QuestionOkay..never been on this site before but i am lost and think it's worth a shot :)
So, Last August - 2005 - i was a passenger in my boyfriend's caf and somebody T-Boned my side, we were going 45 mph -- bad wreck, anyway - my head hit the windshield and my knee bashed into the dashboard.
Long story short: my boyfriend broke his hand had to get surgury, the car was completley totalled, i was in physical therapy for my black and blue knee and leg for 5 months, whiplash for a month - and i have a huge puffed out scar on my forhead.
Now time is comming to settle, I have a very low self esteem - and i suffered HUGE amounts of depression after this wreck mainly becasue of the scar on my face - it is very large, (keloid..i believe is the term) and every person i meet asks about it...which sucks. My knee is never going to be 100%, however MRI's and scans done show that there is nothing surgury can do to fix - it LOOKS okay, but the way it acts for me is not okay.
WHAT IS A FAIR/RESONABLE SETTLEMENT PRICE TO PUT ON THIS? I am a broke college student - and I can not help but think about how this scar will be in my wedding pictures, first pictures with my children..etc.:
The medical costs probably totalled about 7000.00 or so - the car was totalled and probably worth about 8,000.00 -- not sure what my boyfriend's medical bills totalled.
I want to settle for $100,000.00 Do you think this is ridiculous? How can one put a price on their image being changed for the rest of their life? OR - the fact that if my knee is not 100% now, what will be the outcome 20 years from now? ARthuritus? Another 20,000.00 in damages?
Anyway - I think this is completley reasonable...insurance companies have money for things like this...and I just dont think that i am asking for TOO much. But, I could be wrong?
WHAT do you think?! Thanks for your time!
-Amy
AnswerSmart Tips to Buy Automobile Insurance
Remember loss of consciousness
Report loss of consciousness
Loss of consciousness remembered later
Post concussive syndrome
Neuropsychologist post concussive syndrome
Never too late to correct medical records
Add to medical records afterwards
Never too late to correct medical records
Must correct medical records ASAP
Narrative letter big help insurance demand letter
Insurance claims settlements using doctor narrative reports
Policy limits insurance claims
Insurance settlement for policy limits
Underinsured Motorist Claim (UIM) against your policy
Valuation computation personal injury claim
Factors influence valuation bodily injury claim
How to deal with insurance claims adjusters
No phone calls insurance claims adjusters
Dear Amy,
I would like to tell you that you will be able to send off something to the insurance adjuster along the line of what you wrote above and then laugh all the way to the bank. But that would not be an honest response. Truthfully, unless you take some ACTION NOW, you will have squandered at least half the value of your claim. Even worse, you may be missing out on professional help for your medical and psychological deficits from this serious accident.
Thus, I started this last night, and I am going to take all day and put forth the effort to guide you both in your medical care contacts and in your claims processing. As to the latter topic, do not have any serious contact with the insurance adjuster until you have done some of the things I am going to suggest here. I do think your claim can be a very large claim, but it will take effort to get it there, or the guidance of a good personal injury attorney.
One of the first topics is to know where you stand vis-à-vis the total insurance available for your claim. What if the tortfeasor has only the statutory minimum insurance for your state? See the minimum limits in Smart Tips to Buy Automobile Insurance http://www.settlementcentral.com/page8008.htm
How much Underinsured Motorist Insurance (UIM) does your boyfriend carry? More on this topic below, but for now at least you can ask your boyfriend how much UIM coverage he had. Then, too, you might have to call upon your own UIM coverage in this situation, so you might have to ask your agent when and how your own UIM coverage comes into play should both the tortfeasor and your boyfriend have just the statutory minimum liability insurance for bodily injury.
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Now, on to your direct question regarding what I think of your $100,000 valuation. What I think is that you have taken this far too lightly, and expect that an insurance company is just going to open the door to stacks of money because "insurance companies have money for things like this."
The insurance industry is the wealthiest in America, and they did not get that way by paying out fair value for their claims. They abuse and delay claimants and give them the run around and overwhelm them with unlimited resources. They will fight you and try to wear you down before they will pay a fair settlement.
So, yes, I do think you are way wrong in your valuation of your claim if it is anything like what you have described above. You truly have no idea what your damages are at this stage, so the value has not yet been built into your claim. You have missed three chances to enhance the value of your claim that would bring it up to six figures, and I do not know whether or not you can now go back and try to fix what you have done and failed to do. Please do not think I am trying to add to your feelings of depression over all of this; I am just pointing out what was missed and what you might be able to do now to salvage your claim (and, more importantly, to get you the medical help you need and deserve!).
