Personal Injury Accident Settlement Negotiations Fail Due to Lack of Valid Evidence of Serious Injury*



Personal Injury Accident Settlement Case Summary:

In this case the Plaintiff attempted negotiations with the insurance company of a driver who had cut him off in an intersection, causing a collision. During these negotiations, the two parties were unable to come to an agreement on the amount of the personal injury accident settlement.

Frustrated with the insurance company's unwillingness to pay the full amount of the medical bills he incurred, the Plaintiff retained counsel and filed a lawsuit.

Statement of Facts...

On February 1st, 2011, Gord Cheve was driving home from work. It was about 6:30 in the evening and the weather was clear. Cheve was travelling southbound on a two lane highway. He was driving close to the posted speed limit.

At the same time Raymond Bush was travelling on the same highway heading northbound. The traffic light was red for both drivers. As both drivers were coming to a stop the traffic light turned green. Instead of slowing down, Bush sped up and attempted to make a left at the light and get across the intersection before Cheve's car came through.

Bush failed to properly calculate his speed and that of Cheve's vehicle. As a result, about half way into his turn, Bush collided with Cheve.

A passerby witnessed the collision and stopped to render aid. As he did he called 911. The police and ambulance arrived a few minutes later.

Both drivers appeared to be shaken. When the airbags deployed Bush suffered lacerations to his nose and forehead. Bush cut his hand when a screwdriver from his toolkit was thrown forward from the back seat. Other than that, both drivers seemed to be alright. Although asked, both declined to be taken to the hospital for observation.

The police issued a ticket to Bush for "Failing to Yield the Right of Way" after speaking with both drivers and the passerby. The police officer told Bush it was his responsibility to make sure the intersection was clear and safe to cross before making his turn.

The next morning Cheve had trouble getting out of bed to go to work. His back had stiffened during the night and his legs were sore. His wife called his employer to say her husband wasn't going to make it into work that day.

Cheve's wife drove him to the local hospital's emergency room. He was seen by the emergency room doctor who prescribed some pain medication and muscle relaxers. The physician told Cheve if his symptoms persisted he should see his family doctor.

Instead of going to see his family doctor, Cheve decided to go to a local Chiropractor. The Chiropractor told Cheve he would benefit from daily treatment. Cheve agreed, and went to the Chiropractor daily. He received electrical stimulation, realignment and massage therapy. He continued to receive treatment for the next ninety days.

The Negotiations...

Shortly after the collision, and before beginning his treatment, Cheve contacted Bush's insurance company. At that time a claim was set up and a Claims Adjuster was assigned to investigate the facts of the case.

The purpose of the investigation was to decide if the insurance company would accept liability on behalf of their insured, and agree to eventually enter into a personal injury accident settlement. The Adjuster told Cheve to let her know when he finished his chiropractic treatment.

After three months of chiropractic treatment had concluded, Cheve called the Claims Adjuster. He wanted to begin the negotiations for his settlement.

The Adjuster told Cheve to submit copies of bills for medical and chiropractic treatment, his out-of-pocket expenses and verification of his lost wages. Cheve copied the chiropractic bills, the emergency room bill, his prescription and over the counter medicine costs, and his employer's verification of lost wages for the two weeks he had taken off during his treatment.

He made a list of those costs and added an amount for his "pain and suffering". He mailed the list to the Adjuster.

Cheve's initial offer:

  • Chiropractor: $3,500.00
  • Out-of-Pocket Expenses: $350.00
  • Lost Wages: $1,200.00
  • Pain and Suffering: $5,000.00
  • Total: $10,050.00

A week later the Claims Adjuster called Cheve and wanted to discuss his settlement demand.

The Adjuster told Cheve his demand was much too high; that his injuries were not serious enough to have required the length and cost of his chiropractic treatment; and in light of the type of injuries he suffered, his time off work was excessive.

The Adjuster told Cheve without an MRI exam or other medical proof of the nature and severity of his injuries, his demand was wholly unsupportable.

The Adjuster asserted the pain and discomfort Cheve suffered at the time of the collision were at most muscle sprains and sore limbs. He failed to submit any proof of torn ligaments, disk herniation, or other medically diagnosable injuries.

She went on to tell Cheve she had been negotiating personal injury accident settlement claims for over ten years and during all that time her company had never authorized that much money for the type of injuries he sustained. Absent further credible proof of his injuries the Adjuster made the below offer.

Insurance Company's Counter-Offer:

  • Chiropractor: $1,000.00
  • Out-of-pocket Expenses: $600.00
  • Lost Wages: $350.00
  • Pain and Suffering: $750.00
  • Total: $2,700.00

Cheve was upset and told the Adjuster his chiropractic treatment was necessary and legitimate. He said the amount of pain and discomfort he suffered required the treatment he received.

Cheve rejected the offer outright. The next day Cheve called the Adjuster and told her he thought about her offer and was prepared to make the following counter-offer:

  • Chiropractor: $2,000.00
  • Out-of-pocket Expenses: $500.00
  • Lost Wages: $600.00
  • Pain and Suffering: $3,500.00
  • Total: $6,600.00

The Adjuster didn't need time to think about Cheve's counter-offer. She denied it and said she would make the following final personal injury accident settlement offer.

The Insurance Company's Final Offer:

  • Chiropractor: $1,500.00
  • Out-of-pocket Expenses: $500.00
  • Lost Wages: $400.00
  • Pain and Suffering: $1,000.00
  • Total: $3,400.00

Cheve angrily refused, saying he was going to hire a lawyer and the insurance company "would be sorry" for trying to "rip him off".

Cheve hired a personal injury attorney and filed suit.

Important Points...

  • Although Chiropractic treatment has been accepted by the insurance industry, relying merely on chiropractic bills for a personal injury accident settlement can be dangerous.

    Without medical proof of the nature and extent of injuries, a personal injury claim will seldom be settled by an insurance company solely on the submission of chiropractic treatment costs.

  • When in a vehicular collision, think twice about refusing transportation by the paramedics to a local hospital. In the majority of vehicular collisions, injuries may not be immediately detectable. Adrenaline produced at times of stress often masks real injuries.

    Accepting medical treatment at the time of a collision is a way to assure your injuries can be medically documented. That is the type of documentation insurance companies primarily rely upon when considering personal injury settlements.


*This case example is for educational purposes only. It is based on actual events although names have been changed to protect those involved. Any resemblance to real persons or entities is purely coincidental.

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TYPE OF ACCIDENT
AUTO ACCIDENT
PERSONAL INJURY
WORKERS COMPENSATION
MEDICAL ERROR
YES! I WANT FAIR COMPENSATION