Question I was a passenger in auto accident 7-1-05 of a 4 car accident & I was taken to a trauma center by ambulance. My injuries were whiplash, pain rt ribs/side (bruised/cracked), severe laceration L. inner elbow that later required surgery & approx 8 weeks PT. I was just released from Dr care in April of this year but I am still having problems/pain at times with all areas.
My total medical bills were $22,000.00 but total out of pocket expense, including lost wages, Rx, etc is $32,000.00 and was off from work 13 weeks.
The claims rep called & gave me there 1st offer of $44,000.00 & of course I told her no. She asked what amount was I looking at. I told her that I did some research & that it should be 2-5 x's the amount of the total. I said I felt like with my injuries it should be @ least x's3. She said that only lawyers go by that amount & that would be part of there portion (@ this time I have no lawyer involved) & that isn't how they settled there cases. I think she is feeding me a bunch of bull. Do all insurance companies usually go by the amount & x's 2-5 times? Or is she been truthfull that not all companies settle that way?
Also related to my injuries I have very bad scarring to my L. arm approx 4-5cm area with a 'T' apperance surrounded by numerous other small scars & I have seen a plastic surgeon in the beginning for estimate on repair but he said he would have to wait 1 yr for it to heal to give an estimate.
What do you think may be a fair estimate range for a settlement. I was thinking @ least $75,000.00 or do you think I can get more?
Any extra advice would also be appreciated.
Thank You Viki
Answer
TAKE THE INITIATIVE in personal injury insurance claims
Policy limits insurance claim
Underinsured Motorist Claim (UIM) against your policy;
Passenger rights: personal injury auto accident
Future medical expenses money
Future pain and suffering money
Doctor opinion firm for future medical care
Doctor narrative reports settle insurance injury claims;
Valuation personal injury insurance claim
Dan Baldyga Scam
B.A.S.E. so-called "formula" is a joke
Factors influence valuation bodily injury claim
5 Easy Steps to Do-it-Yourself Insurance Claim Settlement
Eliminate Personal Injury Attorneys' Fees
Doctor narrative reports settle insurance injury claims
Relationship Insurance Injury Claims Adjuster
Write to insurance settlement adjuster
How to deal with insurance claims adjusters
No phone calls insurance claims adjusters
Dear Viki,
It sounds like you have had some pretty serious injuries. Here are the SIX ISSUES I am going to address for you:
1. 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.
2. Learn about how to submit and settle your own personal injury insurance claims—DO IT YOURSELF SETTLEMENTS.
3. Many factors to evaluate in making a VALUATION FIGURE for insurance injury claims.
4. Payment for FUTURE MEDICAL COSTS requires a FIRM COMMITMENT from your doctor.
5. New topic: CONSIDER USING A DOCTOR'S NARRATIVE REPORT to assist in settling the insurance claims.
6. Consider a POLICY LIMITS situation for the tortfeasor, resulting in an Underinsured Motorist Claim (UIM) against your policy.
7. Effective communications with the INSURANCE CLAIMS ADJUSTER.
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1. 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.
That is how I feel about making successful claims. Now I note that in this instance, the adjuster HAD TO ASK YOU WHAT YOU WANTED. That is a sign that you did not submit your letter first. What I want you to do is to think about the issue of taking the initiative and what it means when you DO YOUR WORK and submit a good solid demand letter.
You asked about what you can expect from your claim. Unless you take the initiative in this claim, what you "can expect" is to become another success story for an adjuster who has run over uninformed claimants and denied them a fair settlement award.
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, as you have done so far: 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.
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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2. Learn about 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
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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4. VALUATION COMPUTATION AND FACTORS THAT INFLUENCE VALUATION
Viki, in the first place, we are not allowed to give legal advice here, and some bar associations have taken the position that evaluating personal injury claims is the practice of law. Futhermore, how could one possibly give any feedback with such limited information? Even if you hired an attorney for valuation, she could never venture an estimate so little information.
