Negotiating effectively with a claims adjuster requires preparation. Before the first contact, you should already know what to say and what to avoid saying at all costs. You must know the proper medical terms for your injuries and how to effectively use them when negotiating your claim.
Knowing the Medical Terminology
Successful personal injury attorneys understand the importance of learning all they can about their clients’ injuries, including the injuries’ side-effects and the possibility of future related medical problems. To be effective, you must do the same. Attorneys must have a high level of overall expertise in medical terminology and procedures, but you only need to be familiar with the few that apply to your case.
All injury victims don’t suffer equally from similar injuries. There’s a range of pain and suffering unique to every injury and every victim. That range includes the injury’s short and long term side effects. Because that range exists, insurance companies are forced to negotiate each claim separately and on its own merits.
Knowing the proper medical terms for an injury and its short and long terms effects is a negotiation tactic used by most attorneys. Knowledge of the range of your injury allows you to negotiate from a position of strength. Most victims who negotiate their own injury claims never take the time necessary to study their injury, including its medical terminology and side effects. Their lack of knowledge is obvious to insurance adjusters.
Understanding Your Injury
Use websites like Web MD or the Mayo Clinic to obtain important medical data about your injuries and their short and long term effects. By improving your understanding of the type and nature of your injury, you can translate that knowledge into a persuasive argument with your claims adjuster.
The following are examples of effective negotiation tactics based on a working knowledge of the injury and a proper application of medical terminology.
Example 1: Brain Concussion
You fell down the steps of an office building due to a faulty handrail. The adjuster knows you suffered a concussion because the medical narrative says you did. The narrative states you were treated in the emergency room for a brain concussion and then discharged. The doctor told you to be vigilant for any future symptoms such as dizziness, nausea, etc. The cost of the emergency room treatment was $1,500.
When you speak with the adjuster, don’t refer to your injury as a concussion. The correct term for your injury is “brain concussion.” According to webmd.com, “A concussion is a brain injury that is caused by a sudden blow to the head or to the body.”
The adjuster may have authority to pay anywhere from one-and-a-half times the cost of the emergency room visit ($2,250) all the way up to four times the amount ($6,000). Where your settlement falls in that range depends on your ability to convince the adjuster not only of the extent of your pain and suffering, but of your serious concern about future effects of the concussion. Head injuries of any type are serious. Sometimes the effects may not show up for months or even years after the injury.
Using information from reliable reference sources, you can gather convincing evidence of the probability of future adverse effects from your concussion. Some victims of brain concussions recover quickly and permanently, while others experience serious long-term problems, even from minor concussions. They can be linked to conditions such as dementia, Parkinson’s disease, hearing loss, and more. Bring this information to the adjuster’s attention.
Putting in the time to research your injury can result in legitimate and viable reasons for the adjuster to increase her offer. You can create the potential to move from the lowest multiplier of one-and-a-half all the way up to four, going from a settlement of $2,250 to $6,000.
Example 2: Broken Collarbone
You slipped and fell in a grocery store. After being admitted to the emergency room, an X-ray showed that your collarbone was broken. The cost of the ER visit and X-ray was $2,000.
When discussing your injury with the claims adjuster, don’t talk about your collarbone. Instead refer to it as your “clavicle.” Instead of saying it was broken, use the term “fractured.” Let the adjuster know that you understand exactly what the clavicle is and how it functions.
Then add this information from the Academy of Orthopedic Surgeons, “When referring to clavicle regeneration there exists the possibility of improper healing. The symptoms may not be immediately apparent to the patient and may take time to appear. When the symptoms do appear there may be a need for surgery. Surgery can align the bones exactly and hold it in position while it heals. In some cases pins may be required to hold the bone in place.”
In this case, the adjuster has authority to apply a multiplier of one-and-a-half to three-and-a-half. She’s already offered two, or $4,000. Stating your medically-supported concern about the possibility of surgery will give the adjuster pause. The statute of limitations for your claim can be up to four years depending on your state. If you lead the adjuster to believe you may want to wait another year or so to see how your injury heals, you may be surprised at how quickly she raises her offer.
By using the negotiation tactic of discussing your injury in medical terms, including your fact-based concern about future effects of the injury, you’ve commanded the claims adjuster’s attention. She wants to settle your claim. She does not want to keep your file on her desk for the next year.
Example 3: “Whiplash”
Your car was hit from behind. Fortunately there weren’t any broken bones or brain concussions. You decided not to go to the emergency room. But when you woke up the next morning, you could barely lift your arms. Your neck and shoulder were stiff and painful, and even turning your head was very difficult.
You went to your family doctor who you diagnosed you as having suffered from what’s commonly referred to as whiplash. You underwent 30 days of therapy and incurred medical and chiropractic bills of $2,500 dollars.
Using the word “whiplash” to describe your injury to a claims adjuster is a HUGE negotiating mistake. Whiplash is not a medical term. It’s a colloquialism used by people when referring to a general injury to the neck or shoulder area. When referring to your neck and shoulder injury, use one of several medical terms which describes the injury.
Cervical acceleration-deceleration, also referred to as CAD, is the most common medical description of whiplash, and you should use it when negotiating. Medicine.net describes the event as a “hyperextension and flexion injury to the neck.” Discuss your valid concerns about CAD and the possibility of its future complications with the adjuster. Tell her that, according to the Mayo Clinic, many people will recover from CAD within the first two to three months, but some may continue to have pain for up to two years after the injury.
CAD injuries are notorious for settlements in multiples of one to one-and-a-half. If you’re properly prepared, your claim could be one of those that settle in a higher range of two to three.
Statute of Limitations
Before you consider delaying a settlement as a negotiating tactic, you must be absolutely sure you know the statute of limitations date. If you don’t settle your claim or file a lawsuit by that date, your claim will be closed and you won’t receive any settlement. You’ll also lose your right to file a lawsuit.
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