Auto Insurance Claims: Auto accident, insurance claims adjusters, personal injury insurance


Question
I know this has been a commonly asked question. My wife was pulled over by a State Trooper on an Interstate to check her tags. Everything was deemed OK and as the Officer pulled away from the passenger side window my wife was rear ended by a pickup truck who had been hit by a Fed EX truck. The police report shows the Fed Ex driver was at fault. The impact of the accident split the back of my wife's scalp. She and the Trooper were taken to the hospital via ambulance. My wife required 3 staples to the scalp and was sent home. Her back was hurting at the time but she assumed it was muscle aches from the impact. After 2 days she went to a doctor for her back. To make a long story short, it will be a year in August since the accident. In April she had back surgery to remove 3 discs. The doctor has in his report that this was caused by the accident. her medical bills are already over 120,000.00. What is a fair amount we should ask for. My medical insureance has paid the bills so far. I assume we would have to pay back the medical bills. Also she has missed about 9 months of work. Thanks for your help.  

Answer
Do not settle personal injury insurance claim too soon;
Very large personal injury insurance claim settlement;
Insurance claim triple disc injury surgeries;
Post concussive syndrome car accident
Accident concussion after-effects, confusion, anger, memory;
Do it yourself insurance settlements
Doctor narrative reports settle insurance injury claims;
Narrative letter big help insurance demand letter;
Write winning demand letter insurance claim;
Insurance claim valuation; how much is my claim worth?
Free legal information insurance adjuster—learn about personal injury insurance claims and insurance settlements;
Overview tort law personal injury legal claims;
Effective communication with insurance claims adjusters;




Dear Dan,

Sorry for the delay; going to bed so late after I finally got home from the replacement flight (after 4 AM) used to be something I might recover from pretty fast, but not these days, at this age.  So I got behind on my work and I hope my delay did not result in any anxiety or loss on your part.

Yours is a complex situation.  It is also a MOST serious case, with the potential of a VERY LARGE INSURANCE CLAIM SETTLEMENT.  In this particular case,


VALUATION BY AN ATTORNEY WOULD BE BEST
To get a good handle on your claim value you should HIRE AN ATTORNEY.  I usually encourage people to try to resolve claims by themselves before involving an attorney.  For example, 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

But in your situation I would most strongly advise DO NOT TRY to value this case on your own.  There are too many wild cards in the mix.  I would be prepared to pay a few hundred dollars to get some ideas from an attorney regarding valuation and presentation of the claim.

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BE SURE TO CHECK OUT POST-CONCUSSIVE SYNDROME
I am MOST CONCERNED about a concussion.  There are a lot of signs of post concussive syndrome that you may be missing and not reporting to her doctors.  That is another totally different area that you have not mentioned.  

But before I even made an Effective Personal Injury Insurance Demand Letter http://www.settlementcentral.com/page0170.htm I would become informed about post concussive syndrome and speak with your wife about it and the symptoms she likely is displaying even now.  Your head just cannot be hit THAT hard without developing some continuing brain damage.  

Gather the evidence, present it to your doctor and get a referral (or self-refer) to a neuropsychologist.  Pay to have her evaluated.  You will not regret the expense, and in fact as long as it is accident-related, your insurance or Fed Ex will pay for it.  

Here are two useful websites:

http://www.headinjury.com/welcome.htm

http://www.subtlebraininjury.com/sitemap.html


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VALUATION COMPUTATION AND FACTORS THAT INFLUENCE VALUATION

Working up a valuation on a triple disc case with potential brain damage and loss of consortium claim from you is something that will take some time and expense.  It involves too many factors that need to be evaluated (see below).  MY WORRY: you are going to have a hard time finding an attorney who will be for hire on a consultation basis for valuation.  They do not want to risk malpractice for a few hundred dollars.  Plus, they will want to get your wife and you as clients and they will push so hard on that topic that you may leave the office.

So you may end up without a serious valuation workup.  Then I am worried that you might try to go it alone.  We teach our members some ways of valuation, and encourage them to look at a number of factors.  I will give you a "heads-up" on some of those here, but just in summary format, not as presented and discussed on the site.  


It is TOO EARLY TO BE THINKING ABOUT VALUATION of your wife's claim if she has shown any signs of post concussive syndrome.  

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.

Next, the seriousness of the injury, and of course, whether or not the injury can be proven by objective evidence (those disc problems), or whether the only proof is subjective (your wife's statements that she feels pain).

Another factor in your wife's favor is the social disapproval of the tortfeasor's actions, which in this case runs high inasmuch as we do not like commercial drivers causing injury

LONGER ANSWER:
Here are some of those factors (as set forth in MORE DETAIL IN the members' section of www.SettementCentral.Com, Dr. Settlement's website):
There are changes in 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.  That would be the case here.  You have not mentioned the lost income component, but if applicable, add it on too.

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 your wife had 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.   Big crash here, hence more value.

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).

Here your wife's injuries are very high on the list.  If brain damage or psychological damage could be added, then it would be higher yet.

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.  Looks like your wife's doctors will be high on the food chain, hence, more value.

6. Prognosis- future care—permanency of injury or pain and suffering—or was she done forever with treatments from 4 months ago, or will she look forward to a lifetime of curtailed activity and residual pain?

Her claim value gets a boost if her doctor specifies that she will need some future medical care.

7. Her 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 her medical records.

11. Lost wages.

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GOING IT ALONE: ON A DO IT YOURSELF BASIS FOR INSURANCE SETTLEMENT

While I recommend your hiring an attorney, I don't want to send you out there without a strategy just in case you decide to do this on your own.  Thus, here is an idea to go as far as you can, and then get an offer and take it to an attorney and insist on exempting it from the reach of attorney's fees.  

For example, to start, you can always ask for $1,500,000 with the thought that such a sum would be covering all of the value of the claim.  Then see what kind of offer they come back with

As for just getting your demand letter out and getting a return offer of insurance claim settlement, 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

Arm yourself to deal with the insurance claims adjuster: learn about personal injury insurance claims and insurance settlements.

Here is some easy reading for free to brush up on the tort system and to help you deal with the insurance adjuster.

Overview Tort Law Personal Injury Legal Claims http://www.settlementcentral.com/page3000.htm

Establish Firm, Professional, and Positive Relationships With the Insurance Injury Claims Adjuster http://www.settlementcentral.com/page0059.htm


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GET A NARRATIVE REPORT: BIG HELP FOR DEMAND LETTER
Before you send in your demand letter, look at the medical records to make sure that they mention all things of importance that occurred in conversations with the doctors.  When applicable, consider asking for a narrative letter 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 the lives of you and your wife 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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Subrogation: Do I have to pay it all back to my health insurer?
Your health insurer does have a derivative claim against the insurance settlement you will be awarded.  If there is a policy limits situation (which one would NOT expect with Fed Ex), be sure to notify me and we can go over the chances to reduce the subrogation claim.  Likewise, in a contested claim, it could be possible to make the claim that you had to hire an attorney, and thus your attorney could help you to ask for some contribution toward sharing those necessary costs.

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FINAL TOPIC—COMMUNICATE IN WRITING AND "DEMAND" NOT "ASK" Effective communication with insurance claims adjusters.

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 wife (and you) a 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