23 answers

Insurance Settlement - What Should You Expect?

I was recently in a car accident. Not my fault. Hit by someone else. Their insurance has covered everything so far. I was not badly injured, but had to go to a chiropractor for a couple of months. I feel like I am close to finishing up my treatments and the insurance company wants to settle. I have no idea what to expect, what to request etc. I don't want to be greedy, but on the other hand, I want to be treated fairly. Is there a general rule about how much you should expect to get in relation to medical bills or anything? I don't even know what is fair. I feel like I have spent a lot in gas going to my appointments and have taken A LOT of my own time dealing with this. Does anyone have any experience with this? Any help or suggestions are appreciated.

4 moms found this helpful

What can I do next?

More Answers

My own inclination, in the case of a minor injury, is to ask for coverage of actual expenses, including costs such as time lost from work, transportation for medical care, any child care needed as a result of the accident, and take-out meals if I couldn't cook for awhile. (I presume you kept receipts, mileage, etc.) More than that pushes a claim into an ethical grey area that might be described as, "Well, other people get generous settlements for pain and inconvenience, and I should, too."

What's wrong with that thinking? Several things.

1. For the most part, people who hire lawyers get bigger settlements than actual costs. The lawyers get rich, the insurance companies raise their insurance premiums, thus increasing their profit margins. The injured may get richer. But the average consumer gets the bill.

2. Other people getting big settlements tend to give everyone a greater feeling of entitlement. That doesn't make it right, and we help perpetuate a system that doesn't really work optimally for most of us. If you had an angel sitting on your shoulder, what do you think you'd tell him is a reasonable amount for what you actually suffered? (Ask the insurance company for that amount.)

3. Life is risk. No getting around it. Modern life, with lots of auto travel, increases risk (including the inconvenience we suffer when something does go wrong), which is something we must balance against the increased convenience of driving cars.

4. They're called "accidents," and not "plans." Next time, you could be the one at fault – it only takes a moment of inattention, or even a sudden, confused situation where something HAS to go wrong. Imagine how you would feel if someone were trying to stick it to you for a big settlement on a relatively small injury. (My first husband actually did this. In his case, it was clearly fraudulent, and if I hadn't been intimidated by his temper, I would have opposed his choice vigorously.)

5. If you were injured by someone behaving in a rude and reckless manner, then a punitive settlement might be warranted. But really, the legal point of that is about correcting the other driver, not making you wealthy.

There may be folks who suggest you go for all you can get, in which case you should hire a lawyer. But you might not be happy with the struggle that could initiate. I had a car back into mine in a parking lot a few years ago. It jolted me pretty hard, and I suppose I could have claimed an injury (though I didn't even get bruised.) I found that by simply being polite and letting the other insurer take the lead, I got a quick and easy settlement for my actual expenses with no hassle, and never lost sleep over the process. If I had grabbed for more, I might have bought myself a long, hair-tearing fight. And might not feel so comfortable with my conscience now.

4 moms found this helpful

Hi D.,

My husband was hit head on by an elderly gentleman that was having a heart attack and ultimately died during surgery just after the accident. Terrible loss. My husband sustained several broken ribs, a broken clavical, serious bruising and other things as well and was off of work for about two months while healing. Our SUV was totalled as well. We felt we had gotten off lucky, more so than the gentleman and his family.

I tell you this because, yes, we could have gotten a lawyer and fought for money, but we weren't about to add more pain and sorrow to this man's family. It was an accident and certainly there was no negligence on the part of that man. Here in Washington you have 3 years to settle a claim and we waited for about 2 1/2 years to settle. We wanted to make sure there were no further complications in my husband's health (thankfully there weren't) because once you settle the claim you can't go back for more.

Our insurance company paid all the expenses (hospital, doctors, ambulance, our vehicle, prescriptions, etc.) upfront and then subroggated agaist the other insurance company to be repaid. We paid nothing. Well, we did have to pay the difference for a new vehicle.

The gentleman's insurance company asked for documents from the doctors, hospital, etc., and they were given those. They called us to see how my husband was doing and if we were ready to settle and we said no each time. They were gracious and said to call when when we were and they would call us in a few months. Once we decided to settle we factored in loss of income, etc., and settled with the insurance company. We let them make an offer and then we countered it and they agreed. We DID NOT go over the limits of the policy, didn't even come close, and there were no lawyers involved.

