QuestionMy husband, my 4 year old, my 1 year old, and myself were hit from behind at a red light by a lady who bent down to p/u something from her floorboard. She stated this in the police report. Our car was totaled due to damage. The kids went to the pediatrician the next day, and my husband and I went to the minor med the next evening. We were then seen by a chiropractor about a week later. We waited a week b/c we were given pain and anti-inflamatory drugs at the minor med. We each had 22 visits with the chiropractor over a 5 month period. The children had 3 and 6 with the chiropractor. The chiropractor stated in our release forms that we would likely still need to see him in the future on our own. My husband's total medical was around $3000 as was mine. The children's medical was around $900 and $1200. I was always under the assumption that we should receive 3 to 4 times our medical? Is this correct in this case? The insurance company was supposed to contact us last week to discuss the claim. I would like to know what we should expect without having to hire a lawyer?
AnswerTAKE THE INITIATIVE in personal injury insurance claims
DO IT YOURSELF SETTLEMENTS.
Firm doctor report for future medical cost coverage
Insurance pay medical costs in future
Future medical payments
Managing Medical Care After Auto Accident:
Personal injury insurance claim minors
Insurance injury minor settlement
Court approval kids' insurance claim settlements
Guardian ad Litem (GAL) children's insurance settlement
"GAL report" minor personal injury insurance settlement
Policy limits insurance claim multiple injured
Free legal information insurance adjuster
Doctor narrative reports settle insurance injury claims
Dear Tracy,
Please forgive the two day delay here inasmuch as my "mail box" was supposed to be closed, I thought, while I was away for a couple of days. I got back tonight and I am going to make the wait worth it for you by bringing together some essential factors and commenting on SIX ISSUES at length for you. Oh, you might think: I just wanted a SIMPLE answer. Well, there is no good simple answer, Tracy. My duty is to take all the time necessary to give you the BEST POSSIBLE ANSWER. And that will take some time for me and also for you; but you and your family will be the better for it in handling these claims. So grab a cup of tea and settle in to read a bit.
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. Court approval required to settle INJURY CLAIMS OF MINORS.
6. 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.
You asked: "I would like to know what we should expect". 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: 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, I am trained by my company to reassure the injured party that I am acting in THEIR behalf, as opposed to the interests of my 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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3. VALUATION COMPUTATION AND FACTORS THAT INFLUENCE VALUATION
We are not allowed to give actual values of cases inasmuch as the various bar associations believe that is the practice of law. Furthermore, with so little information, we just do not have the background to give an opinion of value.
"I was always under the assumption that we should receive 3 to 4 times our medical?" Well, my comment regarding your statement about getting three to four times medicals is that if you could get those values, then that would be pretty good. Some attorneys are reporting that the insurance companies are trying hard to get settlements at one or two times medicals.
Let's take a look at some of the factors that affect valuation. You can use these to add to your arguments for higher settlement amounts. But first understand that insurance claim 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 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 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. Not much you can do to estimate value here, except to know that the more educated or more economically secure an area is, the higher the jury verdicts seem to be.
Next, the seriousness of the injury, and of course, whether or not the injury can be proven by objective evidence such as an x-ray or a nerve conduction study), or whether the only proof is subjective (the claimant's statements to her doctor that she feels pain).
LONGER ANSWER:
Here are some of those factors that change the formula approach, DEPENDING UPON SERIOUSNESS OF INJURIES.
The typical formula approach in determining 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 1.5 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 not mentioned the lost income component, but if applicable, add it on too.
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.
A. LIABILITY DISPUTE & comparative negligence
This is a big one because it most dramatically affects value: minus if you have any fault.
B. 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.
C. 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).
D. 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).
E. 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.
F. 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; he has to be firm in his commitment to the necessity for future care.
G. Your medical and claims history, prior accidents, prior injuries or treatment of the same area of the body.
H. Impairment of quality of life.
I. Quality and persistence of pain suffered.
J. Quality and thoroughness of your medical records.
K. Lost wages.
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4. FUTURE MEDICAL PAYMENTS AND PAIN AND SUFFERING
You stated:
"The chiropractor stated in our release forms that we would likely still need to see him in the future on our own."
This statement made by your doctor—in and of itself—IS CLEARLY INSUFFICIENT to get any award or any coverage or any money set-aside for future medical care. Payment for FUTURE MEDICAL COSTS requires a FIRM COMMITMENT from your doctor.