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Let's start with two of your statements:
1. "My head hit the windshield", and
2. "I have a very low self esteem—and i suffered HUGE amounts of depression after this wreck"
Those two areas needed more medical workup than you have given them (if your statement to me is complete with doctor visits). The reason is that for the first one, you should have had a post concussive workup. Please do some Internet searching on that term and see how many of the symptoms you may have had. I bet you will be surprised.
I bet you hit your head hard enough to temporarily lose consciousness, but that you never even realized it or mentioned it to the emergency room people. Thus, it is not now in your medical records. If this was the case, you should write to your doctors to tell them that you realize you did lose consciousness and thus you are updating your records. (See below for contacting me and I will send you a letter from our members' side of our site.)
Doctors are not going to lead you by the hand through the consultations and referrals that they should be making unless you know enough about the injury you have to make the requests. It is kind of a two way partnership that way.
So I am guessing that you never had even one workup done for post concussive syndrome. Am I right?
Next is the psychological damages overlay. It is natural for you to have depression from this accident, both in terms of the obvious source—the scar—AND in terms of severe emotional distress owning to the trauma and all it involved, and to your direct head trauma.
If you had come in to my former law office shortly after this accident, I would have had you examined for all of these things, and by now we would have the full extent of your mental injuries well documented and you enrolled in a regimen of psychological counseling.
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Even more important than money is safeguarding your long term health. I am concerned with three topics that I do not believe you have a handle on. The first is your depression. Next is a possible head injury. And last is any continued pains that you may get after a day of physical activity.
Taking the depression first, you MUST get some professional care for this ASAP. Use his or your PIP coverage to see a neuropsychologist ASAP. She will help you a lot.
Next is possible mild head injury. I have handled my share of head injury cases, and I can tell you that some of the description you gave to me is compatible with long term impacts from a very serious trauma. If you were my client, I would have sent you to a clinical neuropsychologist for a functional workup, including an evaluation of emotional impacts of the damage.
From what you mentioned, this has not been done at all. Your medical doctors worked on the mechanical side of things, but the head trauma you suffered was so severe I would be very surprised if you did not carry forward long term functional problems.
Too often neurological examination after a head injury is "normal" and standard tests as well as imaging studies (such as MRI or CT of the head) similarly fail to reveal abnormalities. Therefore, aberrant behaviors and other symptoms that do not "fit" were thus attributed to psychological. But microscopic studies have shown disruption of the nerve fibers in the brain due to the stretching or shearing forces of the trauma.
Do you or your boyfriend recall whether when you first were seen in the ER if you had repetitive questioning but did not remember the event or what exactly happened?
If you experienced post traumatic headaches, you may also have experienced other symptoms of the post traumatic or post concussion syndrome. There may be other neurological symptoms such as dizziness, ringing in the ears, vague blurring of vision, psychological symptoms occur such as depression, anxiety, personality change, disturbance in sleep and impairment of libido.
Finally people with post concussion syndrome have changes in their mental functioning, primarily difficulty in concentration, inability to work efficiently and associated difficulty maintaining attention and retaining memory.
An adjunct of that head trauma is the possible displacement of the disc upon which your condyle rotates in your jaw joint. That can be the explanation of some of symptoms you might still be having, such as headaches and general pain. I am surprised that your doctor did not ask about this or have you see your dentist. Check it out here:
http://norcalpt.com/jawjoint.htm
http://www.paulsethpt.com/excersises/unrestricted/headneck/tmj.html
The third area that I am worried you have not totally resolved is your pain and suffering that you will get from physical activity. I am worried about your knee and your soft tissue rehabilitation. For settlement purposes, those two can also be discussed in a narrative letter, although I realize you are not now made of money to buy those letters. But for future pains I wonder who is going to pay for the medical expenses if you settle now, before your doctors have a solid prognosis for the need of treatments in the future.
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Here is what I think you need to do about the scar. Again, it will take a SOLID REPORT by your doctor to indicate all of the potential problems with that kind of scar, and the limited opportunities for revision. That kind of valuable information is NOT GOING TO BE INCLUDED IN THE DOCTOR'S OFFICE NOTES. That is why you pay for a narrative letter: it brings a lot more money to the table in helping the insurance adjuster to have a firm commitment by the doctor to a stance that this scar is not going to be easily revised.
