgeon. Oh, yes, I am aware that chiropractic is better for you than taking drugs prescribed by a surgeon, but the insurance industry does not know that. http://www.settlementcentral.com/page8010.htm?x&q=orthopedic
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A second, not so obvious, but very important factor that shows how inaccurate a 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.
Just for the heck of it, here is another factor that shows the Baldyga BASE formula is BOGUS and a scam. What about the proof of the injury? It can make a HUGE DIFFERENCE whether or not the injury can be proven by objective evidence (nerve conduction study, x-rays, etc.), or whether the only proof is subjective (your statements that you feel pain).
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.
2. Trauma suffered
The value of your 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.
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?
Your claim value gets a boost if your doctor specifies that you will need some future medical care.
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.
9. Quality and persistence of pain suffered.
10. Quality and thoroughness of your medical records.
11. Lost wages.
HINTS ON DISCUSSION OF CLAIMS DOLLARS: total, subrogation, new money, etc.
I suggest that you learn about how to discuss the claim dollars. Is their offer of $3,800 “new money”; will they also pay existing medical billings? Have you any other source that paid bills that might want to subrogate against your settlement?
Introduction to Subrogation—Forced Payback to YOUR OWN Insurer From Your Personal Injury Award http://www.settlementcentral.com/page0459.htm
You may send out a counter-offer demand letter, but make it for EITHER TOTAL CLAIM VALUE (the amount that will appear in the release document that you will sign) or for just “NEW” money—that is, net money, exclusive of what they have already paid for medical costs.
For example, if they have already paid around $4,500 on your medical bills, but none of your lost wages, then their offer of $3,800 is probably “new money” to you in that it is in addition to that which they have paid. BUT, you do not get to keep it all, since you stated that some medical bills remain unpaid. This is your call, as to how you want to communicate your demand (i.e. “total settlement dollars” versus just “new money”), but just make sure that you and the adjuster are all on the same communication sheet so that you do not have a misunderstanding about who is going to pay unpaid bills or subrogation that is owning.
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4. Get a neurologist involved if your pain continues.
I have an idea that you suffered some significant soft tissue injury. I also have an idea that this will be the first season of physical activity since you were first on the medications. Thus, I believe you will experience pains this season.
It may start as a dull pain at night—something just nagging. But do not let it go as just normal. If you pay attention and it if becomes worse, I would insist upon a referral to a neurologist.
That is the specialty that can best help you now. And of course, her report adds a lot to the value of your claim.
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5. Narrative Reports—THE SECRET INGREDIENT FOR SUCCESS!
It sounds like the adjuster may not appreciate the seriousness of your injury. Maybe the records he got are not all that good. Have you seen any of the doctors' records that went 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 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.
We recommend that 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 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, you best go in for another appointment first and document for the doctor all of those 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
Use a narrative report
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6. TAKE THE INITIATIVE in personal injury insurance claims—don't wait for the adjuster to suggest the first settlement figure—SEND IN YOUR DEMAND LETTER FIRST.
You should be commended for having the initiative to seek out a website such as this and to ask for help, but the most important part of achieving a successful personal injury claim HAS TO START WITH YOU, NOT THE ADJUSTER. Do NOT let the adjuster set the parameters of the negotiation: get your demand letter out there RIGHT NOW. It is not all that hard or mysterious to put together an Effective Personal Injury Insurance Demand Letter http://www.settlementcentral.com/page0170.htm It does not have to be "fancy" or complex; just hit the main points and get it out to the adjuster soon.
It is not too late for you to take the initiative, and I will explain how below. But just for a second, put yourself in the shoes of the adjuster and see what you have done by letting him have all the control of the claim. As an adjuster, he is trained by his company to reassure the injured party that he is acting in THEIR behalf, as opposed to the interests of his company—sort of like a car salesman who convinces a customer that he will fight for them versus the auto store manager. Sure.
But both of those are relationships are to the disadvantage of the consumer, aren't they? We would like to trust people who are in the position of the adjuster to act at least nominally in our behalf. But it is just as much as a mistake to take a passive role here as in buying a car: you have to get up and make something happen yourself.
If I were you, what I would do right now is to become as fully informed about the insurance injury claims process as I can, with the objective of seizing the initiative in prosecuting my claim, instead of taking a passive, reactive role. Can you see the difference in postures and how one works to your advantage and the other to your disadvantage?
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7. 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
