Visitor Question

How is compensation for medical bills handled with insurance coverage?

Submitted By: Terry (Palatine, IL)

I slipped and fell in front of my office one morning last year. The accident was due to ice build up in front of the building. The property owner and insurance company have assumed responsibility and have paid some of my medical expenses.

The insurance adjuster that I have been working with indicated that I need to prepare a demand letter for compensation for pain and suffering. The injury required surgery and extensive rehab.

When determining the total medical bills for the compensation formula, do I add the raw cost of the medical bills or just the out-of-pocket costs (deductible and coinsurance)? The former approach seems excessive (my total bills plus therapy total about $60k), while the latter method seems too low. How is this handled? Thank you.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Terry,

Add the raw cost of all medical bills. Doing so is a traditional method of framing demand letters. The multiple you use is meant to cover not only reimbursement for medical and therapy bills (you should not be penalized for having your own medical insurance), but also for your out-of-pocket expenses, lost wages, and for your pain and suffering.

Your pain and suffering is what the bulk of the amount of compensation should be. If your medical bills were $60K, then your pain and suffering must have been great. The insurance company may not agree to your demand, but making a demand of at least 3 times your medical bills, at $180k is not an unreasonable place to start. You can negotiate down form there.

With injuries requiring $60k in medical bills, it would be wise to consult an attorney. In serious injury cases like yours, an experienced attorney is often able to get much more for an injury victim than the victim could working on their own, even after the attorney’s fees are taken out.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published: March 25, 2015

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