This case study illustrates why proof of injury is vital for a successful insurance claim. See how a lack of evidence can undermine settlement negotiations.
This case example is for educational purposes only. It’s based on actual events, although names have been changed to protect those involved. Any resemblance to real persons or entities is purely coincidental.
Our study will review how the accident happened, the victim’s injuries and treatment, and the victim’s negotiations with the insurance company.
Finally, we leave you with important points to remember about personal injury claims.
How the Accident Happened
The accident occurred at about 6:30 p.m. on a clear summer evening.
Gordon Miller was driving home from work in his SUV. He was heading southbound on a two-lane highway, traveling at the posted speed limit. Gordon began to brake as he approached a red light at the four-way intersection.
At the same time, Raymond Smith was traveling on the same highway heading northbound. As he approached the intersection in his mid-sized sedan, Raymond began braking for the red light.
As both drivers were coming to a stop, the traffic light turned green. Instead of stopping and waiting for the intersection to clear before turning, Raymond tried to make a left at the light and get across the intersection before Gordon’s vehicle came through.
Raymond failed to calculate his speed and that of Gordon’s vehicle properly. As a result, about halfway into his turn, Raymond collided with Gordon.
A motorist who had been traveling behind Raymond saw the crash and called 911.
Injuries from the Collision
Both drivers appeared to be shaken. When his airbags deployed, Raymond suffered lacerations to his nose and forehead. Other than that, both drivers seemed to be alright.
Because of the 911 call, a police officer and a rescue squad arrived at the scene.
Gordon was full of adrenaline from the sudden impact of the crash. He told everyone he was okay and refused to let the paramedics look him over.
His SUV was damaged but drivable, so Gordon drove himself home.
The next morning Gordon had trouble getting out of bed to go to work. His back had stiffened during the night, and his legs were sore. His wife called his employer to say her husband wasn’t going to make it into work that day.
Gordon’s wife drove him to the local hospital’s emergency room. He was seen by the emergency room doctor who prescribed some pain medication and muscle relaxers. The physician told Gordon if his symptoms persisted, he should see his family doctor.
Instead of going to see his family doctor, Gordon decided to go to see a chiropractor who advertised as specializing in treating car accident injuries.
The chiropractor told Gordon he would benefit from daily treatment. Gordon went along with the chiropractor’s advice and went to treatment daily. He received electrical stimulation, realignment, and massage therapy. He continued to receive treatment for the next ninety days.
Driver Liability for the Crash
After reviewing the accident scene, talking to witnesses, and taking both drivers’ statements, the investigating police officer determined Raymond was at fault for the collision.
Further, the police report stated that Gordon did not contribute any fault for the crash.
Raymond was cited for failure to yield the right of way. The officer told Raymond it was his responsibility to make sure the intersection was clear and safe to cross before making his turn.
Because of Raymond’s negligent driving, he was liable, meaning responsible for Gordon’s injuries.
Raymond’s auto insurance carrier accepted liability on his behalf. That left it up to Raymond to prove the extent of his injuries from the vehicle accident.
Damages and Settlement Negotiations
Auto insurance liability insurance pays for the bodily injuries and property damage caused by the incurred driver.
Claims for vehicle damages are usually handled separately from injury claims. Gordon’s car repairs were covered by Raymond’s insurance company sooner after the crash.
After three months of chiropractic treatment had concluded, Gordon called the adjuster assigned to his bodiliy injury cliam. He wanted to begin the negotiations for his settlement.
Bodily injury damages can include:
Gordon gathered his chiropractic bills, the emergency room bill, his prescription and over-the-counter medicine costs, and his employer’s verification of lost wages for the two weeks he had taken off during his treatment.
Gordon’s “hard costs” included:
- Chiropractor: $7,500
- Out-of-Pocket Expenses: $150
- Lost Wages: $1,200
Gordon had $8,850 in hard costs, called special damages in insurance lingo. He wanted to get as much money as possible from the insurance company, so Gordon decided to ask for another $8,850 for pain and suffering.
Offers and Counteroffers
Gordon sent a settlement demand letter to the insurance company seeking $17,700 to resolve his car accident claim.
A week later, the claims adjuster called Gordon to discuss his demand.
The adjuster told Gordon his demand was much too high; that his injuries were not serious enough to have required the length and cost of his chiropractic treatment, and in light of the type of injuries he suffered, his time off work was excessive.
The adjuster told Gordon without an MRI exam or other medical proof of the nature and severity of his injuries; his demand was wholly unsupportable.
The adjuster offered $3,000 to settle Gordon’s injury claim.
Gordon waited a few days before rejecting the low settlement offer. Gordon realized his first demand was high, but he also knew the adjuster’s first counteroffer was ridiculously low.
Gordon told the adjuster he was willing to negotiate and countered with a demand for $ $14,000.
The adjuster argued that the pain and discomfort Gordon suffered from the collision were at most muscle sprains and sore limbs. She pointed out that he refused medical treatment at the scene and told everyone he was okay.
She explained to Gordon that they are only obligated to pay for reasonable medical treatment. Since he had no proof of torn ligaments, disk herniation, or other medically diagnosable injuries, three months of chiropractic therapy was excessive, as was two full weeks off work.
She went on to tell Gordon she had been negotiating injury claims for over ten years, and during all that time, her company had never authorized that much money for the type of injuries he sustained.
Given that he refused treatment at the scene, his car was drivable, and he had no proof of injuries worse than sore muscles, her final offer to settle his claim was $9,000.
Gordon thought it over for a few days. He admitted to himself that he just didn’t have enough evidence to strengthen his claim.
Gordon settled his injury claim for $9,000 and felt lucky he got enough to cover his chiropractor bills.
Important Points About Injury Claims
- Never refuse medical treatment after a car accident. Refusing or delaying medical treatment gives the insurance company a reason to question your injuries.
- Watch out for “accident doctors” who recommend excessive treatments or tests to inflate your medical bills. You could be on the hook for some of those bills.
- Strong evidence of your injuries is vital to a successful injury claim.
- Know how to calculate the value of your claim so you can make a reasonable settlement demand.
- Don’t be shocked by an initial low-ball offer from the adjuster. Be prepared to negotiate with patience and persistence.
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