When someone else caused your injury, you’ll have to prove negligence before the insurance company will pay your claim. Here’s what you need to know.
People of all ages are injured every day because of someone else’s negligence. Injury claims are filed with insurance companies after car accidents, slip and fall accidents, dog attacks, workplace incidents, and more.
If you’ve suffered an injury caused by someone else, you have the right to seek compensation for your financial losses and pain and suffering. Filing an insurance claim is only the beginning.
In most cases, the injured victim won’t see a dime in compensation unless they can show the adjuster that their insured was to blame for the victim’s injuries.
Here’s where we unpack what counts as negligence, and how to prove it to the insurance company.
Definition of Negligence for Injury Claims
In legal terms, negligence is conduct that falls short of what a reasonable person would do to protect another person from a foreseeable risk of harm.
In plain language, a person is negligent when they do something wrong, or fail to do what any reasonable person would do in the same circumstances to prevent harm to others.
In personal injury cases, the at-fault person can be held liable, meaning responsible, for the injured person’s damages if their conduct falls short of reasonable standards.
What is reasonable conduct?
To determine whether conduct is reasonable or not, you must examine the circumstances that led to an injury, then decide what a reasonable person would have done under those same circumstances.
There is no chart or rule you can use to figure out if a person’s conduct was reasonable under specific circumstances. If your case were to end up in court, the jury would be asked to look at what’s called the “totality of the circumstances” to determine whether a person’s conduct was negligent.
What might be reasonable conduct for one person may not be reasonable for another person.
For example, when a child suffers birth injuries that could have been avoided by a timely cesarean delivery, was the doctor negligent? It depends on the totality of the circumstances:
- If the mother were admitted to a fully-equipped medical center in early labor under the care of a trained obstetrician, the doctor would likely have been negligent for not using available technology to monitor the baby’s condition during labor.
- If the laboring mother arrived at a rural hospital emergency room in the last stages of labor, the emergency room doctor would likely not be negligent for allowing a natural delivery.
Because there was no time to transfer the laboring woman, and sophisticated monitoring equipment wasn’t available at the country hospital, it was reasonable for the emergency room doctor to proceed with a natural delivery.
On the other hand, a trained obstetrician with the time and equipment would be reasonably expected to monitor the unborn baby and perform a surgical delivery when the infant was found to be in distress.
Key Elements of Negligence
There are four important elements of negligence you’ll need for a successful injury claim. You must have all four elements to get anywhere with the insurance adjuster. Think of the elements of negligence like the four wheels on a grocery cart. You won’t make it to check out if one of the wheels is missing.
The key elements of negligence are:
- Duty of care: The at-fault person or business had a duty of care to avoid causing harm to others. A store owner has a duty to clear ice from the store’s sidewalk.
- Breach of Duty: The at-fault person breached their duty by doing something wrong or failing to do what any reasonable person would do in the same circumstances. A driver breaches their duty to drive safely by driving while intoxicated.
- Cause: The at-fault person’s breach of their duty of care is the proximate cause of your injuries. A distracted driver who rear-ends your car is the direct cause of your neck injury.
- Damages: You have verifiable injuries, supported by medical bills, medical records, and evidence of emotional distress.
Learn more about The Four Elements of Negligence in personal injury claims.
Using Evidence to Prove Negligence
If we could assign negligence automatically, using a set formula, personal injury claims and lawsuits wouldn’t be necessary. Unfortunately, it’s not that simple. Opinions on reasonable conduct vary from person to person and are often influenced by self-interest.
Insurance adjusters are interested in saving money for the company. Although the at-fault party’s negligence may seem perfectly clear, you will bear the burden of proof to show that the responsible person’s actions were unacceptably negligent.
Because you bear the burden of proof, the other party technically doesn’t have to prove anything. The reality is that the insurance adjuster won’t hesitate to put the blame on you.
Example: Proving Negligence for Rear-End Collision
Sally was heading to work on the interstate on a very foggy morning. She turned on her car’s fog lights and headlights. The fog was so heavy, Sally and many other motorists slowed their speed to less than 40 miles per hour because of poor visibility.
