8 Factors Affecting Bodily Injury Claims and Settlement Payouts

Explore key factors that impact the amount of compensation you can get for bodily injury settlements.

When another person’s negligence causes you harm, they should compensate you for your losses. Injury claims are filed with the at-fault party’s insurance company. How much the insurance company is willing to pay depends on many factors. We unpack those key factors here.

Common Factors Affecting Injury Payouts:

  1. Insurer Accepting Liability
  2. Allegations of Shared Fault
  3. Evidence of Fault and Damages
  4. Reasonable and Necessary Medical Costs
  5. Bodily Injury Insurance Limits
  6. Venue and Jurisdiction
  7. Multiple Victims for Limited Funds
  8. Experienced Legal Representation

Bonus: Calculating Bodily Injury Claims

1. Insurer Accepting Liability

For claims against the other person’s insurance company, you will bear the burden of proof to show their insured was liable, meaning responsible for your injuries.

Unless the insurance company accepts liability for their insured, your claim will be denied.

To prove liability, you’ll need to show their insured:

  1. Had a duty of care to avoid causing harm to others
  2. Did something wrong, or failed to do what any reasonable person would do under the circumstances, making them negligent
  3. Directly caused your injuries through their negligence

If you’re injured in a car accident in a no-fault state, you won’t have to prove who caused it. You will work with your own insurance company to settle the claim under your Personal Injury Protection (PIP) coverage. PIP won’t pay for pain and suffering or property damage, so your total compensation will be limited. 

When you make an injury claim against the at-fault party’s insurance company, you will seek payment for all your compensatory damages, including pain and suffering.

2. Allegations of Shared Fault

You may be convinced the other party was completely at fault for your injuries. However, the adjuster will always look for ways to put some of the blame on you.

Insurance companies can deny or reduce your bodily injury claim if you share responsibility for your injuries.

Contributory Fault

In Alabama, Maryland, North Carolina, Virginia, and the District of Columbia, the insurance company can use the pure contributory negligence rule to flatly deny your claim if you share as little as one percent of the blame for your injuries.

Comparative Fault

In states with pure comparative fault rules, you can seek bodily injury compensation from the other party, even when you are mostly to blame.

Most states use modified comparative fault rules, meaning the insurance company would have to prove you were equally to blame (50% rule) or more to blame (51% rule) than their insured before they can deny your injury claim.

Example: Settlement Offer Reduced for Comparative Fault

Jim was stopped at a red light when his car was struck from behind. He was injured in the collision and made a settlement demand of $10,000 to the other driver’s insurance company.

Normally, a driver who rear-ends the car in front would be 100 percent liable. But in this case, Jim’s brake lights weren’t working when he was hit. The other driver claimed they didn’t see him until the last minute.

The adjuster decided that Jim was 20 percent at fault for the accident, and her insured was 80 percent at fault.

Under comparative fault rules, Jim’s claim value is reduced according to his share of the blame. Jim was offered $8,000 to settle his claim, representing a 20 percent reduction to his demand.

You don’t have to settle for the insurance adjuster’s version of who is to blame. You can continue to negotiate your injury settlement with a counter-offer, along with your reasons why the adjuster’s division of blame is not correct.

At any point in the negotiations, you have the right to consult an attorney. Sometimes a letter from your attorney is all it takes to convince the adjuster to make a fair settlement offer.

3. Evidence of Fault and Damages

The final payout you get from the insurance company will be directly affected by the evidence you collect to support your claim.

You or your attorney will use evidence to prove:

  1. The insured party was at fault for your injuries
  2. The severity of your injuries
  3. The scope of your pain and suffering

The better your evidence, the more injury compensation you’re likely to win.

Valuable claim evidence includes:

  • Your medical records and bills
  • Photographs and videos
  • Police reports
  • Witness statements
  • Wage statements
  • Your notes about the injury and your recovery

4. Reasonable and Necessary Medical Costs

Higher medical expenses usually lead to higher injury settlements if the medical costs make sense. You can’t assume the claims adjuster will simply agree with the amount of medical and chiropractic bills you submit for reimbursement.

Insurance companies are only obligated to pay for “reasonable and necessary” medical treatment bills. The adjuster knows the medical standards for treating whiplash and other soft tissue injuries.

Beware of “accident doctors” who run repeated tests or order questionable therapy for your types of injuries, just to run up your medical bills for the insurance company. The insurance company can legally refuse to pay excessive bills, and you’ll be on the hook for the balance due.

Adjusters are always on the lookout for exaggerated injury claims, and won’t hesitate to send you to one of their doctors for an independent medical exam.

5. Bodily Injury Liability Insurance Limits

While there are different types of personal injury insurance coverage, most bodily injury claims are paid by auto insurance or homeowner’s insurance policies.

Premises liability claims, like a slip and fall in a store, are covered under business liability insurance, either through the store owner or a corporate entity like Walmart.

Coverage limits are the maximum amount the insurance company will pay for a qualified claim.

If you are severely injured and the at-fault person has low bodily injury coverage limits, the insurance company may hand over the limits as soon as liability is clear. For example, when a drunk driver runs off the road and hits a pedestrian.

If you’re hurt in someone’s home or yard, or their dog bites you, they may have homeowner’s insurance that includes med-pay or liability coverage that will pay for your injuries.

Auto insurance coverage for bodily injury claims may be paid under:

  • Bodily Injury Liability Coverage on the at-fault driver’s policy
  • Personal Injury Protection (PIP) coverage on your policy for you and your passengers
  • Uninsured or Underinsured Motorist Coverage from your policy if the at-fault driver had no insurance or insufficient coverage

Each state determines the minimum amount of auto coverage drivers must carry. Your injury compensation amount may be affected by the limits of available insurance.

