Sample Insurance Negotiation for a Slip and Fall Accident

Follow sample claim negotiations between a slip and fall victim and the insurance company, along with helpful hints throughout the dialogue.

Slip and fall accidents are right behind car crashes as the leading reason for personal injury claims. Slip and falls can happen anywhere, indoors and out, and usually happen when you least expect it.

Property owners have a duty to keep their property free of hazards that could cause a visitor to get hurt.

When a person slips and falls because a property owner or their employee was negligent, the injured person has a right to seek compensation for their damages.

For most of us, that means dealing with the property owner’s insurance company. When you’ve recovered from relatively mild injuries, like bruises and sprains, you can probably negotiate a fair injury settlement on your own, just like Susan, our fictional slip and fall victim.

Severe injury claims are best handled by a personal injury attorney to get anywhere near a fair amount of compensation. Most injury attorneys don’t charge for their initial consultation.

Sample Claim Summary: Grocery Store Slip and Fall

Susan Stone is a busy mother of two elementary-aged children. She works full time as a secretary for a local real estate company. After work on a Tuesday afternoon, Susan stopped at the store for a few groceries before picking her kids up from after-school care.

Like most injury victims, Susan never expected to slip and fall in the supermarket.

As she pushed her cart down the aisle, she was scanning the shelves for the items on her list. Suddenly, her feet flew out from under her. Susan tried to hold onto her grocery cart, causing the cart to tip over as her body slammed to the floor.

Susan was too stunned to move as she lay on the hard, cold floor. Her right hip, arm, wrist, and shoulder throbbed with pain. As a store clerk pulled the cart off her legs, Susan began to realize she was sitting in a slick, oily spot, and her leg was bleeding from the glass that was on the floor.

Sitting up, Susan didn’t think she had broken any bones. She realized what caused her to slip and fall when she looked around and saw the broken bottle on the floor, and the pool of olive oil that had spilled across the aisle.

The manager came rushing over to where Susan sat on the floor. She heard the clerk frantically telling him, “I’m sorry boss! I was going to clean up the mess when a shipment came in, and I got busy in the back!”

Susan was helped back to the manager’s office, then given first aid for her cuts and a cold-pack for the swelling on her wrist. She called her sister to pick up the kids and called her husband to come to get her.

Susan told the manager she was going straight to urgent care and asked him for the store’s insurance information. The manager said someone from the main office would be in touch with Susan.

Before she left with her husband, Susan told the manager she would like a copy of the incident report and asked the manager to save the security camera film for the day.

The urgent care doctor ordered X-rays of Susan’s arm, wrist, shoulder, lower back, and her hip to confirm she didn’t have any broken bones. She had deep bruises to her hips and shoulder and a badly sprained wrist. She was ordered to rest, take over-the-counter pain relievers, and was given a prescription for muscle relaxers.

Her right wrist was in a brace, and her hip, back, and shoulder were extremely stiff and sore for several days. Susan was out of work for the rest of the week and the following week because she couldn’t use her dominant right hand for typing, writing, or holding anything.

While she recovered, Susan was unable to shop or cook for her family. Because of her pain and stiffness, she missed the parent/teacher meetings at her children’s school.

Susan’s hard costs totaled $5,500 for her medical expenses and lost wages.

Susan filed a personal injury claim with the grocery store’s insurance company. When she was fully recovered, she submitted a compensation demand packet seeking $20,000 for her hard costs, and her pain and suffering.

Click the   buttons to better understand insurance negotiation tactics. 

Negotiating Hard Costs with the Adjuster

Frank Brown is the claims adjuster assigned to Susan’s slip and fall claim. Frank has a reputation as a tough negotiator who won’t let claimants “milk” their injury claims. Frank telephones Susan to discuss her demand for compensation.

SUSAN: Hello?

ADJUSTER:  Is this Susan Stone? My name is Frank Brown. I’m with Classic Insurance Company calling about the little incident you had at the grocery store in September.

