Don’t trust the insurance adjuster to tell you what’s fair compensation. Learn how to calculate what your slip and fall claim is really worth.
It isn’t easy to figure out how much money is enough to fully compensate you after a slip and fall loss.
Unfortunately, there are no tools, formulas, or calculators that can easily determine a fair settlement specific to your claim.
While different slip and fall claims often have similarities, each one is unique.
No two injuries are identical, and even if they were, they’d impact each victim in different ways. This means you can only really determine a fair settlement by using your specific damages.
Damages describe the types of losses you suffer because of another party’s negligence or unreasonable actions. Your damages might include medical expenses, lost wages, property damage, and emotional distress.
Here’s what you need to know to calculate the damages for your particular slip and fall injury. You’ll also learn what insurance companies don’t want you to know about determining fair compensation for your accident.
Determining Your Slip and Fall Damages
A useful fact to keep in mind when calculating your slip and fall damages is that there are two categories of damages. In insurance lingo, the categories are special damages and general damages.
The Value of Special Damages
The first step in calculating your damages after a slip and fall injury is to add up your “special damages.” Sometimes these damages are referred to as “specials.”
Special damages are the hard costs from your injury like medical bills, service invoices, pharmacy receipts, and wage loss statements.
Specials are easy to determine because the value is already assigned by a third party, meaning the doctor or facility that sent the bill.
Keeping an organized injury claim file will help you keep track of these expenses.
Special damages can include:
- Medical expenses, including emergency care, surgeries, therapy, and nursing care
- Past and future lost wages or other lost income such as commissions or bonuses
- Out-of-pocket costs, like prescription and over-the-counter medications, medical equipment, and travel expenses for medical appointments
- Replacement service expenses, such as childcare, housekeeping, grocery shopping, and yard work while you were unable to perform them
- Property damage for any items damaged or lost in your fall, including jewelry, clothing, or cell phones
Thoroughly consider all of the expenses associated with your slip and fall claim to accurately arrive at a total for your specials.
It can be easy to overlook some medical bills, portions of your wages, and out-of-pocket costs. Carefully log every expense you can think of since the day of your slip and fall.
Also, keep in mind that some medical services will generate more than one bill.
If you went to the emergency department, you’d likely receive a bill from the hospital and one from the treating physician. Likewise, if you had tests in a radiology department, you’ll receive a bill from that department and another from the doctor who read your test and provided the results.
When determining your medical expenses, be sure to use the full amount. Even if you have health insurance covering part of the costs, you’ll want to use the total cost billed by the provider, before any insurance offsets.
Understanding Medical Billing and Special Damages
Be sure you include the full cost of your medical care, before health insurance copays, deductibles, or offsets from health insurers, Medicare, or Medicaid.
For example, consider a situation where:
- The hospital billed your insurance company $3,000 for your emergency room care
- The emergency room physician billed $800.
- You have a $250 copay for emergency room visits.
Your special damages for the emergency room visit are $3,000 for the ER and $800 for the ER doctor for a total of $3,800.
Don’t include your $250 copay because copays and deductibles only reflect your portion of the total bill, not an added cost.
To calculate the value of your hard costs, add the actual dollar amount of each together. An accurate accounting of your special damages is also the basis for adequately calculating your general damages.
The Value of General Damages
Receiving fair compensation for your general damages is just as essential as specials. However, calculating their value isn’t as straightforward and is much less objective.
General damages are typically known as “pain and suffering.”
When trying to arrive at an estimate of these damages, you must keep in mind that there aren’t any identical slip and fall cases. As a result, general damages will differ widely among accident victims.
Even if you sustain similar injuries to another slip and fall victim, how those injuries impact your life will differ. For example, one party could develop an infection after surgery, or the other could suffer from depression. One might not be able to care for their children, while the other might not even have children.
General damages can include:
- Physical pain and discomfort
- Emotional and mental pain
- Anxiety and depression
- Difficulties concentrating
- Problems sleeping
- Loss of consortium
These damages don’t come with any bills or receipts. There’s no pre-assigned value and no standard way to calculate their exact worth.
However, you can calculate a fair estimate of general damages by adding up all your medical bills and other specials, and adding one or two times that amount to account for your pain and suffering.
If your injuries are mild to moderate, most insurance companies are willing to negotiate a settlement for general damages in this range.
Severe slip and fall injuries should be handled by an experienced personal injury attorney to maximize your compensation.
Keeping a diary to document pain levels and activities you can’t participate in after your injury can help support your general damages claim value. Include things like being unable to attend events, participate in recreation or hobbies, canceled vacation plans, or the inability to hold your baby or walk your dog.
If your injuries are severe, your attorney may seek general damages in an amount three to five times that of your special damages, or even more.
High-dollar general damages may arise from:
- Severe mental anguish: Injured people who require mental health services after their injuries are more likely to receive higher compensation for their mental anguish. For example, someone diagnosed and treated for post-traumatic stress disorder (PTSD).
- Extreme pain or permanent injuries: General damages are typically more significant for claimants who suffer severe or long-term pain, or those with permanent injuries like disfigurement, amputations, or paralysis.
- Shocking events: Although not as common in slip and fall claims as others, injuries arising from shocking or traumatic events can lead to higher-value general damages.
No one else can assign a value to your general damages. You’re the one who experiences them and lives with their consequences. However, the more you ask in general damages, the harder it is to convince the insurance company to pay.