As Sally began to exit the interstate, she suddenly ran into the back of Sam’s gray pickup truck. At the time of impact, Sam did not have any of his truck lights turned on.
Sam and his insurance company blamed Sally for the accident. Sally and her attorney filed a lawsuit against Sam when his insurance company denied Sally’s claim.
In most circumstances, a driver who runs into the rear of another vehicle is considered negligent for following too closely. However, Sally’s attorney used witness testimony and other evidence to show the jury that:
- Sally took reasonable precautions to avoid an accident under the foggy conditions by reducing her speed and using her car lights.
- Sam was driving his truck without any headlights, or fog lights turned on.
- Sam knew or should have known that other drivers would not be able to see his gray truck in dense fog.
The jury found that Sally did not act negligently. The jury determined that Sam failed to do what any reasonable driver would do under the circumstances, therefore Sam was liable for the accident.
Understanding Direct and Proximate Cause
The evidence must show that the at-fault party was primarily responsible for the accident. It also must show that the responsible party’s negligence was the direct and proximate cause of your injuries.
Proving a person’s conduct was unacceptably negligent, by itself, is not enough to win a personal injury case. You must also prove that their error or failure to act responsibly directly caused your injuries.
You need to be able to say, but for the other person’s negligence, you would not be injured. For example, if you suffered a spinal cord injury in a side-impact collision, you could say that, but for the at-fault driver running a red light, you would not be injured.
Supporting Your Damages Claim
Let’s assume you proved the responsible party’s conduct was negligent, and that the negligent act directly caused your injuries. The next step is to prove your damages. Damage is a catch-all term for all the financial and emotional costs related to your injuries.
Damages are often the most important part of a personal injury case. If you can’t prove the financial and emotional costs related to your injuries, it doesn’t matter how negligent the at-fault party was, you don’t have a case.
In a personal injury claim, damages can be tangible and intangible. Tangible damages include all the money spent treating your injuries, and the value of your damaged property. Intangible damages include all your emotional distress, mental anguish, loss of consortium, and other psychological trauma.
Evidence of tangible damages includes:
- Hospital and doctors’ bills
- Chiropractic and physical therapy bills
- Receipts for out-of-pocket medical expenses
- Lost wages verification
- Estimates for damaged property
Evidence of intangible damages includes:
- Reports from mental-health care providers
- Your diary notes about pain levels, anxiety, sleep disturbances, and other symptoms
- Personal testimony from friends, family, and colleagues
- Any other evidence of emotional distress or mental anguish
Attorneys are Experts at Proving Negligence
When liability is clear, minor injury claims can often be settled without an attorney. If you aren’t looking to collect much more than the cost of your reasonable medical expenses, the insurance company will pay to quickly resolve your claim.
Severe injury claims always need an attorney to get anywhere near a fair amount of compensation. Insurance companies train their adjusters to avoid paying high-dollar claims. The adjuster will refuse to accept liability for their insured without incontrovertible proof.
Remember, it’s up to you to prove the insured was negligent. This requires hard evidence. Your opinion of fault won’t sway the insurance adjuster, and convincing evidence can be hard to get.
That’s where a skilled injury attorney can help your claim.
Your attorney can use subpoenas and other “discovery” tools to obtain critical evidence you would never have access to on your own. It doesn’t matter if you were in a car accident, hurt at work, slipped and fell, or were injured some other way.
Depending on the circumstances of your injuries, your attorney can get:
- The other driver’s cell phone records
- The other driver’s medical records showing drug and alcohol levels
- The at-fault party’s insurance limits
- Driving records of at-fault drivers
- Criminal records of potential witnesses
- Surveillance camera footage from the business where you were hurt, or from cameras near where you were injured
- Deposition testimony of business employees
- Accident records from your workplace
- Safety inspection records for your workplace or another location where you were injured
Proving negligence for your injury claim is just one reason to hire an attorney. Most personal injuries attorneys don’t charge for their initial consultation. There’s no cost to find out what an experienced attorney can do for you.
Video: The Definition of Negligence
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