SUSAN: Yes, this is Susan. Thank you for calling. The “incident” you’re referring to is the fall that left me laid up for nearly two weeks because the store employees failed to clean up a broken bottle of oil. Have you looked at the packet I sent on November 2 that details my damages?

Susan politely headed off the adjuster’s attempt to minimize her claim by pointing out the scope of her injuries and the negligence of the insured. Property owners have a legal duty to protect visitors from hazards on the premises.

ADJUSTER: I’ve looked over your demand and have to tell you we can’t come close to what you’re asking. For one thing, our medical department says some of your medical expenses don’t make sense. There’s no need to have several X-rays for a couple of bumps and bruises.

SUSAN: Frank, please look at the doctor’s notes from the urgent care center. You’ll see that I was already black and blue over the entire right side of my body and in terrible pain from being slammed onto a concrete floor, not to mention having a large metal grocery cart falling on top of me.

There was every reason for my doctor to be concerned about broken bones. Regardless of your opinion, it was good medical practice for the doctor to order X-rays under the circumstances. Given my physical trauma, the doctor would have been remiss to let me walk out of there without checking for fractures.

Always study your medical records before negotiating your injury claim. When you fully understand the reasons for your treatment, you can justify your medical expenses to the adjuster.

ADJUSTER: Okay, I can go ahead and approve the X-rays. That takes us to the excessive claim for lost wages. Ten days off seems out of bounds for muscle soreness. If you wanted to spend an extra week at home with your feet up, that doesn’t mean we have to pay for it.

The adjuster was intentionally insulting, suggesting that Susan was malingering. Every adjuster has their own style and tactics. It’s important to stay calm if the adjuster is rude or belligerent.

SUSAN: As directed by the urgent care doctor, I followed up with my personal physician three days after I was hurt by your insured’s negligence. As you can see from Dr. Burn’s notes, my wrist was badly sprained. I was ordered to continue with the muscle relaxers for another week and stay off work to prevent further damage to my wrist.

I work as a secretary, Frank. That means I have to be clear-headed and have the full use of my right hand for typing, writing, filing, and other tasks. You have a desk job. Would you be able to work without your dominant hand and your mind muddled by medication?  

The insurance company will make you work for every dollar of compensation. Be ready point to your evidence to support all your hard costs during injury claim negotiations with the adjuster.

ADJUSTER: Tell you what. I’ll accept your hard costs, including the lost wages, and let’s get this wrapped up. I can settle your claim today for $6,000.

SUSAN: I think that offer is extremely low, but I’ll talk it over with my husband and get back to you next week.

Susan was expecting the adjuster to start with a low-ball settlement offer, so she didn’t overreact. Adjusters typically start with low offers to see if you know the value of your claim, or if they can get you riled up enough to say something they can use against you.

Dealing with a Difficult Adjuster

Susan and her husband had done their homework, so they knew Susan needed to negotiate patiently to get a good settlement. Susan waited through the weekend, calling Frank the following Tuesday.

SUSAN: Good morning, Frank. My husband and I discussed your offer and agreed the amount is far less than I can accept.

ADJUSTER: Paying a little over your hard costs is a good offer. You know, I have to tell you our insured seriously considered fighting this claim. 

Adjusters often try to make the injured person feel like their claim is weak, and they would have a hard time proving their claim in court.

ADJUSTER: You know the bottle of olive oil was only eight ounces. We have statements from people at the scene who said the broken glass was in plain sight, and the olive oil was all over that area of the aisle and was clearly visible. They said they saw it and were very cautious as they walked by. Our witnesses said anybody could have seen it and avoided falling.

It’s common for adjusters to try to minimize your compensation by putting some of the blame on you. Don’t hesitate to insist you did nothing to contribute to the circumstances leading to your fall.

SUSAN: Interesting. If your witnesses are store employees, you should ask them why they didn’t clean up the mess when they first saw it. As for me, I was pushing my grocery cart slowly down the aisle, looking at products on the shelves, like any normal shopper.

I didn’t know about the oil and glass on the floor until my feet flew out from under me, and I slammed to the concrete floor. I’ve asked the store manager to preserve the surveillance camera footage from that day. Let’s look at it together, and you’ll see for yourself I did not see the spill and could not have avoided the fall.