Example: Calculating Slip and Fall Compensation
Roy was finishing up Christmas shopping for his family at a local department store. While busy focusing on finding the right clothing item for his wife, he failed to see the puddle of carpet cleaning solution spilled on the linoleum floor next to him.
He slipped and fell, hitting his head on the corner of the shelf and then on the floor.
Two women nearby immediately came to his aid, stating that they’d complained to a manager approximately 15 minutes ago about the spill.
Due to his violent fall, Roy was in the hospital for one week recovering from a brain injury. He also required surgery to repair his broken wrist. He missed Christmas at home with his family and eight weeks of work.
Roy calculated his total damages as follows:
- Ambulance Service $950
- Hospital ER $10,500
- Surry (ER physician) $1,000
- Cabernash (orthopedist) $3,500
- Tundell (neurologist) $4,500
- Surgery $14,500
- Anesthesiologist $1,250
- Physical Therapy $2,200
- Lost Wages $12,800
- Prescription medications $1,200
Total special damages: $51,200
Pain and Suffering: $102,400
Total Damages/Demand for Compensation: $153,600
Writing a Compensation Demand Letter
Once you’ve determined the total amount of your special damages and how much your general damages are worth, it’s time to write a demand letter. A demand letter requests the slip and fall compensation you deserve from the business or property owner that caused it.
Your demand for compensation should include an itemized list of your special damages and copies of your medical bills.
Also, include copies of any other supporting evidence such as photos of your injuries or the area where you fell, receipts for out-of-pocket expenses, and a lost wages statement from your employer.
In your letter, you’ll want to establish the elements of negligence:
- Describe what happened immediately before, during, and after your fall
- Explain how your evidence proves that their insured is directly responsible for your injuries
- Detail your physical and emotional injuries and pain and suffering
Adjusters see dozens of demand letters in a single day. Sending a professional letter gets their attention and tells them that you’re serious about getting the compensation you deserve for your injuries.
Tips for preparing a professional-looking letter:
- Check your letter for any grammar and spelling errors
- Ensure the correct spelling of names and addresses
- Double-check your math
- Use quality bond paper to print your letter
- Sign the letter in blue or black ink
- Send the letter by USPS certified mail, return receipt requested
Keep a copy of the complete packet you send for your records. When the green receipt card comes back to you from the USPS, attach it to your copy of the letter.
Special Factors to Consider
Most slip and fall accidents involve dealing with the at-fault property owner’s insurance company.
Even when your general damages are what you say they are and your specials are easily verified, other factors impact the amount of money you may be able to seek for compensation.
Limiting factors might include:
- Policy limits: If an injury claim value is more than the available insurance policy limits, usually the only recourse is to file a lawsuit against the at-fault party for the difference.
- Shared fault: The insurance adjuster will always look to limit or deny your claim by shifting some of the blame on you for causing your injuries. They might say that you weren’t wearing the right footwear for the circumstances, weren’t paying attention, or should’ve known the floor was wet.
- Unnecessary medical expenses: Insurance companies will only cover reasonable and necessary medical expenses. If a healthcare provider pads their billing with excessive tests, treatments, or additional unnecessary charges, the adjuster can deny payment.
- Your location: In venues where juries are more likely to return a verdict in favor of an injured person, adjusters will pay more to settle a claim out-of-court.
Beware of Faulty Calculations
It’s highly unlikely that the insurance adjuster will pay your initial settlement demand. They’ll look at how you calculated your demand and check to see if you have evidence to prove their insured’s liability.
Adjusters are trained to question the reasonableness of your medical bills and your time missed from work. Then, they’ll find ways to excuse their client from any legal responsibility whatsoever for your injuries.
Your job during settlement negotiations is to convince the adjuster that:
- You have credible evidence to back up your claim
- Your pain and suffering damages are worth the value you gave them
- Your calculations are realistic
- You aren’t at fault for your injuries
Computerized personal injury calculators have grown in popularity with insurance companies over the past decade. One of the most widely-used is a software program called Colossus.
Injury value computer programs only benefit insurance companies, not injury victims. The programs put a dollar value on different injury types, then factor in if the victim has an attorney and the location in which they live.
Personal injury attorneys are strongly opposed to the use of Colossus and similar injury value calculators because there are too many ways to short-change the victim. It’s too easy for a data-entry clerk to punch in the wrong injury code, leave out crucial information, or ignore general damages, resulting in unfairly low valuations.
Computer programs use statistics and data to calculate injury settlements. They can’t measure the extent of the pain and suffering you’ve endured.
The insurance adjuster will use the Colossus calculation of your claim value to establish the most they will pay, but will do their best to get you to accept substantially less.
Ensuring Fair Compensation
If you miscalculated or missed some of your medical bills, you usually can’t pursue those damages after settlement. Once you accept a slip and fall settlement, you can’t go back and ask for more money. It doesn’t matter if you simply forgot to add something.
Ensuring that you include all of your damages and correctly calculate what your claim is worth is crucial for full and fair compensation.
By speaking with a personal injury attorney, you can ensure that you receive the maximum amount possible for your claim.
Don’t let financial concerns keep you from getting the legal assistance you need after a slip and fall. Most injury attorneys don’t charge for the first meeting with slip and fall victims.
Should you decide to hire an attorney, you won’t need to pay anything out-of-pocket. Most injury attorneys receive payment through contingency fees. If and when they obtain compensation for your injuries, they receive a percentage for their services.
Don’t wait to seek legal help. It costs nothing to have a skilled slip and fall lawyer review your claim.
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