QuestionI was involved in a auto accident on the job. OJI is paying my salary for being off of course. The other party was at fault in the accident. The other party's inurance company has sent me a couple of letters for me to call them. I have not called them yet and probably won't until i go back to work. I have a back injury and have been off of work a little over two months. I also have been going to PT as well. How do i deal with them when i do respond to the letters and aslo on getting a fair settlement? What minimum ball park figure should i be looking at.
AnswerHi Tim,
I am going to give you some help in making a full valued third party (that is the bad guy) claim, including some tips on questions his insurance adjuster will probably ask you.
Your claim has two aspects to it. First, of course, is the payment history from workers’ comp (WC), which we will address for its subrogation issue advantage. Second is your tortfeasor claim (the bad guy), which should include the full value of medical costs and wage losses. You asked the value of that third party claim (the tortfeasor), and I will address that last.
#1. REDUCTION IN WC SUBROGATION CLAIM POSSIBLE?
Let’s address first the issue of subrogation on the WC claim. Insurance subrogation claims http://www.settlementcentral.com/page0459.htm are similar to the WC claims against your tortfeasor award. Just for background on how it will work, your third party award will be for ALL DAMAGES, including pain and suffering, PLUS medical costs and lost wages. Some part of that award will go directly to your WC administrator.
To the extent that your WC paid money, they will want it back from your settlement. You have a remote chance to get some reduction in subrogation. Read the defenses and ask your WC administrator if she will approve a subrogation reduction if you settle the claim yourself. If they would grant you a subrogation reduction in the event you hired an attorney, why can’t you argue for a reduction if you accomplished the same thing yourself?
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#2. INCLUDE FULL MEDICAL COSTS AND WAGE LOSS IN THIRD PARTY CLAIM
One mistake made by a lot of injured workers with third party claims is that they allow the third party settlement to be based upon what their WC claim paid out in medical costs and wage loss INSTEAD OF THE FULL VALUE OF THE LOSSES.
[You can skip this part on medical cost differences if your total medical bills are less than $5,000.]
Many WC administrators are able to get medical costs at a discount. That IS NOT THE TRUE VALUE OF THE MEDICAL SERVICE. Do NOT allow the WC administrator send the bills that she pays for the doctors to the third party if they are substantially less than full market value for those services. One reason for this is that the value of that third party claim will in part depend upon the total of the medical costs. Hence, if your actual medical bills amounted to $14,000, but there were reductions so that the WC administrator paid only $9,000, you want the third party to have the full value of the billings so that they can compute a higher value for your claim.
As for the wage loss, if your WC payments were 100% of your lost wages, skip this part as well. But if your WC payments for lost wages were just part of the wage loss, then GET YOUR FULL WAGE LOSS INFORMATION TO PROVE THE THIRD PARTY CLAIM.
Here is a good example, Tim. In many states, the WC pays some percentage LESS than the actual wage loss: anywhere from 65% to 90% can be expected. Hence, if one were off work for four weeks in a job that paid $42,000 per year, the normal and actual wage loss would be $3,230. But if the WC pays the worker only 70% of the lost wages, he will receive only $2,261, or 969 LESS THAN he is entitled to.
Hence the worker MUST include the actual wage loss information in his demand letter to the third party insurance company. The wage stubs or leave and earning statements can be supplemented by a memorandum from the employer as to the days of work that were lost, INCLUDING SICK LEAVE AND VACATION DAYS TAKEN. Be sure to include the latter two inasmuch as those are compensable at your wage rate, even if you did not suffer an actual loss of cash because you took a day of sick leave.
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#3. Valuation of personal injury claims: Yours is impossible to guess at for lack of information.
Here is a list of topics that affect valuation of a personal injury claim. Insurance settlements based upon maximum VALUATION COMPUTATION AND FACTORS THAT INFLUENCE VALUATION.
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 he present to the jury is a most important consideration (i.e. is he credible, does he 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.
LONGER ANSWER:
Here are some of those factors (as set forth in MORE DETAIL IN the members' section of Dr. Settlement's website http://www.SettlementCentral.Com There are changes in the formula approach, DEPENDING UPON SERIOUSNESS OF INJURIES.
The typical formula approach 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. And add on transportation expenses (48.5 cents per mile) to and from medical treatments.
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 the claim increases with a bigger crash (i.e auto accidents), and decreases with a low damage fender bender. Why? Just human nature.
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 Mother’s medical records.
11. Lost wages. Not a factor here.
As an example of the above, Tim, similar injuries will have different results if one is from a low impact minimal damage accident and the other is from a huge crash. That is how these factors impact the value.
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As for what to do next, and how to treat the issue of recorded interviews, here is a collection of pages from Dr. Settlement’s website that will give you some ideas. Learn 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
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
Outline of questions to be expected from insurance claims adjuster http://www.settlementcentral.com/page0190.htm
Detailed listing of questions to be expected from insurance claims adjuster http://www.settlementcentral.com/page0207.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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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