So, I think you can reasonably factor in your time and expenses involved in your treatment. It sounds like you were lucky and I'm very glad for you in that regard. I think you need to follow what you feel is right and just in pursuing this, but do not settle before you have to. Let your body heal and recover - it takes time. Don't let anyone pressure you and if you feel you need a lawyer to understand your rights, then get one. A little education is always good.

I hope you find a solution that feels good in your heart and recognizes that accidents do happen. As my husband always tells me "that's why they're called accidents." God bless.

3 moms found this helpful

There are a lot of articles on settling your own claim, but no one but an attorney should be giving advice on this for legal reasons. Most attorneys will do a free consultation with you as well to determine your needs and if you need any assistance getting what is reasonable in regard to your injuries and suffering. I've been in a few accidents and always have an attorney handle it. And I work in the insurance industry, so I know more than the average person about dealing with it all, but it's easier not to, trust me! Oregon has different laws and statutes which I'm not familiar with, so check with a local attorney or see if their websites have more articles and information. Find one that specializes in personal injury claims. And I don't know when you accident was or what the statutes are in Oregon, but in Washington we only have three years to file suit if a settlement is not reached by that point. Good luck!

2 moms found this helpful

Hi D.

A few years ago I had the same thing happen. I was told by my insurance agent to wait at least a year after the accident before you settle your medical claim with the insurance company. That way if in a couple months you start having problems again than your claim is still open and the insurance company will have to pay for anything else that you need done. Because once you settle you can never go after them for more money so it is best to wait awhile and if I remember right my insurance agent told me you that you have 3 years before you have to settle. As far as what to ask for I would keep track of mileage back and forth from the chiropracter and all the time lost from work plus any pain and suffering that you fill you had. From experience never take their first offer. And don't let them pressure you into anything. They want to close your claim as soon as possible. Don't let them push you into anything you don't fill comfortable with. For me it helped to talk with my insurance agent and he gave me a lot of helpful tips. Take care and it will get better I promise. Insurance companies are not fun to deal with.

M.

2 moms found this helpful

Talk to your doctors and chiropractor. While you want to get covered, it's also nice to be done with the ordeal. Insurance companies want to settle to cut expenses. If you are doing well and feel fine and your doctors say you're good, I'd settle. If you have more care, keep seeing your doctors (you have a year) and make sure you are ok. I was 21 when I guy dropped his cell phone and while digging around for it, rear ended me going 45 miles an hour while I was stopped at a red light. I thought I was ok and took the settlement. A month later, I started having some severe problems and still 25 years later I have problems from it. If I'd received proper care and that first year, both a settlement and on-going treatment would have been unneccessary. I don't believe in suing and running up rates, but I believe you should make sure you are taken care of too. Your health and recovery are far more important than a check.

2 moms found this helpful

D.,
I settled auto insurance injury claims for 13 years and I am now in a different line of work. I always tell my friends to write down what happened to them that was subjective "pain and suffering " part. How did it affect your life and to what degree, then try to come up with a number that you feel would be fair compensation for that. Insurance companies do not have a formula or a set # as each injury is different (and it's illegal too!). Work with the adjuster and explain how it affected you, if you truly do not like the settlement, just wait or ask to talk to a manager. You have 2 yrs from the date of accident in OR to settle. Make sure they are covering all your medical under PIP-personal injury protection- coverage , which is on your policy (they pay your company back). If you have any questions please feel free to contact me, it can be confusing trying to understand everything! Feel better soon!
T.

2 moms found this helpful

Get a lawyer. My daughter went through this exact same thing . . . twice in 13 months. Before she got a lawyer, the insurance company was AWFUL to her. Like you, she just wanted to be treated fairly. She just didn't know the right questions and/responses. Believe me when I say that the insurance company is NOT in it for you or even the guy who is paying them. They are in it for their bottom line: the profit. Ask your chiropracter if he/she knows a reputable lawyer for the kinds of injuries you suffered. Good luck.

2 moms found this helpful

Call around and get an attorney. NO insurance company is going to be "fair" with you. They are going to try and low ball everything and make you pay out of your own pocket for something that was not your fault. You shouldn't have to pay for anything AND you should get compensated for things that don't have monetary value - like your time. Only an attorney who has experience with auto claims will know how to handle this. It may cost you some money, but the end result should be having all of your bills paid for plus money in your hand (even after you pay the attorney).

Good luck!!

(I've been a legal assistant for over 5 years in a plaintiffs firm (we protect the rights of injured people) and have seen far too may people get ripped off by insurance companies!!)

