Tips for Resolving Your Bodily Injury Insurance Claim

So you’ve been in an automobile accident and you were sort of injured, or think you might be injured. This article really does not apply to anyone seriously injured in an accident. Those claims, ironically, are typically the easiest to settle once the cost of medical treatment has been calculated. This is geared more toward those with minor to moderate injuries; also known as “soft tissue” injuries in the claims industry. I spent several years investigating and resolving bodily injury claims for one of the “big 5” insurance companies. I have seen every type of claim from one end of the spectrum to the other. The insurance company, while not necessarily trying to cheat the person filing the claim (the claimant), will always try to settle at the low end of what is considered the fair range. And they will try to convince you that your “soft tissue” claim is worth very little if anything. Here are a few tips which should guide you toward a settlement more favorable to you.

First, (and I cannot stress this enough) never hire a personal injury attorney unless it is the absolute last resort. It is a prevailing misconception that an attorney will automatically get more money out of the insurance company than you can alone. There are some inherent reasons why this is not true. First, common sense should tell you that hiring someone to speak on your behalf does not add dollars to the value of your claim. Secondly, I can assure you that these attorneys do not work for you out of the kindness of their hearts. They are in it for the money. The typical fee is 33% of your settlement, 40% if it goes to litigation. The attorney obviously knows as well as you do that no sane person wants to give one third of his money to someone for a few letters and 20 or 30 minutes of telephone conversations (which is what it adds up to). So how does the attorney add value to your claim? He encourages you to accrue medical expenses. He convinces you that the higher the medical bills, the more the claim is worth, even if you end up receiving treatment you do not need. The problem is that most insurance companies are adamant about only paying reasonable costs for necessary medical treatment. And there is plenty of medical research and documentation available to show what is reasonable and necessary treatment for most soft tissue injuries like strains, sprains, whiplash, etc. Therefore, if you receive extended treatment which you realize is probably not all necessary, it stands to reason the insurance company will refuse to pay a portion of it. Your attorney will complain that the jerks over in the claims office refused to pay all the medical bills, but the doctors still have to be paid. He will kindly explain that after the bills are paid and his fee is taken out, you have to accept what is left. What he may not tell you is that he and the doctor have a deal in place for him to only pay what the insurance company allowed. So the attorney gets his 33%, the doctor gets his agreed upon payment, and you are left hung out to dry with far less money than the attorney initially implied you would receive.

This leads to the next point. Do not over-treat. You know your body. Do not let anyone convince you to keep going to the doctor if you know it is not necessary. The honest truth is, most soft tissue injuries will eventually dissipate on their own over 6 to 8 weeks. This is not to say you should not seek medical treatment if you are in pain, but be sensible. Go to your family doctor if you have one. He will refer you for further treatment if you need it. Avoid going to doctors or treatment facilities you have never heard of. Be wary of medical facilities that tell you they will file your claim for you. This is a definite signal that there is or will be an attorney involved. When you are no longer in pain, end your treatment. Also, if the treatment you are receiving is not working, seek a second opinion rather than continuing to treat with no improvement. Watch out for referrals for expensive diagnostic testing. If a doctor you do not know and trust tells you an MRI is needed because your neck is sore, ask for another opinion. High cost diagnostic tests are another means of running up the medical expenses. Ask your medical provider questions about your treatment at every visit so you understand what your diagnosis is and are aware of your treatment plan.

The next important thing is to know your rights when dealing with the insurance adjuster. Do not sign anything without reading it and understanding it. Many of the leading insurance companies today will have an adjuster at your home to discuss your claim by the day after it is filed. The point of this meeting is for that adjuster to get your name on a release before he walks out your door. The sooner the claim is settled the less expensive it is. This may not be the right thing for you, but the meeting can still be beneficial. You get to meet the person you will be dealing with and lay the groundwork for settling your claim. Just be honest about your injuries and do not be pressured into signing the release until you are ready. You will probably receive a settlement offer at that first meeting. Do not accept the first offer unless you truly feel it is fair. You can tell the adjuster you are not ready to settle anything yet. You can ask for a different amount if you have a number in mind. Do not be surprised if the two of you are far apart. The first offer will inevitably be based on the assumption that you will need little or no medical attention. Whenever talking to the adjuster, whether during the first conversation or any after that, be prepared. Be able to give details about what you are dealing with physically. Try to estimate a settlement range as early as possible that you feel would be fair to you and document your reasons. Always start high and work your way down as necessary.

Finally, be reasonable. Being the victim of an auto accident is not equivalent to holding a winning lottery ticket. You should not settle for less than you deserve, but you need to provide sound reasons for your demands. The general damages (pain and suffering) money for a soft tissue injury will not blow you away. A good number to start at is twice your medical expenses. Some attorneys will assure you they can get 3 times the medical expenses, but that rule of thumb went away a long time ago. Unless you live in a very liberal county, twice the medicals is a pretty good settlement. The insurance company will never agree to that initially, but again, the earlier they can settle, the better. Estimate the cost of your needed treatment early (preferably based on advice from a family doctor or reputable medical provider). Double that amount and add any other related expenses including lost wages. When the adjuster balks at the resulting number, be willing to negotiate to an extent. Do not be greedy, but be firm. That adjuster’s job is to get the claim settled as early as possible. That means doing whatever it takes. He would rather overpay a little bit in the beginning than have your claim sitting on his desk for the next three to six months.

Using these guidelines will give you a better opportunity to personally negotiate and settle your minor to moderate injury claim resulting with the most money possible in your pocket. Remember, if you seek legal counsel, the attorneys and the doctors they do business with will always end up with the majority of your settlement. If you reach an impasse in your efforts to personally resolve the claim with the adjuster, try speaking with his manager, the holder of the purse-strings. If all else fails and you feel you have to hire an attorney, ask lots of questions. And the same thing applies: do not sign anything without reading and fully understanding it.