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.
This is the so-called "formula" of Dan Baldyga, a long-ago retired insurance adjuster who has never in his live settled a claim using the computer software that is now in use. I am sure that Mr. Baldyga did have some good ideas long ago, but one wonders if they have not been overtaken by changing times in the decade since he retired.
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 that this was no real "secret", inasmuch as anyone in the business knew that years ago it was somewhat relevant, Dan stopped using that 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
Here is his bio page, in which he neglects to tell how many years ago he last saw a real live insurance claim. He is hitting his mid-seventies now, so you do the math on that. http://www.autoaccidentclaims.com/bio.asp No doubt a very nice man, with formerly-relevant knowledge of how things used to work in this business.
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 "very bad scarring". Now we do not know the price of revision work, or even if it would be successful. But a formula can never account for the value of that element of your claim.
A second, not so obvious, but very important factor 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. And the differences can be huge between these areas.
Those are just two reasons why it is important in huge cases such as yours to get a professional opinion in person.
Next, the seriousness of the injury, and of course, whether or not the injury can be proven by objective evidence (your cracked ribs and scars), or whether the only proof is subjective (your statements that you feel pain).
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 you 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.
Once the computations called for above are completed, add another 50% of the total to determine the starting amount for beginning negotiations on the total value of the compensation due you on your claim.
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.
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 you some future medical costs added in at this time.
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4. FUTURE MEDICAL PAYMENTS AND PAIN AND SUFFERING
Payment for FUTURE MEDICAL COSTS requires a FIRM COMMITMENT from your doctor.
It seems to me that you do not yet have the figures from the plastic surgeon, nor do you have any estimate from other doctors for any future medical care.
A comment by one of your doctors to the effect that you "would likely still need to see him in the future on our own" just IS NOT SUFFICIENT TO GET THE JOB DONE.
I would look at the typed records of your doctors. Or it is OK if he has readable handwritten notes. You are looking for words, a narrative—not some scratched code of some kind. And you are looking for some kind of statement that shows he made A FIRM COMMITMENT therein to the need for further treatment.
Without that, there will be no award for further treatment. Damages cannot be awarded on the basis of speculation. Your doctor has to state that it is his opinion that you (or some member(s) of your family) are "MORE LIKELY THAN NOT" going to need additional care in the future. And it would be best do some analysis and discussion of your medical situation in order to sustain his opinion in the eyes of the insurance adjuster who will be writing the check in this case.
For example, in order to lay the foundation for his opinion, he will have to discuss both the findings of his concluding examination and the types of activities any particular part of your life that is impacted by the injuries and may thus require future medical care.
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3. New topic: CONSIDER USING A DOCTOR'S NARRATIVE REPORT to assist in settling the insurance claims.
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.
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6. Consider a POLICY LIMITS situation for the tortfeasor, resulting in an Underinsured Motorist Claim (UIM) against your policy.
What if the tortfeasor has coverage of only your state minimum insurance liability policy limits http://www.settlementcentral.com/page8008.htm? Well, since the first offer was above most of the state limits, it seems he has a policy limit of at least $50,000.
But what if $50K is his maximum? Do you know what to do in order to get a settlement, to cut back on your subrogation, and to preserve your own UIM claim?
If $50K were all the insurance that is available, then you would for sure have a limits calim, and in fact even it $75K were to be the limits, you would be in a policy limits situation if your doctor is predicting future problems with your injuries. Take a moment and become familiar with some of the issues in policy limits insurance claims http://www.settlementcentral.com/page0451.htm
NOTE: don't go asking what the limits are until you get into full blown negotiations. We teach our members how and when to demand limits information.
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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
P.S. I apologize for the delay of two days in getting back to you inasmuch as I had noted my vacation time away through Saturday, or at least that is what I thought. Well, when I checked this morning, I see that either I or Allexperts got the dates of my absence wrong. Hope this miscommunication did not inconvenience you.