PS - I should have read your other responses first, but now having done that..... PLEASE get an attorney. Your accident and it's end result/settlement has NOTHING to do with higher insurance premiums for other people, "the system," greedy attorneys, winning the lotto, or "ethical gray areas." You pay insurance and thankfully so did the other person involved. Therefore, you should be financially compensated for this event and it's outcome. The insurance company will bury you in paperwork that you cannot possibly respond to correctly (or timely) without knowledge of the laws and they will use your lack of experience against you to penalize and short change you. I've never heard of blanketed "one year paid medical expenses" and I think making any decisions based on that thought is a bad idea. And before you spend what will end up being a TON of time trying to do the leg work on your own, go get a free consultation with an attorney. The Oregon State Bar has a referral line 1800-###-###-#### and they can give you the names of auto claim/ personal injury attorneys near you.

Again, good luck :)

1 mom found this helpful

You seem to have quite a few great responses so I will just add my small experience. I was hit by a commercial truck. I walked away with a totaled vehicle and very minor injuries (a hospital visit which resulted in only bruising). The insurance company gave me the value of the car, my medical bills and a a few extra thousand for my minor pain and suffering. I didn't consult a lawyer or counter offer. I thought it was pretty fair and the insurance company to be easy to deal with.

1 mom found this helpful

Hi Diane,
All I can tell you is from my own personal experience, my accident was pretty much like yours, no major injury but I spent about 2 months doing PT and another 10 months or so with a chiropractor. The "other" insurance co. wanted me to settle immediatly and offered $1500.00 pretty much the entire year, even though I kept denying the offer. When I decided I was done with treatment they still held strong at $1500.00. My thought was what do I need this money for? I work 12+ hours a day and am on my feet 99% of the time. Could this nagging back and neck ache contimue to bug me? And if so, what kind of cash would I need to seek occasional therapy, message, adjustment, etc. And this money has to last me. With all that in mind I decided to seek the help of an attorney. Most accident attorneys work just for the settlement percentage. If you don't win, they don't get paid. Using an attorney it still took us about 8 months to settle, the "other" insurance co. kept low balling at $1500.00. And I am just worth more than that! I ended up settling for just under $10,000 and my attorney got 33%. Well worth the wait. And I have since used some of that money to visit my chiropractor on occasion for cont adjustments. :-) Good Luck!

1 mom found this helpful

Hi D.,
I don't have alot of experience in this but I do know that you should be super cautious about closing out the claim. Things can crop up months later that are still accident related, so make sure you're really comfortable before you close the claim.
Good Luck!

K. Koitzsch
Owner and Chief Operating Officer
JBF Consignment Sales, LLC
www.jbfsale.com
E-mail: ____@____.com
Address: JBF Consignment Sales, LLC, PO Box 68041, Seattle, WA 98168
Phone: ###-###-#### Fax: ###-###-####

Check out "Why We Love JBF!" on You Tube!
http://www.youtube.com/watch?v=NTrb43KetYg

1 mom found this helpful

I'm a chiropractor and always suggest my patients use a lawyer to get a fair settlement. You don't have to pay the lawyer. They will get a part of the settlement. I use Gatti and Gatti. They specialize in motor vehicle accidents. You can also ask your chiropractor what he or she advises. The main thing is that you don't want to be cheated because you know too little. A lawyer will make sure you are cared for. At least do a consult with a lawyer so you know the downside of trying to reach a determination on your own.
Good luck,
C.

1 mom found this helpful

D., I haven't read your other responses, so I apologize if this is duplicating anything else.

I have no experience on your side of the situation but I used to work for a chiropractor and helped in the billing office. So, first of all you need to talk to the chiropractor and massage therapist you are seeing and find out if you are near done with care. Because while it may seem so to you that often isn't the case with car accidents. When your body has experienced a trauma like that your body and muslces stiffen and pull in ways that hurt you and while you might be "feeling" better it is important to continue your care to make sure your muslces do not go back to that state. This takes awhile, and can take a year because for the firt 3-4 weeks you probably went to the chiro 3-4 times a week, and then will slow to twice a week for 6-8 weeks, and then 1-2 times a week for another few months. This all depends on your body and the chiropractor. But don't let the insurance company pressure you into settling - they'll do that to avoid having to pay more money, they usually want to settle after 2-3 months. Just stay open with your chiropractor and talk to them about this and they will tell you how you are doing and how much longer you need care. Another thing the insurace will probably do is to request reports and notes from your chiropractor so they can see how you are really doing to insure that you aren't milking the situation.

