Visitor Question

Is the insurance adjuster low-balling us with settlement offer?

Submitted By: Bobi (Humboldt, IA)

My son was in an auto accident. The other driver was cited for failure to stop at a stop sign. He was traveling on a 55mph hwy and hit them and then careened off an embankment. Luckily there was no one killed. Our health insurance paid the claims, they are a pay and pursue company.

The medical bills totaled nearly $10,000. When arriving at the pain and suffering figure, the adjuster offered us an amount based on the amount the health insurance reimbursed the hospital, NOT the actual cost of all the charges! The reimbursed amount was $4,000…considerably less than the actual charged amount.

The total amount she offered us was $8,000, and $4,000 would reimburse the health insurance. I understand that she is low-balling us and doesn’t even have to tell us the truth, but am I still within my rights to expect her to at least use the $10,000 amount when multiplying for pain and suffering? If our health insurance hadn’t paid, she would have nothing BUT the $10,000 figure to work with, right?

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 Bobi,

Unfortunately, the amount paid for pain and suffering is not controlled by Iowa statutes or regulations. In fact, the insurance company technically doesn’t have to pay any amount for pain and suffering. The amount of compensation paid to an injured party is normally determined by intra-company policies, and not by outside factors.

When determining pain and suffering amounts, many insurance companies rely on one of several computer programs dedicated to determining appropriate amounts of compensation.

These programs, including one called “Colossus,” determine settlement amounts based on investigations of thousands, and sometimes millions of injury claims with similar fact patterns. Factors such as jury awards, non-jury court awards, and previous settlement amounts are included in these determinations.

Even with the most sophisticated computer determined settlement awards, it’s safe to say most injury settlements amounts, including pain and suffering, are paid based on the type and severity of injuries plus the total amount of the inured party’s medical, dental, or chiropractic bills (called “medicals”).

In soft-tissue injury claims, including those with relatively minor injuries, pain and suffering amounts are normally paid at anywhere from one and a half to three times medicals. Soft tissue injuries include strains and sprains to muscles, tendons, and ligaments, minor cuts, bruises, and abrasions, and the like.

For more serious “hard injuries” like fractures, second and third degree burns, head trauma, scarring, and the like, pain and suffering is normally paid at a multiple of medicals ranging from three to five times medicals, and sometimes much higher for very serious or permanent injuries.

Using the information above, you should be able to tell if the amount you’ve been offered is fair or not.

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: May 9, 2014

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