July 11, 2009,
D.E. asks from Portland, OR on July 09, 2009
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.
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P.M. answers from Portland on July 09, 2009
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.
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C.C. answers from Seattle on July 10, 2009
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.
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T.J. answers from Seattle on July 09, 2009
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!
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M.P. answers from Spokane on July 10, 2009
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.
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A.Z. answers from Portland on July 10, 2009
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.
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T.O. answers from Portland on July 10, 2009
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!
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P.G. answers from Seattle on July 10, 2009
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.
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J.W. answers from Portland on July 10, 2009
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).
(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 :)
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