So, from a billing side of things, most chiropractors don't get any money while you are recieving treatment until you settle with the insurance. When we bill every week, we send the bill to the insurance company and they save them until the settlement is done. Sometimes the insurance pays the bill to the chiropractor and whatever other services you've had (massage, PT), but some insurance companies pay ALL the money to you and it is your responsibility to pay your balance. So, that is something important for you to find out. I have a feeling that since it isn't your insurance company and the other person's they might pay everything to you, but different companies and different plans are all different. So, that is something that you need to ask and find out.

So, don't let the insurance company pressure you. Here is something else important, were any of your kids in the accident with you? If they were it is very important for them to see the chiropractor too. Their treatment won't take as long as yours because there bodies are more resilient than an adults, but they still need to be seen because left untreated it can cause problems for them as they grow and become adults.

I hope that helps! Good Luck, this is never something fun to deal with!

1 mom found this helpful

well we currently had to hire a laywer to handle my (and my daughter 3) accident back in 2008. Our medical bills + exceeded our PIP and in order to not have to pay out of pocket *which we cannot afford; we had to get a lawyer so we could have a lien. I am still seeking treatment and it has been over 8 months. This was for an accident where I was sandwiched in the middle. The guy behind me is at total fault so that part has been pretty smooth it has just been the heeling process. Most often you will receive payment for PIP, Total Loss or damage loss (which you should have already got), personal items injured in vehicle, and maybe a little bit to cover possible future expenses. But remember you do NOT have to settle for three years and once you settle you can't go back. Now if you had a child in the car they do NOT have to settle until they are 18 yrs old... I wouldn't jump the gun on the settlement there is no rush. Unless the accident was very very minor give it a little more time.

But unfortunately unless you are an accident laywer it is hard to know exactly what is fair...even if you are a lawyer it is hard to know what is fair. You will most likely learn something about this that you had no idea should be like we learned the hard way to have the maximum PIP possible because PIP goes FAST. And you can use PIP for an amazing amount of things that I had no idea I could use it for until I talked to a lawyer.

So sorry to hear about your accident it is no fun to be a mom having to heal from an injury!

1 mom found this helpful

Thanks for being the voice of reason Peg. Our litigious mindset has led to high insurance premiums for all and a system that empowers attorneys, not the public at large. Was the person whose fault it was negligent (i.e. intoxicated, speeding excessively, etc.)? If not, this was simply an accident and nothing more. They happen all the time to good people on both sides of the fault line and they are a part of life, not a lotto ticket. That being said, you should request full compensation for your DC bills from the insurance company. If you are reasonable in your requests, they will most likely be reasonable in their pay out.

1 mom found this helpful

I've heard it's approx. 3X your medical bills. When I settled that seems about right for pain and suffering. If you can even get twice your medical bills you can cut out the lawyer fees, but if they are jerks go with an attorney.

Yes indeed sister, if you do not have a attorney get one by all means even just to check the records so far for a settlement, never settle nothing with the insurance companies ever they will bluff you right out of your fair ride even though you feel better most from going to the drs, think about it years from now even just a year down the line, never any estiamated amount could solve all issues the insurance companies will settle for far less i know as from a friend who did not really want an attorney but got one later then decided to go with what the insurance wanted to settle for and lost out over three thousand dollars, i been around and dealt much with this kind of situations please just do your self a favor and end the time before you end up saying i should of gotten a lawyer be good to your self you can find a lawyer who take a small pay after your paid they usually get between 1% to 3% pay of the total settlement just be good to yourself do what is not only fair but right you were not at fault so why be treated as if you were. Friend S., vanc,wa,

Hi D.,
Sorry to hear about your injuries. My hubby is an attorney and of course, he always suggests that anyone dealing with an insurance company on an accident with injuries seeks at the very least a free attorney consultation. After that you can form your own opinion if you need legal assistance. From hearing him talk about work on a day to day basis, insurance companies typically have a set amount that they give for specific injuries, sometimes despite the amount of medical treatment received by the injured. What you might feel is fair is not necessarily what the insurance company deems fair as they are typically not wanting to pay out too much. If you seek legal consultation, be sure to find out how much the lawyer will charge (normally they get a cut - often 1/3 - of the finished settlement as their fee, rather than charging you up front). Now, remember, you DON'T HAVE to hire a lawyer if you don't want to but usually (not always) you will get more to compensate you for the time, travel, medical care, and grief that you have incurred. It is completely up to you whether to go with an attorney but you should at least get a free consultation from one.

Good luck and hope you are better soon!
L.

Don't settle get a lawyer. You have two years to decide if you are well.