I would look at the typed records of your doctor. 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, since he is a chiropractor (as opposed to, say, an orthopedic doctor), whose fellow practitioners have (fairly or not) developed a reputation for overtreatment, then he had best do some analysis 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 member of your family might participate in. For example, if one of you had been an active bowler, then he would mention that activity as one that will bring with it the likelihood of further treatment.
Thus, if you are serious about making a claim for future medical costs and making it stick with the adjuster, it sounds like you might need to tighten up your doctor's statement with a supplementary narrative letter addressing that topic more directly. Consider asking your doctor for a narrative report to explain in detail the possibilities—AND PROBABILITIES—of future problems.
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5. Court approval required to settle all but small INJURY CLAIMS OF MINORS.
Usually, in a personal injury insurance claim for minors a Guardian Ad Litem (GAL) is appointed to report and help in the court approval process
It does not look like your children have a very serious injury or anything other than a small claim. Thus, you may be able to give the insurance company a hold harmless letter and avoid going to court. But I would suggest reading the following anyway, just in case there might be a need to proceed in accordance with your state's rules regarding settlement of minor's claims.
Generally, a parent may NOT SETTLE her child's personal injury claim UNLESS it is small, or until a court approves the settlement AND the investment protection for the funds. The reasons for that are sound, and if you want you can read an exposition on the entire process to settle minor insurance claims http://www.settlementcentral.com/page8017.htm Guardian ad Litem (GAL) will interview you and your children, investigate the accident facts, review the medical records and talk to doctors, write what is called a "GAL report", and present it to the court. The order will be entered and filed with the clerk. Thereafter, the GAL may become involved in setting up the "blocked accounts" in their names, or verifying that the funds were disbursed as ordered by the court.
But to summarize here in my answer, if your children just have very small claims, it can be worked out with the insurance company to settle the claims yourself, to sign the release yourself, and to guarantee the settlement for the security of the insurance company.
The insurance company will forego the court approval process only on SMALL insurance settlements, and ONLY if the parent gives it a hold harmless agreement in exchange (i.e. to protect the insurance company should the minor later try to repudiate the insurance settlement agreement and release). But this is unusual, inasmuch as the insurance adjuster is instructed to get a full and effective release of the claim.
Since there are examples of former minor settlements being reopened when done without court approval, most adjusters do not have authority to let a parent sign a release on behalf of her child unless the claim is very small.
Plus, who is to guarantee that the parent will invest the proceeds in a blocked account for the minor instead of using the money herself to buy things that she would like her child to have but cannot afford on her own? Thus, the protection of the child's assets from the settlement is also a primary focus of the court.
We believe that in many cases, parents CAN AND DO make good settlements of their child's insurance injury claim. There is no reason that a parent cannot negotiate a fine settlement for her minor child. The only catch is that the insurance settlement and the investment of the insurance proceeds MUST BE APPROVED by a court of general jurisdiction in your state.
It is possible for the parent, with guidance and proper forms, to present the case yourself for approval. However, in most jurisdictions, an independent Guardian ad Litem (guardian for the litigation—most often an attorney) will be appointed to review the settlement and report to the court whether the terms and conditions are satisfactory. THE GAL REPORT will NOT RECOMMEND approval of settlements if it does not include consideration of long term consequences to the child. The court will then give approve the settlement, issuing a formal order approving the settlement and requiring investment of the proceeds in a safe and prudent manner.
A common question from parents is whether or not the money can be used to buy something that the child really wants, but which the parent cannot afford. All the cases I have seen the parent's request to use the child's money is refused, excepting in two instances: first, where the child wants a car and has a job that is so far that he requires a car to get to and from the job; and second, where the child is in poor physical and mental condition and the expenditure would, according to the child's doctors, go a long way in cheering him up and thus promoting his healing.
Other than those two kinds of examples, the court is not going to allow any parent to use the child's money for any other purpose.
Read about Guardian ad Litem for the minor, his attorney's fees, procedures for court approval of minor insurance settlements, paying fees and court costs, and asking for insurance company payment of all fees and costs http://www.settlementcentral.com/page8017.htm
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6. 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 her 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 her what the options are to resolve the matter fairly should he not agree to a reasonable claim value. In other words, let her 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