Footage from nearby security cameras can be compelling photographic evidence in support of your claim, especially in front of a jury.

ADJUSTER: I’m not saying we’re not going to compensate you for some inconvenience the fall may have caused. But I do have witnesses who said the spill was easily seen by other customers, and they safely walked around it.

SUSAN: It doesn’t matter to me if you can produce one hundred witnesses to tell me how small the oil spill was or that I could have seen it. My point is that the store employee admitted out loud he knew the spill was there and didn’t get around to cleaning it up until it was too late.

Whether there was a spoonful of oil or a bucket full of it, it shouldn’t have been there, and because it was there, I was seriously injured. I was in pain, and my life was disrupted for weeks, because of your insured’s negligence.

ADJUSTER: I don’t doubt the extent of your injuries, but you’re asking us to pay you an excessive amount for your inconvenience. You know I can’t do that.

SUSAN: “Inconvenience” doesn’t begin to describe what I suffered because of your insured’s negligence. You can’t imagine how mortified and distressing it was to be in terrible pain, sprawled on the floor with my oily, wet dress hiked up around my thighs.

It happened so fast, and I hurt so bad I couldn’t think straight, but I was getting panicked about getting to my children, who were waiting for Mommy to pick them up from after-school care.

The doctor’s notes are clear that my body was battered from hitting the hard floor. I hurt so badly that I couldn’t get out of bed for the first few days. After that, I still needed help for two weeks to bathe, get dressed, or even get my hair into a ponytail to keep it out of my face. I barely slept because I was too sore to turn over in bed, and everything hurt.

I couldn’t care for myself, much less our little girls. My friends and relatives had to come over to help care for the children so my husband could go to work. I completely missed their parent-teacher conferences because they happened right after I was hurt.

If you look in the packet I sent you, there are letters from some of the good people who stepped in to help our family while I recovered from my painful injuries.

Using descriptive language and pointing to corroborating evidence is a smart way to justify more compensation for your emotional distress, pain and suffering.

ADJUSTER: We handle thousands of injury claims against this supermarket chain every year. They deny most claims. When some claims end up in court, we win nine times out of ten.

Rather than deny your claim, I’ve convinced them you’re a reasonable person and that you understand we usually settle claims like these for expenses only. With that understanding and because we have already agreed to pay your hard costs, it doesn’t seem like we have a lot to talk about.

SUSAN: If you’re not going to negotiate compensation for my pain and suffering, we have nothing more to speak about. I wanted to handle this myself, but maybe it’s time for me to consider hiring an attorney.

You can consult a personal injury attorney at any time during the negotiation process, but don’t threaten to end negotiations unless you mean it.

ADJUSTER: You don’t need an attorney for this claim unless you want to throw your money away. Let me see what I can do, and I’ll get back to you next week.

When you have a strong case with good evidence, the adjuster is willing to boost your injury compensation rather than have your claim turn into a lawsuit.

Reaching a Reasonable Settlement

Professional negotiators understand that both parties must compromise to reach a fair settlement agreement. Even when you have a strong case, there’s no guarantee you’ll end up with more money if you take your case to court.

ADJUSTER: Susan, I’ve talked it over with my manager, and we are prepared to offer you $11,000 for your hard costs and your pain and suffering.

SUSAN: Well, it’s less than I wanted, but I’m willing to accept that amount.

Always confirm the agreed-upon settlement amount in writing to the adjuster. An e-mail confirmation is fine.

ADJUSTER: Thank you.  I’ll get the settlement agreement to you right away. As soon as you sign and return the agreement, we’ll send your check.

It’s important to carefully review the settlement and release agreement before signing to be sure it matches your verbal agreement.

Susan only spent a few weeks actively negotiating her injury claim, but the time she invested beforehand in organizing her paperwork and preparing for negotiations paid off in the end. She was able to recover all her medical costs and lost wages, and convince the adjuster to pay nearly twice the amount of her hard costs to compensate for her pain and suffering.

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 >>