If you were involved in an automobile accident in which you sustained injuries as a result of someone else’s negligence, you are entitled to be compensated for your economic and non-economic damages. Whether you suffered minor injuries, such as a slight whiplash or cuts and bruises, or more severe injuries, such as broken limbs, internal bleeding, severe soft tissue sprains or strains, the at-fault driver has a responsibility to make you financially whole and to put you back to where you were before the accident occurred. This is true whether that driver has auto insurance or not. If he does not, you will likely have to sue him for your damages. If he has insurance, you, or your attorney, will be working with a claims adjuster employed by his insurance company, to try to obtain a settlement. This may or may not involve filing a lawsuit and going to court, depending on whether or not you and your attorney see eye to eye with the insurance company on the value of your insurance claim.
Evaluation of your claim
How an adjuster evaluates an injury claim depends on the company’s procedures, but in general, these are the criteria he or she takes into account when determining how much money an injured individual should receive to settle his or her claim:
• Facts of the accident
What happened, at what speed, where, who was involved, were any laws broken, were the police called to the scene, was anyone ticketed, etc., are the basic facts the adjuster will consider.
• Liability
Claims adjusters must evaluate a claim for fault before offering any settlement. If one party is clearly liable and there is no question, it is not a difficult issue. But there are accidents where it is difficult to determine who was responsible, such as those in an uncontrolled intersection, or a left turn made in front of a speeding car entering the intersection. Sometimes reconstruction experts need to be employed to evaluate the accident scene, the damage to the cars, etc. in order to determine what actually happened to figure out who was in the wrong. Sometimes it is determined that both parties were negligent and fault may need to be apportioned.
• Extent of Injuries
The adjuster will request certain information regarding your injuries so he or she is able to determine how injured you really are. They sometimes look at injuries with a rather skeptical eye. Since fraudulent claims are fairly common, don’t take it personally. Just provide what they are asking for. Usually they want a medical report from your physician with a diagnosis and a prognosis for your recovery. They want to know what treatment and/or medication was prescribed and what the status of that treatment is now. Their experience helps them to determine if the treatment was reasonable and necessary for your type of injuries. They may ask if your doctor told you to take time off from work. This way the adjuster gets a complete picture of the difficulties you are having since the accident.
• Expenses
This is fairly simple. How much did you spend on medical bills as a result of the auto accident? How much did you lose in wages? Any other expenses? You will need to provide documentation to support your claim: copies of medical bills and statements, wage stubs, receipts for medicines and other expenses. One difficult item to prove may be how much money you lost if you have your own business and you had to miss work. Sometimes a financial expert is required to help determine the losses. Then there is the damage to your property that needs to be submitted, unless your own insurance pays for it. If the at-fault driver’s insurance will be paying, you will need to provide at least one repair estimate; they will likely want to take a look at the vehicle themselves if where, or to what extent the car is damaged will help determine liability.
• Other Factors
Sometimes there are other factors involved that should be taken into account and you might want to point them out to the adjuster who is evaluating your insurance claim. For example, if you were caring for young children or an elderly relative before the accident and now you cannot, you may need to hire someone to do so. If you were working in a job requiring physical activity that you can no longer do either temporarily or permanently, you’ll want to let them know. If you can no longer do housework and have to hire someone or your spouse has to take time away from work to do that, tell them. All of these factors affect the value of your claim.
Once the adjuster has all of the necessary documentation to evaluate your claim, it is really quite subjective. He or she will come up with a value range based on all the information and make you an offer, likely from somewhere near the bottom of their range. There is no set formula, like 3 times the medical bills, although many use that as a guide. They do not expect you to take their first offer; they expect you to negotiate. If you have an attorney, he or she will do the negotiating for you. If you do not, you are on your own.
Remember that insurance companies are not in the business of spending a lot of money on claimants. They want to protect themselves and their bottom line, and not pay more than they have to or than they believe is a fair amount. But if you negotiate wisely, you can get them to the top of their range and walk away satisfied. If you believe their range is too low, and your attorney agrees, it is time to go to court.
Read more...