D., you legally have one year to receive treatment, and the insurance company has to pay. They will try to pressure in any way they can to get you to settle, so they don't have to do it for a year, but don't do it!! You have the legal right to a year's worth of free medical care. That's what my chiropractor told me after I settled in a similar situation to yours. I was bummed that I didn't know that before I settled.

Good luck!
D.

Hi D.,
I used to work for a Chiropractor, so I saw this all the time. My hubby also used to be a claims adjuster, so I know a little bit from an "insiders" perspective. First of all, if you are now nearing treatment, it may be too late for you to get a lawyer. We had a great and repuatble lawyer that we worked with out of my DC's office, and he always told people it was better to get on board with him early on in your treatment, so he can monitor your progress. He didn't like to take people at the end of their treatment. he would, though, if they had already TRIED negotiating with their ins company and were getting no where. If it were also a "simple" case (kinda sounds like yours is) he oftern told people they could do it themselves and save themselves the money they wouyld have to pay him. So, again, I respected the guy for that. So, my point is, I think you can do it yourself, and keep all the settelment money. Now, it's been a while since my hubby was in the biz, but Ins co's ALWAYS low-ball you on their first offer!! Don't accept it. And just becuase your are a SAHM does not mean your time is not valuable!!! Gas iS expensive and so is your time, so your trips back and for the the DC appts are worth compensation. I would not accept anything less from them then the total amount of the Dr bills. If you medical treatment cost 7K, then keep that figure in your mind and negotaite that. You'll have to shoot higher then the number you have in mind, becuase it IS a negotiation process. NEVER let them know the minimum amount you'll accept. And if you HAVE to threaten getting a lawyer, then by all means do so. Also, you may want to talk to a few lawyers, most should offer you a free consultaion. If they Don't affer a free consult, then they are sharks and don't deal with them! Try and get some info that way, but just don't sign anything! And don't sign anything from the Ins co, either, until you have reached an agreement on the settlement. Good luck to you, be glad this awful process is almost over, it IS a huge pain in the butt!!!
;-)
~A.~

Twice the amount of all medical bills plus any wages lost.

I recommend telling the insurer that you would like to complete treatment. Since PIP is supposed to cover the first year (my insurer did two years), you should be WAY within the time limit.

The insurer may ask to have "an independent medical exam." My chiropractic office said flat out that I didn't have to agree and that the ime is generally a scam to disqualify you. I trusted my insurer (Amica) and knew I was really injured, did it, and the chiropractic office staff just about fell over dead when my ime came back "yes continue" ... but you are forewarned. If you refuse an ime, they can try to dump you and then you'll be stuck with having to sue.

My lawyer took 1/3 when I had to settle (it was obvious my treatment was going past the two year mark and so I had to claim up for cash to continue), which SUCKED, but presumably I would've gotten a lot less on my own. You kind of have to judge whether that 1/3 loss takes you down below 'useful' cash-in.

Unfortunately if you are a SAHM, you cannot bill for hours missed of work like a remote worker can. You might be able to claim miles/gas if you have documented it clearly.

What I WISH I had known was when I was too disabled to do laundry and when I had to find babysitters so i could go to the doctor, I could have HIRED OUT the laundry and HIRED babysitters (instead of forcing myself to do it and guilting family into helping too much, which is what I did)--actual cash out, they are supposed to reimburse, but they will NOT hand you the cash value if you didn't put the cash out. (DARNIT!!! so much for being all thrifty and calling in all my resources and personal courage ;) !! Sigh.)

You should also replace (and they should reimburse) both car seats if your children were in them during the accident. I wrote a clear and demanding letter about "In order to keep my child safe, I immediately purchased a replacement for the carseat she was riding in that was involved in the accident. Please reimburse me $99.99."

Call *your* insurance to ask whether the other person's insurance is supposed to cover certain items. I have been 'recovered' since 2004 (mostly recovered), so the line-items in the laws may have changed.

Hope those bits and pieces help.

Required Fields

Our records show that we already have a Mamapedia or Mamasource account created for you under the email address you entered.

Please enter your Mamapedia or Mamasource password to continue signing in.

Required Fields

, you’re almost done...

Since this is the first time you are logging in to Mamapedia with Facebook Connect, please provide the following information so you can participate in the Mamapedia community.

As a member, you’ll receive optional email newsletters and community updates sent to you from Mamapedia, and your email address will never be shared with third parties.

By clicking "Continue to Mamapedia", I agree to the Mamapedia Terms & Conditions and Privacy Policy.