About 16 months ago, a car turned across my path and struck me while I was riding my bicycle. I was transported by ambulance to the ER and suffered a broken shoulder and painful road rash. My shoulder did not need surgery. The driver was charged and plead guilty to a class 1 misdemeanor (careless driving resulting in injury).
My own auto insurance paid for $5K of my medical bills. The other bills – orthopedic surgeon appointments and physical therapy (PT) – were paid by my health insurance company (who expects reimbursement from the driver’s insurance) and out-of-pocket by me.
The injuries were painful. I wasn’t able to sleep well for months and physical therapy was very painful. I still don’t have full range of motion of my shoulder. I went to so many PT appointments, I finally accepted that it’s probably not going to improve at this point, so I stopped PT and I’m ready to settle my case.
I have a few questions…
First, I was told by an attorney and adjusters from my insurance companies that when calculating my medical bills, I should use the billed amount from the medical provider, not the contracted discount rate from my health insurance company. Is that correct?
My auto insurance adjuster told me that they don’t expect to be reimbursed by the driver’s insurance. Am I still entitled to that $5K? Although I was told my auto insurance rates would not go up from this accident, they went up substantially the next renewal, although I was not in a car and not at fault.
I missed the day of work (was commuting when I was hit) and the following three days. So, I’m asking for compensation. I’m also including the time I spent at doctor and PT appointments as lost income, since I had to either take vacation, sick leave, or work after hours to make up the time. Is that legitimate?
I haven’t seen a mental health professional, but I have really been affected by this accident. I don’t have access to a car during the day (one-car family) and I commuted by bike every day to work for years. It provided exercise, stress relief and was an efficient means to travel.
I wasn’t able to ride for a few months and my shoulder was stiff and painful once I tried to resume riding. But the main issue is that I’ve become so anxious to ride, that I changed my route to avoid the area where I was hit, which adds one mile each direction and I end up not riding most of the time and taking the bus due to anxiety. I also feel vulnerable crossing streets on foot and am struggling trying to get past this.
I was lying on my back, unable to move, in the middle of a busy intersection after the accident until the ambulance arrived. I think it’s had a huge impact on me, though I’m the type of person who tries to just get on with things.
I’ve also gained 10 pounds since the accident from losing this daily exercise, in addition to feeling anxious and depressed.
Will this be taken into account for the settlement? Should I consider seeing a therapist to document these issues before I start negotiations?
Totaling medical bills using the *billed* rate, adding up my hours lost from work for medical appointments, the days I missed at work at the time of the accident and repairs to fix my bike, the total is $15,598.05. What would be a reasonable amount for the initial demand and what should be the lowest I settle for?
I want to do this myself, but if I feel that I’m not being offered a reasonable settlement, I will hire a lawyer and file suit. I live in Colorado. Thanks so much for your help.
Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.
While you have every right to pursue your injury claim without legal representation, you would not be helping yourself. To help you decide whether or not you need an attorney, read this article.
Serious injuries such as fractures, dislocations, serious burns, etc. are hard fought by insurance companies. They don’t want to pay a penny more than they have to. Don’t be lulled into believing the driver’s insurance company will to treat you fairly. What is fair to them, is ….well, usually just not fair.
As a “pro se” victim, when representing yourself you have no leverage. If the insurance company tells you that’s all they are going to offer, no matter how they try to convince you how magnificent your negotiating skills are, that’s all they will offer. What are you going to do?
Practically speaking you can’t file a lawsuit and expect to to succeed in court. Unless you are filing a small claims lawsuit, you will end up in a higher court where you can be sure the insurance company will be represented by an experienced and very aggressive attorney.
When considering the appropriate amount with which to make a settlement demand, you are not required to lessen the amount of that demand by the amount of money your insurance company has already paid. You should not be penalized because you are responsible enough to have your own medical insurance.
While your insurance company says they are not going to pursue the driver for monies paid to you, that is probably not correct. Insurance companies normally “subrogate” against the negligent driver after paying claims to their own insured.
You have a right to compensation for the damages you sustained as a result of the crash. Damages can include your medical and therapy bills, out-of-pocket expenses (for medications, crutches, slings, etc.), lost wages, and pain and suffering.
While you have a right to demand additional compensation for your psychological difficulties, that amount must be supported by a psychiatrist’s or psychologist’s written narrative conclusively stating the collision caused you to sustain mental difficulties.
Insurance companies have their own methods of calculating settlement offers. Today most insurance companies rely on proprietary software such as Colossus. Colossus takes into account the nature of injuries sustained by a victim, the average settlement or court verdict for similar injuries, the attorney’s reputation, and more.
When calculating a settlement demand letter, most injury victims can take their total medical bills and multiple them by anywhere from 2 to 5 times. Where 3 or 4 represents injuries such as fractures and dislocations, and 5 and higher represents injuries such as severe head trauma, permanent disfigurement, permanent loss of bodily function and more serious injuries.
While it doesn’t seem fair, your insurance company does have a right to increase your premiums.
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.
Best of luck,
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