Visitor Question

Insurance company firm on lowball offer due to previous injury?

Submitted By: Jonathan (Mobile, Alabama)

I was involved in a car accident and was rear ended. Damage to the car was not much but I did sustain a soft tissue injury (per doctor). I went to the emergency room, then my PCP who referred me to a physical therapist for a back injury. The Insurance company accepted fault and said to submit medical bills and notes. I submitted them as follows:

Medical bills: $6,100
Auto damage : $450

Requested for pain and suffering: $7000

The insurance company offered to pay medical bills and $1300 for pain and suffering. They stated that there was minimal damage and that’s why the first offer was $900, then $1,100, then $1,300. We’ve seemed to hit a wall and they say they aren’t offering anything else.

I don’t know how to move forward and if I should just accept the offer without getting lawyer. I’m sure they have wiggle room and am not in a hurry for the money, but it seems ridiculously low.

I also had an injury on my shoulder that was reopened once I got in the accident. It was healing and it opened up because of the force of the accident. They are trying to avoid direct response to that injury and group it with a general soft tissue injury. They are giving reasons as to why they weren’t responsible for it and it can’t be proved that it was from the accident.

What should I expect and how do I move forward? Thank you.

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.

Answer

Dear Jonathan,

Let’s start by looking at your medical bills. There is a distinct difference between medical bills and physical therapy bills. Based on the facts you present, your only medical bill was from the emergency room and PCP. The balance of the your bills appear to be from physical therapy.

Insurance companies have traditionally lent more credibility to medical bills, than to therapy bills, especially when the only injuries are soft tissue. According to Johns Hopkins Medical School, soft tissue injuries are classified as:

  • Contusions (bruises)
  • Sprains
  • Tendonitis
  • Bursitis
  • Stress injuries
  • Strains

Determining the amount of your settlement demand requires a review of two types of damages considered in personal injury claims.  One  is Special Damages” which include economic losses, and the other is “General Damages” which include non-economic losses.

Special damages are relatively easy to quantify. They can include the costs of medical and physical therapy treatment, lost income due to work missed while treating and recovering from your injuries, your property damage caused by the accident, and additional out-of-pocket costs for such items as medications, costs of travel to treatment, nursing costs, wheelchairs, slings, etc.

General damages are not as easy to quantify. These can include physical discomfort, emotional distress, mental anguish, and anxiety. These are often combined into the category of Pain and Suffering.

While insurance companies often rely on sophisticated software to determine settlement offers, victims are left to rely on much less sophisticated methods.

The Multiple Method has been relied upon by attorneys and victims for many years. Under the multiple method, the victim may take his or her medical bills, and multiply them by a certain number, called  the multiple. The multiple will be determined by several factors, which can include:

  • Severity of the crash
  • Seriousness of  injuries
  • Length of treatment and recovery
  • Whether there will be any permanent health problems associated with the accident
  • The existence of aggravating circumstances, such as intoxication of the at-fault driver, previous arrests, driver’s license suspensions, etc.

Typically, you will use a multiplier of 1-5x, and sometimes even higher, depending on the severity of the injury and its consequences.

In your case, it appears the majority of your bills were for physical therapy. Beginning with a multiple of 3, it would appear a settlement demand would be about $18,000.

However, if it is true your only medical bills were for the emergency room, and the rest were for physical therapy, the claims adjuster should offer you 1 .5 to 2 times your special  damages. A settlement demand of $9,000 would be the lowest appropriate. That amount is much higher than the $7,400 dollar already offered.

It is always worth your time to speak with an experienced personal injury attorney. Even if you don’t retain an attorney’s services, you can learn a lot from just a free consultation.

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,

Published: October 19, 2017

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