Why insurance claims for soft tissue injury are so critical?

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PostPosted: Sun Jan 08, 2012 7:13 am   Post subject:   

Well, last night I'm sitting in traffic in my car on a big highway. Not moving. I look up into the mirror and see a car that's coming at me too fast and I just knew it. So I had a second, just enough time to turn my steering wheel into the next empty HOV lane to avoid the car full of kids in front of me. And the next thing I hear is the crash and I go flying into that lane. I'm on the brake but my car still moves forward about 4 car lengths. I'm not hit by anyone else. I avoided the car with the kids, I have a really bad dizziness so I kept still. State Troupers arrive, and they stop traffic on all the lanes to help us get off. I can barely see and the car hardly drive able but thanks to those troupers both the other car and I make it safely off the road. The troupers were great they did an accident report, had my car towed got delivered all the paperwork to me later - thank goodness everyone involved (me and a young girl driver who hit me) were insured. She was uninjured but her bit green sedan was looking to be in bad shape. I'm an older person (in my 50's) and at this point I have a bad head ache. The paramedics are there (I don't know how they got there so fast or who called them). They check me out and decide to take me to the hospital where I'm checked out by er. I'm dizzy, sick to my stomach, I hurt in y neck and back. They do a cat scan and some simple physical tests and send me home with meds for the stomach 8 hours later. The next day I hurt, but I expected this. My car has been towed. My husband called the insurance company. I don't know what to do next. I'll never make it to work next week as I can't really move and am still pretty sick to my stomach. I'm sure the insurance will fix my car (if fixable, I hope it is) - it's 5 years old but a good car. I'm planning on seeing my MD on Monday if I'm still stick and hurt. I need to work, but am not sure what to do next. I don't want to call an attorney. This is not a situation to make money at. My husband is missing work, I feel right now that I'll miss a week of work or two (I work at a desk but the drive is 50 miles each way and sitting is painful right now). How do I ask for my med bills and work missed for me and my husband to be covered? And I don't want to go to specialists, but if my doc suggests it... should I? I think if I lay low for a few weeks I'll be okay. But should I expect insurance to help me cover that time and specialists? (I sort of feel that the more specialists you see and the more meds you take, the more risks you are taking with your overall health). And my car, it was reliable, what if it isn't any more, what if they can't fix it? I can't afford to buy another car and since I have to travel so far for a my 10 dollar an hour job (any job in this economy is a good thing) I need a reliable car. What will I do. What do I do with my anxiety about driving again (yes, I'm really rattled by all this) will the insurance cover one or two visits to a therapist to help me over the fear? And will the car insurance cover my lost week or two from work if I miss it? Everyone wants me to see an attorney, but I don't want to. I worked for attorneys years and years ago, I know that routine. I'm not trying to make money on this but I do want coverage and a little compensation for the pain and my husbands lost work and my broken car. Anyone have any ideas how ins company will handle this? and am I silly not wanting to talk to an attorney? (FYI: If I had amnesia or a broken leg then I feel an attorney is valid). ALSO my car had high miles and is old... but it worked so well.

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PostPosted: Sun Jan 08, 2012 8:37 am   Post subject:   

Quote:
And the next thing I hear is the crash and I go flying into that lane.


So I'm assuming that you were rear ended by the other car?



If you are in a PIP or Med Pay state, notify your own carrier.



You get paid by the other carrier by submitting your medical bills and making a demand. You add up your medical bills (if not paid elsewhere or if who paid they can collect from you), figure in your loss wages and then add in pain and suffering. Pain and suffering can include your anxiety but unless you have some type of medical indication that this exists, don't expect it to hold much weight.



If you don't know how much to ask for then you may want to consult an attorney.



Your demand should be higher then what you want. Their initial offers will be low. Its a negotiation.
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PostPosted: Sun Jan 08, 2012 8:37 am   Post subject:   

Quote:
And the next thing I hear is the crash and I go flying into that lane.


So I'm assuming that you were rear ended by the other car?



If you are in a PIP or Med Pay state, notify your own carrier.



You get paid by the other carrier by submitting your medical bills and making a demand. You add up your medical bills (if not paid elsewhere or if who paid they can collect from you), figure in your loss wages and then add in pain and suffering. Pain and suffering can include your anxiety but unless you have some type of medical indication that this exists, don't expect it to hold much weight.



If you don't know how much to ask for then you may want to consult an attorney.



Your demand should be higher then what you want. Their initial offers will be low. Its a negotiation.


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PostPosted: Sun Jan 08, 2012 9:08 am   Post subject: anxiety, diagnosed with ptsd  

I have an ongoing anxiety problem, this has really tweeked it. I just want to be able to see my therapist 2 times to work on a plan but I don't think I should have to pay for it. As far as the car (I live in AZ) I'm worried that it is toast and old and many miles may mean I'm out a working vehicle with very little to help me get another. I'm not sure how this works. I just want to stay in bed until the head achs stop and go to work in a week or so. Not sure how to work thatt either. I'm in a lot of pain from the bruising and just thing 2 weeks off to heal is reasonable. I am not sure what kind of a demand someone rear ending a car, totalling it, hurting me with bruises nad a slight concussion should ask for. I think there is at least 5,000 in car damages, ER and a doc visit, and two weeks off work... not sure what to ask, of course my thinking is fuzzy today.