Auto policies generally have two limits for bodily injury coverage: A per-person limit and a per accident limit, such as $50,000/$100,000.

The per-person limit applies to each person injured in an accident. If the person who hit you has a per-person limit of $50,000, the most you can get from their insurance company for your injuries and pain and suffering is $50,000.

The per-accident limit applies when more than one person is hurt in the same accident. If the per-accident limit is $100,000, and three people are injured, the $100,000 is the only amount available for their combined damages, up to the per-person limit for each person injured.

6. Venue and Jurisdiction

Where your accident occurred can have a big impact on the amount of compensation you receive. Insurance adjusters take venue and jurisdiction into account when they decide how much to pay for settlements.

Jurisdiction describes which court has the authority to handle your case. Venue is the location where your injury claim will go to trial if you file a lawsuit. Some venues are known to be more favorable to injury victims than to big insurance companies.

The adjuster is likely to offer more money to settle your claim if you’re filing a lawsuit in a venue that awards big verdicts for bodily injury cases.

Caps on Injury Settlement Amounts

Some venues impose tort reform laws that put caps on the amount of compensation an injured claimant can get for some kinds of damages. Tort reform is intended to reduce the number of lawsuits in the jurisdiction, and prevent the cost of high-dollar awards from being passed on to the consumer.

States with caps often have a maximum limit allowed for non-economic damages (pain and suffering) and punitive damages (intended to punish the at-fault party for egregious negligence).

For example, California imposes a cap of $250,000 for non-economic damages in medical malpractice cases. Florida limits non-economic malpractice damages to $500,000, increasing to $1 million if the injured patient was left in a vegetative state or died.

7. Multiple Victims for Limited Funds

When multiple vehicles are involved in an accident, determining who’s liable for your injuries becomes more complicated. Also, although your injuries may be real, and the costs of treatment reasonable and necessary, your settlement amount may be limited by the insurance policy limits of the at-fault driver.

Using the $50,000/$100,000 liability limits example, the at-fault driver only has $100,000 of coverage to go around. If there were three badly injured people, the most any one person can get is $33,333.

Suppose each of the three injured people had $50,000 in damages? In most states, the insurance company won’t take responsibility for dividing up the money.

The funds will be deposited with the court. Then it’s up to you and your attorney to convince the court your costs were reasonable and necessary, and your pain and suffering was greater than anyone else’s.

8. Experienced Legal Representation

Commercial vehicle policies, business liability policies, and medical malpractice policies can easily have million-dollar limits. Companies that offer high-dollar insurance have armies of defense lawyers ready to fight any serious injury claims made against their insured.

You don’t need money to talk to a personal injury lawyer about the value of your insurance claim.

Most injury attorneys offer a free consultation, and represent injury victims on a contingency fee basis, meaning they don’t get paid unless your case settles or you win a court verdict.

Most Cases Settle Out of Court

If you’ve fully recovered from mild injuries, you can probably handle an injury claim on your own. For more serious injuries, you’ll need an attorney to get a fair settlement. Insurance adjusters routinely offer less money to claimants who are not represented by counsel.

Your attorney will do more than argue your case in court. There are other ways your attorney can increase your final injury compensation without proceeding to a jury trial.

An experienced injury attorney has the legal tools to:

  • Determine assets of the at-fault party outside of insurance
  • Look for additional sources of insurance money from the at-fault parties
  • Handle underinsured motorist claims against your insurance company
  • Negotiate a reduction of medical liens against your settlement

Calculating Bodily Injury Claims

Figuring out the general value of your bodily injury claim starts with adding up your hard costs, also called economic damages or “special” damages.

Special damages include:

  • Medical or chiropractic bills
  • Therapy or treatment bills
  • Out-of-pocket expenses related to the injury
  • Cost of replacement services, like lawn care
  • Lost income

Adding up economic damages is pretty easy because you will have bills and receipts. Just make sure you are adding up the full cost of your medical and pharmacy costs, even when some or all of it was covered by health care coverage.

Figuring out non-economic damages, also called “general” damages, like pain, suffering, and emotional distress can be a little trickier. There is no objective measurement for the injury’s impact on your life. The adjuster won’t just take your word for it.

If you’ve fully recovered from your injury, and have evidence of your pain and suffering, you can add one or two times the total of your special damages to account for your pain and suffering.

Example: Minor Injury Claim Settlement 

Carol was slowly driving through a restaurant parking lot when another patron, Tracy, suddenly backed out of a parking space without looking, colliding with the right front of Carol’s car.

Tracy admitted fault and the women exchanged contact and insurance information. Carol took pictures of the cars and the scene, then went to urgent care where she was treated for contusions to her forehead and a sprained wrist.

The fender-bender occurred on a Friday morning. Carol missed one day of work, returning to her secretarial job on Monday.

  • Medical expenses: $250
  • Lost wages: $112
  • Economic damages: ($250 + $112) $362
  • Non-economic damages: ($362 x 2) $724

Estimated Claim Value: ($362 + $724) $1,086

Carol send a demand letter to Tracy’s insurance company asking for $1,200 to settle her injury claim. After a short negotiation with the adjuster, Carol settled her claim for $900.

The total of your special and general damages is a good estimate of your bodily injury claim value.

Pain and suffering for severe, potentially disabling injuries is calculated at a much higher rate. You won’t be able to get a fair amount of compensation on your own. If you or a loved one have suffered severe or permanent injuries, talk to a personal injury attorney to protect your interests.

Charles R. Gueli, Esq. is a personal injury attorney with over 20 years of legal experience. He’s admitted to the NY State Bar, and been named a Super Lawyer for the NY Metro area, an exclusive honor awarded to the top five percent of attorneys. Charles has worked extensively in the areas of auto accidents,... Read More >>