QuestionI am attempting to settle my claim with the other "at fault" insurance company. I have a chiropractor bill, lost wages, & am asking for pain & suffering. I have a feeling they are trying to get out of paying me what I should get and basically want to know what my rights are. They told me I would only be reimbursed for 80% of my lost wages & I am getting the feeling that I will not be getting any extra for pain & suffering, only my doctor bill reimbursement. Is this correct? What am I entitled to? Thanks very much for your help!
AnswerHi Candice,
In direct answer to your question: your rights to settle a personal injury insurance claim are the same whether you do it yourself or hire an attorney. I will review those rights below, but first let's take a look at two introductory topics.
First, STAND FIRM FOR YOUR RIGHTS. You have taken a good first step by challenging the assertions of the adjuster. Take the time to read the homework I am assigning and you will have a better idea of how to have the confidence to stand firm for what is due to you.
Second, lets 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.
I will divide your answer into three initial points.
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.
And then, I will follow with two closing topics:
4. 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.
5. Establish a firm and professional relationship with the adjuster: communicate only in writing.
Ready? Here we go!
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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?
Let’s take that last item first: NO, the insurance company MAY NOT ARBITRARILY REDUCE any elements of your damages. In this case, they seek to reduce your lost wages for some reason you do not disclose.
Can they reduce your payments because you do not have an attorney? NO. One of our members at my website had an adjuster tell her that while her case was worth $30,000, if she had an attorney she would only get $20,000 because of the attorney’s one-third fee, and hence his offer of $25,000 was a split of one-half of the fee, with her thus saving $5,000. That is ABSURD! Stand firm for the full $30,000 is what we told her, and eventually she got her full $30,000. DO NOT LET THE INSURER REDUCE YOUR AWARD UNLESS YOU ARE PARTLY AT FAULT.
Thus, as you can see, partial fault can be legitimate grounds to reduce an award, but fight any attempt to tag you with comparative negligence: this is a common tactic in recent years. Just tell them the facts and DO NOT LET THEM even hint that you were partially at fault.
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.
Future damages (which will be both special and general) will be paid ONLY UPON A FIRM COMMITMENT by the doctor. She cannot just state that you will need some additional care in the future. NO, she 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 her prognosis.
You doctor does not need to give a firm statement of costs if she is not comfortable in doing so. But maybe she can tell what a course of treatment would be. For example, it is easy to know the plastic surgery 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 TWO 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.
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.
Next, the seriousness of the injury, and of course, whether or not the injury can be proven by objective evidence (that nerve conduction study), 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—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.
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4. 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 her have all the control of the claim. As an adjuster, she is trained by her company to reassure the injured party that she is acting in THEIR behalf, as opposed to the interests of her 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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5. 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