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PostPosted: Sun Jan 08, 2012 9:08 am   Post subject: anxiety, diagnosed with ptsd  

I have an ongoing anxiety problem, this has really tweeked it. I just want to be able to see my therapist 2 times to work on a plan but I don't think I should have to pay for it. As far as the car (I live in AZ) I'm worried that it is toast and old and many miles may mean I'm out a working vehicle with very little to help me get another. I'm not sure how this works. I just want to stay in bed until the head achs stop and go to work in a week or so. Not sure how to work thatt either. I'm in a lot of pain from the bruising and just thing 2 weeks off to heal is reasonable. I am not sure what kind of a demand someone rear ending a car, totalling it, hurting me with bruises nad a slight concussion should ask for. I think there is at least 5,000 in car damages, ER and a doc visit, and two weeks off work... not sure what to ask, of course my thinking is fuzzy today.

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PostPosted: Mon Apr 09, 2012 4:00 am   Post subject: car accident  

19 months ago, we were in a car accident, we were stopped at a light and got rear ended. It was late at night on a friday. I opted not to take the ambulance ride, but knew that I was sore. Monday I started treatment with a chiropractor. The damage to our vehicle was 2400.00. I have had 88 chiropractic visits, 20 physical therapy visits 11 massage therapy visits, 2 visits to a MD, x rays, and an MRI and a TempurPedic bed. There is soft tissue damage. They also thought that I had a cracked vertebra. This is not for certain however, and would require yet another MRI. The accident was no fault of ours. There were 2 other people in the vehicle, in the front seat. They were not injured. My insurance company has paid the medical and reimbursed the massage. The bed hasn't been paid for, but was prescribed. I was a house cleaner making $25 an hour 3-4 days a week 6 hours a day. With these injuries, I am still unable to complete the duties that are required of the profession I had pre-accident. I have lost the ability to hunt for my family (which was 80% of the meat for our family for a year) I cannot vacuum, ski, take care rides, or plane trips without pain. I have to travel with a Tens Unit to have shock therapy. I cannot play with my kids or lift more than 20 lbs. I cannot stand for longer than 2 hours without my back spasming and my legs going numb. I cannot sit for extended periods without spasms in my back and numbness/pins needles in my arms. Because of these limitations, I am unable to work in the profession that I was in, and have a hard time completing the requirements of a new job. With all of these factors, I am curious what kind of settlement I should be looking for.


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PostPosted: Mon Apr 09, 2012 12:45 pm   Post subject:   

Quote:
I am curious what kind of settlement I should be looking for.




First, see my sig.



You have a soft tissue injury and with the limited information you mention, somethings don't add up. Setting that aside, there is no way for anyone to say what this is worth as all the facts are not known. For starters, we don't know the amount of the meds or if your state allows for an offset on what your carrier paid. We also have not reviewed your medical notes to know what is going on. We don't know your age, etc.



($25/hour for house cleaning?)
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PostPosted: Sat Apr 21, 2012 4:01 am   Post subject: Darn Good House Cleaner  

Yes $25/hour for house cleaning. I am in an oil boom area and cleaners are in high demand. We are in North Dakota. Medical is over 12,000. My carrier has paid for everything because North Dakota is a no fault state. I am 32 now, so was 30 then. Fairly active, skiing, softball, playing with kids and yes cleaning house. What else do you need to know?

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PostPosted: Sat Apr 21, 2012 4:03 am   Post subject: Darn Good House Cleaner  

Yes $25/hour for house cleaning. I am in an oil boom area and cleaners are in high demand. We are in North Dakota. Medical is over 12,000. My carrier has paid for everything because North Dakota is a no fault state. I am 32 now, so was 30 then. Fairly active, skiing, softball, playing with kids and yes cleaning house. What else do you need to know?

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PostPosted: Wed Jun 20, 2012 12:25 am   Post subject: soft tissure injury  

I was involved in an accident whereas someone backed into the rear quarter panel of my car while I was sitting still and my body was turned sideways. I had 1200.00 damage to my car and 2000.00 in chiropracter bills and one trip to urgent care in which I was prescribed pain meds and muscle relaxers. What is the appropriate amount I should settle for. I missed one day of work but was in agonizing pain for a few weeks whereas I couldn't sit still or stand in teh same position for more than minutes. Lower back, neck and mid back pain as well as headaches.



What should be the lowest amount to settle for and highest?


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PostPosted: Wed Jun 20, 2012 5:42 pm   Post subject:   

Quote:
1200.00 damage to my car and 2000.00 in chiropracter bills and one trip to urgent care in which I was prescribed pain meds and muscle relaxers.


Your "chiropracter bills" are far too excessive in relation to the amount of damage done to your vehicle.



Quote:
What should be the lowest amount to settle for and highest?


