QuestionIn January-2009 I was involved in an automobile accident. The driver of the vehicle that hit me, crashed into the rear of my vehicle and he was traveling at a speed of about 40 mph. The other driver was totally at fault for this accident and the police officer issued him a citation for the accident. I did not believe that I was that injured at the time the accident occurred, but a couple of days later, I did seek medical treatment. First, I was treated at an urgent care facility, then followed-up with my primary care physician, who then referred me to an Orthopaedic physician who prescribed treatment included 5 months of physical therapy. The damage to my vehicle was minimal and was repaired. My medical bills totaled $7,273, Lost Wages of $477 and Mileage and Miscellaneous Expenses of $114. Therefore, my total expenses were $7,864. I have been released from my physician and treatment, but I am still not at 100% and I was told that I may have some re-occurring pain and soreness for up to a year. I do not have an attorney and decided to try and settle this claim myself. However, after having my first discussion with the other person’s claims adjuster (Progressive), he as significantly undervalued my claim. My initial offer was $35,000 and his counter offer was roughly $6,720. He said he was only allowing about $5,193 for my medical expenses because my treatment should not have taken 5 months. He said it should only have taken 2 ½ to 3 months. Then the remaining amount of $1,527 was for my pain and suffering. I told him that this was insulting. I could not believe that he was not even willing to cover my total medical bills. I went back to him with a second offer of $25,000 and again he said no. I know that this is his job, but I also know a little about insurance claims. I know he is trying to get me to offer a really low amount like $10,000, but I believe that amount is too low. I am trying very hard to settle this claim without having to get an attorney. Do you have any suggestions or advice that can help me? I really appreciate any help you can offer. Thank you.
AnswerHi Crystal,
Your treatment plan and the demand of $35,000 sounds totally logical to me
especially if you also presented a letter from your doctor stating that you
may have re-occurring pain and soreness for up to a year along with your
demand.
Progressive does have a right to question your treatment plan and length,
but the proper time for that is while you are still treating. If they
had felt that you were overtreating, they could have called for an (IME)
independent medical examination to question your doctors treatment and length
of time that you treated.
For your type of injury, an orthopedic doctor's opinion and treatment is
considered the top of the line and hardly anyone is willing to challenge him.
Now you have some greenhorn claims adjustor is saying that he knows that your
treatment should only have taken 1/2 the amount of time. No one including your
doctor knows how long treatment will take until it's over and you are back to
100%. The adjustor can NOT refuse to allow consider legitimate medical bills
and treatment lengths based upon his "opinion" as to time and treatment.
Progressive had legal ways to challenge while you were treating and didn't.
20+ years ago, I was rearended at a redlight and only incurred $800 damage
which was clearly visible to the naked eye but hardly visible on a Polaroid
photo. I was in physical therapy for 2 1/2 hours per day, 5 days per week for
almost 8 months (herniated disk L1 S5) and collected policy limits of 50K from
the at fault ins co and an additional 30K from my company after filing thru
the underinsured motorists portion of my policy.
Settling a claim direct with the adverse company is a negotiation game. You
demand more than is needed to make you happy and the adjustor counters with a
very low-ball offer. You slowly lower your demand and he slowly increases his
offer over a period of several weeks to several months until an amount is reached
that you both can agree upon.
You seriously erred by immediately lowering your demand by almost 30%. You should
have only lowered the demand by 2K - 3K. Now you are really backed into a corner
by the adjustor, by have made an offer to settle for 25K and have no "wiggle" room
left to negotiate downward because your claim is definitely worth $23,000-$25,000,
based on your injuries and the QUALITY of the professional that made the diagnosis
and oversaw the treatment.
You need to reiterate in writing to the adjustor that you reject his most recent offer
and that your final demand of $25,000 is not negotiable. Tell him that you expect a
settlement check in hand within 30 days or you will place this case in the hands of an
attorney.
You must settle this claim before the expiration of the statue of limitations in your
state or file a lawsuit to protect your interests. The statue is only one year in
Tennessee, Kentucky and Louisiana. Approx 23 states have a two year statue and the
remaining vary from three to five years.
The first consultation with an attorney is usually free or has a minimum charge of about
$20. Be sure to only consult with personal injury attorneys who have TRIAL experience.
The latest statistics I have read state that only about 15% fall in this category.
If you don't know one, call your county attorney referral service (it's free) and they
will give you the names of 3-6 or more qualified attorneys. Progressive would be very
happy if you hired one of the 85% because they know that group will negotiate with a
couple of telephone calls and 'boilerplate' a slew of demand letters but never take a case
to trial because they would be more frightened in front of a jury than you. Progressive
knows they can then drag this out until near the end of the statue date (while keeping all
the money in their bank and earning interest) and then settle for a minimal amount. They
DO NOT want the extra expense of a trial, so hire someone that they know means business
and reach an early settlement.
Personal attorneys work on a contingency basis meaning if they don't win, you don't pay.
A fairly standard contract is 1/3 to the attorney if settled out of court, 40% if they
must go to trial. Some attorneys will want you to sign a contract that also gives them
all their expenses off the top before dividing the settlement by the terms of the contract.
DO NOT enter into a contract that gives the attorney expenses plus a percentage of the settlement. Keep shopping until you find the right attorney. The attorney will probably
make his demand for $35,000, but even if he settles it out of court for $25,000 you
would still get over $16,500 (which is not enough) but more than double the offer that
you are getting from progressive.
Please feel free to send me any additional questions. Let me know your state of residence
and if you live in a metropolitan area, small town or rural area.
I hope that you find this information helpful. Your feedback by rating my response
will be appreciated.
Bennie
San Francisco Bay Area
