Visitor Question

Is pain and suffering based on total medical costs or just out of pocket expense?

Submitted By: Lisa (Wake Forest, NC)

I live in North Carolina. I was rear ended by a SUV traveling 55 mph on impact. My car was a Total Loss and I had just paid it off – a 2009 Nissan. I keep reading online about pain and suffering. Do they base it somehow on out-of-pocket medical expense?

I have great private insurance that I gave to the hospital when I went for treatment. My total out of pocket will only be $50. I’m sure the total bill will be around $15,000 or more.

So I guess my question is, do they base my pain and suffering on my total medical bill or just my out-of-pocket? Thanks for the info.

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.


Dear Lisa,

Pain and suffering is determined by adding together your medical bills, including physical therapy if necessary, out of pocket expenses such as prescriptions and over the counter medications and/or health aids, and lost wages. Those items are referred to as a your “Specials.”

Once the total of your Specials is added together the insurance company will apply one of several methods to determine what amount to pay you for pain and suffering. When it comes down to it pain and suffering can usually be generally determined by multiplying your Specials in an amount of anywhere from 1.5x – 5x or even higher.

Your having private medical insurance has no bearing on the amount of your reimbursement from the other driver’s insurance company for your pain and suffering. Your claim is independent of your private insurance.

If your Specials added up to $15,000 you can be comfortable asking for anywhere from about $30,000 dollars up to $45,000 or even higher. Your facts don’t mention the severity of your injuries. The more severe the injuries and resulting pain you suffered and may continue to suffer, the higher the multiple should be.

Learn more here: Calculating Pain and Suffering Costs

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 888-972-0892.

We wish you the best with your claim,


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