A keloid is a scar that continued to grow; it doesn't know when to stop. When the skin is injured, cells grow back to fill in the gap. Somehow, normal scar tissue "knows" when the scar tissue is even with the contour of the skin, at which point they stop multiplying. When the cells keep on reproducing, the result is what is called a overgrown (hypertrophic) scar or a keloid.
The treatment of keloid scars is complex and is not always successful. Steroid injections, applications of pressure or silicone sheets, radiation and scar revision surgery are sometimes needed.
Unfortunately all scars are permanent and there is no technique to remove them completely. A plastic surgeon tries to conceal the scar by "revising" it. This often means removing the scar and trying to repair it in such a way as to make an improvement in its appearance. But it is also the case that oftentimes keloids do not subside.
Thus, rather than just submit your claim as you are—on the existing office notes, and the present looks of the scar, and your belief that it is semi-permanent, you MUST GET A NARRATIVE REPORT from a plastic surgeon. You will use your boyfriend's PIP or your own PIP to get an appointment to discuss revision of the scar. THAT ONE LETTER CAN ADD MANY THOUSANDS OF DOLLARS TO YOUR CLAIM.
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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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Consider a POLICY LIMITS situation for the tortfeasor, resulting in an Underinsured Motorist Claim (UIM) against your boyfriend's UIM policy (or your own if his limits are low)
What if the tortfeasor has coverage of only your state minimum insurance liability policy limits http://www.settlementcentral.com/page8008.htm? Look up the state where the tortfeasor resides to see what the minimum liability insurance policy limits are. It looks like most states require only 25/50. That means that $25,000 is the bodily injury liability for one person in an accident, and $50,000 is bodily injury liability for all people injured in an accident. Thus, if the tortfeasor has just the minimum, then $25,000 would be all that is available to you.
If that were all the insurance that is available, then you likely would be in a policy limits situation if your doctor is predicting future problems with your disc. 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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VALUATION COMPUTATION AND FACTORS THAT INFLUENCE VALUATION
Amy, I think it is WAY TOO EARLY TO BE THINKING ABOUT VALUATION OF YOUR CLAIM. What if you go through an examination and a course of treatment with a neuropsychologist who diagnoses mild brain injury?
What if your knee doctor writes a solid narrative report telling about the expected future problems with your knee?
What if the plastic surgeon makes a solid letter that even with surgical revision, your scar will always be visible from even 25 feet away?
We cannot value your claim until those things are known. 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.
DO NOT EVER GET STUCK USING THIS FORMULA APPROACH, AMY. It no good in a case of psychological damages and scarring that is gross and semi-permanent. I have an idea that you will exhaust all of the available insurance before you reach the value of your claim if you follow my advice, above.
But, for your information, here are some of the factors we teach our members how to employ to value and to settle their claims.
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 (your X-rays or MRI), or whether the only proof is subjective (your statements that you feel pain).
1. LIABILITY DISPUTE & comparative negligence (none in your case)
2. Trauma suffered
The value of your claim increases with the big crash you suffered through
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. This is where you need NARRATIVE REPORTS that can argue for future 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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PLAN OF ACTION:
Here is what I would like to see you focus on at this time, Amy. It involves suggestions for both the maximum value of your claim, AND, more importantly, a plan to get better through continued treatment.
1. Research post concussive syndrome on the Internet, and try to remember whether or not there was a brief loss of consciousness;
2. Write to doctors to correct your medical records regarding loss of consciousness, if in fact that is what you now recall—e-mail me at my site and mention you met me here and I will send you a letter from our members' side that you can use to correct your records. IT IS NEVER TOO LATE TO CORRECT OR SUPPLEMENT YOUR MEDICAL RECORDS http://www.settlementcentral.com/page0218.htm but the sooner you do it the better, especially if you later on recall a loss of consciousness http://www.settlementcentral.com/page0134.htm
3. Make an appointment with your doctor to seek a referral to a neuropsychologist regarding your depression. THIS IS A MUST. Severe Emotional Distress is a compensable item of damages, but not as you present it. You cannot even testify to emotional distress as a separate item of damages unless you have a professional opinion that ties it to the accident. I suggest a neuropsychologist because of possible mild brain injury.
4. Moreover, this is the best way to get better. You will find a lot of help from a neuropsychologist or psychiatrist.
5. Open or re-open your boyfriend's PIP or Med/Pay first party insurance to pay for these doctors. If he has no PIP left, then open with your own PIP policy.
6. Consider getting narrative reports on both your knee and your scar (see below for why). I would set aside (or borrow if you have to) $500 and tell the nurses that you want a limited report for that much money ($250 each).
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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