No one here can answer that question for you. But I'm sure you will find an attorney who will lead you to believe that your new home and future retirement are now secure as the result of your injuries if you allow him to sue the at fault party.



I wouldn't believe it.


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PostPosted: Wed Jun 20, 2012 7:04 pm   Post subject:   

That could be the ER bill _and_ chriro bills together.


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PostPosted: Wed Jun 20, 2012 8:37 pm   Post subject:   

A trip to urgent care -- not the ER -- is about a $150 event (and considerably less, if a person in only counting their HMO copay of $15-$30). I know, I was just there last week for a pulled muscle.



The bulk of the charges are the DC. And we know that they will keep "adjusting" until the insurance companies refuse to pay.



You, better than anyone, should know the kind of energy it takes to do $1200 damage to a rear quarter panel, and how little it really is -- a kid on a bicycle could do that much. I don't think there is as much reported "soft tissue" injury possible by comparison. But I wasn't there either.



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PostPosted: Wed Oct 03, 2012 7:07 am   Post subject: settlement amount?  

I'm 22 and from Milwaukee WI. July 9th a driver pulled out into 2 lane traffic and I hit him after screeching on the breaks. I was found 15 percent at fault because cars in the turn lane that prevented me from seeing the driver, the same cars that prevented him from seeing me. I had bruises and scratches from stomach to chest from seat belt and burns on my arms from air bags. I also had a minor concussion. I was offered 1000. 3 days after the accident I realized the foot pain wasn't going away and I started getting headaches everyday. I declined the offer and went to the dr. After xrays they found that my neck was straighter than it should be due to whiplash. I was sent to physical therapy for the foot muscle strain and whiplash. After 2 and 1/2 months of physical therapy, headaches and migraines daily which prevented me from sitting more than 15 mins and driving longer that 15mins. I was miserable everday with pain at a 6 for hours a day. I tried 3 different types of muscle relaxers. I even had one ER visit (due to the worse headache I've ever had in my entire life) I also had 2 apts with neurologist because my primary dr referred me. I'm doing better now. $7000 medical bills. $200 wage loss. $100 shoes my physical therapist documented that I needed. $.75 for prescriptions and other medical stuff like icy hot pads, tennis balls (recmnd by physical therapist) and $105 in milage for apts at the states .47 a mile. Where do I even start for an amount on my demand letter. Additionally, what's a reasonable amount to settle for?

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PostPosted: Wed Oct 03, 2012 10:49 am   Post subject:   

Quote:
Where do I even start for an amount on my demand letter. Additionally, what's a reasonable amount to settle for?


You start by listing all the expenses you have listed here. Expect the insurance company to deny many of them (if not most). Things like corrective / orthopedic shoes are almost always going to be denied, on the premise that their need was something unrelated to the accident.



You will have to fight them on that, based on medical records and expert witness testimony from your physician (or another physician, which may not be as credible). Insurance companies frequently look at claims like yours as an attempt to collect money for things that aren't collision related, which might, legitimately, be examples of insurance fraud.



If you can affirmatively show that your expenses were 100% related to the collision, and you agree that your share of fault was 15%, you are entitled to 85% of the expenses incurred. Those are known as "specific" or "special" damages. They are documented with bills from health care providers.



When it comes to "general" damages for pain & suffering, those claims are subjective, and insurance companies don't like paying them, because they are not verified by any documentation (other than psychiatrist's or physician's notes, as an example). No one can tell you what they are worth, if they are worth anything at all.



What do you settle for? That, too, is a tough call. Before you get an attorney involved, you add up your actual expenses, deduct your 15% (perhaps), and some folks say multiply that number by 2 or 3 or more as a way to state "pain & suffering" as a dollar value. So let's just say, with medical expenses and lost wages of $10,000 - $1,500 = $8,500, you might ask for $17,000-$25,000 as your general damages.



The insurance company will counter offer something less than that, like $5,000.



You have to decide whether to accept that or not and keep up your demand for a larger settlement. When you come to the point that what you are asking for and what the insurance company is willing to pay is not moving in your direction, then you begin to think about involving an attorney. But the attorney is going to demand between 30% and 40% of whatever settlement or jury award you are given.



And that's where you have to do the math. Let's say the insurance company offers to reimburse for all your specific damages (anything paid for by other insurance will have to be turned over to the other insurance companies, such as your medical insurance (or your employer's workers comp, if you received a WC benefit, for example). And let's say the insurance company offers you $10,000, but no more than that, for your general damages.



If your attorney does no better for you than that which you could have had on your own, you are the big loser. Because your attorney's 30% is based on the total settlement. $8,500 + $10,000 = $18,500 minus $5,550 (or more) = $12,550 minus $8,500 = $4,050 (or less) in your pocket. You could have had $10,000. That $4,050 is actually 60% of what you could have had on your own. You get $4050, your attorney gets $5550. Who won?



Not you.



So just be aware of all those things. And if your collision-related medical expenses

will last many years into the future, you need to consider that as well, and make it part of your claim for damages.


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