Increase Your Pain and Suffering Award by Thinking Like a Claims Adjuster

Boost your injury compensation with a convincing demand for your hard costs and mental anguish. Here’s how to justify your pain and suffering award.

“Pain and suffering” describes the physical pain and emotional distress a victim endures as a result of a personal injury accident.

Emotional distress, also called “mental anguish,” can include depression, anxiety, insomnia, irritability, and more.

Insurance companies refer to hard costs like medical bills and lost wages as special damages. “Specials” are calculated by adding up the bills and receipts for reasonable expenses.

Pain and suffering awards are considered general damages. General damages are paid to a victim in addition to the actual costs associated with their injuries and treatment. There are no objective measurements for general damages.

To get a fair pain and suffering award as part of your compensation, you’ll need to understand how insurance adjusters evaluate general damages.

How Adjusters Calculate Settlement Offers

Imagine you’re at the point where you’ve completed your medical treatment and therapy. You still have some lingering pain, but the doctors cleared you to return to work.

It’s time to prepare your settlement demand letter. You expect fair compensation for your medical expenses, lost wages, and pain and suffering.

You’ve totaled your special damages but aren’t quite sure how to assign an amount for general damages. The most common way for injury victims to calculate pain and suffering compensation is with the multiple method.

The multiple method uses the total of your special damages, multiplied by a number from one to five or more.

Example: Using the Multiple Method to Calculate Claim Value

Sally was injured in a rear-end collision and evaluated in the emergency room with a CT scan and some X-rays. Sally followed up with her family doctor for treatment of mild whiplash.

Sally missed a week from work while recovering from her neck strain. She was released from medical care and went back to work.

Sally had $1,500 in medical bills and $500 in lost wages, for total special damages of $2,000.

Sally used a multiple of 1.5 to calculate her pain and suffering. The pain and suffering calculation of $2,000 x 1.5 = $3,000, added to the $2,000 in specials came to total claim value of $5,000.

Sally described her pain and suffering in the demand letter. She referenced her medical records to show that her doctor did not allow her to drive, bend over, or lift more than 10 pounds until she was cleared to return to work.

Sally went on to explain that because of the limitations imposed by her injury, she had to rely on a relative to care for her toddler and drive her older children to school. She couldn’t sleep because of pain and stiffness.

Sally told how she was further distressed by the cries of her youngest child to be picked up by Mommy, and her constant worry about missing a paycheck.

Sally did a good job of organizing the paperwork for her injury claim. She was able to use copies of her medical records and a statement from her childcare provider to support her pain and suffering claims. Sally will likely settle her claim within a few hundred dollars of the $5,000 demand.

The more evidence you have to prove your level of pain and emotional distress, the higher the adjuster’s offer will be. Your ability to communicate the severity and duration of your pain and suffering can also play a role.

Factors That Raise or Lower Claim Value

Here’s where it helps to understand how claims adjusters evaluate pain and suffering. Insurance adjusters make settlement decisions based on:

  • Their work experience handling personal injury claims
  • The insurance company’s policy for valuing claims, that often includes a computer program designed for the company
  • Your ability to persuade the adjuster

Keep in mind that insurance companies only care about their bottom line. No matter how polite or sympathetic the adjuster sounds, they are not your friend. Adjusters are trained to look for any reason to reduce or deny your injury claim.

There are several important factors that influence how the adjuster values your claim:  

  • Soft Tissue Injuries: Bumps, bruises, and sprains are examples of soft-tissue injuries that won’t show up on x-rays or CT scans. Adjusters are very skeptical of pain and suffering claims with soft tissue injuries and will usually allow only a small settlement amount over the total of your special damages.
  • Low Impact Collisions: You’ll have to be particularly persuasive and have good evidence to convince an adjuster you suffered much of an injury after a fender-bender or other minor accident.
  • Shared Liability: The insurance adjuster will not pay the full value of your claim if they can pin part of the blame on you. For example, even if you broke your arm after slipping on a spilled drink at a club, the insurance adjuster will argue you might not have fallen so hard if you hadn’t had a couple of Margaritas yourself.
  • Venue: When insurance companies talk about “venue,” they are talking about the way juries treat insurance claims in your part of the country. You can go to your county clerk’s office for help looking up jury verdicts for cases like yours. The adjuster will pay more to settle your claim out of court in areas where the venue is more favorable to injury victims.
  • Disfigurement: Injuries that permanently scar or disfigure the victim often justify pain and suffering compensation that is many times the cost of special damages. Examples of disfigurement include facial scars, severe burns, and amputations.
  • Attorney Representation: Insurance adjusters are notorious for offering lower settlements to seriously injured claimants who handle their own claim. Unless you are completely recovered from a minor injury, you need an experienced personal injury attorney to get anywhere near the full value of your claim.

Negotiating Your Injury Settlement

Insurance companies strongly resist paying fair amounts for pain and suffering. They often seem to take the position that most victims don’t deserve much more than their special damages, particularly in minor injury cases.

Despite the adjuster’s bias against paying general damages, knowing how to calculate pain and suffering will help you negotiate a reasonable settlement for most injury claims.

Serious injury cases are nearly impossible to settle directly with the insurance company for a fair amount of money. The insurance adjuster knows when they make their “final offer” you probably won’t have the legal skills or the energy to fight for more compensation.

You don’t have to fight alone. Most attorneys don’t charge for the initial consultation and will represent injury victims on a contingency fee basis. There’s no cost up front, and your attorney won’t get paid until your case is settled or wins a court verdict.

Don’t settle for less. There’s no cost to find out what an experienced attorney can do for you.

Video: Increase Your Injury Compensation

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 >>