Why insurance claims for soft tissue injury are so critical?

by Modelkrb » Mon Apr 13, 2009 10:01 pm

Filing for an insurance claim is a tedious process. You eventually get paid for the losses, but only after the insurance company verifies that your claim is authentic. You would rather not expect them to pay more than what your loss had been. On the contrary, the insurers may try in every way to pay as less as possible. In that case, you may have to fight hard to receive a satisfactory compensation. Demanding insurance compensation for soft tissue injuries might be all the more difficult.

What is a soft tissue injury?

Soft tissues in a human body include everything except the bones and the organs. Thus, any injury to the muscles, ligaments, tendons, and other connective tissues can be termed as a 'soft tissue injury'. Bruises, sprains, strains, abrasions are the common soft tissue injuries that might affect an individual. Whiplash is one of the most prominent forms of soft tissue injury that affects the neck and upper back of the individual, if his/her car is rear-ended during an accident. Top

When to claim compensation for a soft tissue injury?

Claims for the soft tissue injuries are incorporated as a part of personal injury compensations that you can seek from your insurer after an accident. It is only justifiable to file a soft tissue injury claim when the injuries have been caused by:
  1. Auto accident
  2. Reckless or violent activity
  3. Defective equipment
  4. Defects in playing surfaces
  5. Lack of proper supervision
  6. School sporting activitiesTop

How are the injuries treated?

The soft tissue injuries cannot be easily diagnosed and there are no specific treatments for such injuries. However, health care specialists often use prescription drugs to relieve the pain from the injuries. The most recommended forms of treatments include:
  1. Rest
  2. Physical therapy
  3. Chiropractics
  4. Oral pain relievers and muscle relaxants
  5. Soft cervical collars (to immobilize neck after a whiplash injury)
  6. Massage
  7. Heat
  8. Ice
  9. Injection
  10. Ultrasound.
    11. Top

Why soft tissue injury claims are different from other injury claims?

Soft tissue injuries cause pain and soreness to the affected individual. Not only that, it also affects the earning capability of the individual. However, unlike other injuries, it's difficult to document them. Most of the time, the injuries don't show up on the skin. Even X-rays may fail to point out that injury in the area. The treatments may not follow the conventional path, as for other form of injuries. It's also hard to determine the claim amount for pain and suffering and loss of pay. The insurers often take a long time to settle a claim for a soft tissue injury. Often, the injured has to go to a trial to get a reasonable amount as compensation. Top

How much to claim for settlement of soft tissue injury?

The claim amount for soft tissue injuries differs from person to person. Your soft tissue injury settlement claim would depend mainly upon the factors mentioned below:
  1. The treatment - Your diagnosis and the mode of treatment will affect the claim amount, since you'll be asking your insurer to reimburse the corresponding expenses.
  2. Your income - Your income will affect your claim amount, since you'll be asking compensation for the loss of pay. Losses of past and future income along with the cost for future care are included when an insurance claim is filed. Besides, it would also depend upon the duration for which you were unable to work.
  3. Attorney fees (if any) - In case you're hiring an attorney, your claim amount should be more than the actual expenses for the treatment and loss of pay. It is so, since the attorneys deduct a share of the settlement amount that the insurer pays you.Top

Points to remember when filing claims for soft tissue injuries

Certain factors should be kept in mind, if you want to file an insurance claim for a soft tissue injury, as mentioned below:
  1. Take pictures of any visible symptoms - It is difficult to prove the extent of injuries. Therefore, any physical symptoms like swelling or bruising should be documented with the help of photographs.
  2. Save the documents - All details of medical advices and treatments should be stored in a proper order. You might need them to substantiate the treatments for your injury.
  3. Negotiate on your own - Try to settle the amount yourself initially. Negotiate with your insurer to arrive at a reasonable claim amount.
  4. Consult an attorney - Hire an attorney to represent you, only when your insurer refuses to pay anything. You should keep in mind that you'll need to pay the attorney, out of the claim amount that you receive.
  5. Don't make haste - You must have patience when dealing with your insurer. A settlement will take time, if you want to receive a decent amount at least. You can claim for any soft tissue injury, if the other party is responsible for it in any way. Every insurance claim needs to be proved. As for a soft tissue injury claim, substantiation is all the more vital.

You can claim for any soft tissue injury, if the other party is responsible for it in any way. Every insurance claim needs to be proved. As for a soft tissue injury claim, substantiation is all the more vital.Top

Related discussions

i have a similar post but i am going to go into detail with this.i need you alls advice.i am wondering what is the highest amount i can get from soft tissue injury settlement after my attorney takes her 33 percent out.Here Is My Situation,On December 26,2008 I Was At A Stop Light Waiting For It To Turn Green.The Light Finally Turned Green.As I Was Pulling Off The Lady Behind Me Ran Right Into The Back Of Me.We Pulled Over She Came To Check On Me To See If I Was Ok.At The Time I Was Fine.She Immediately Got On Her Phone And Called Her Insurance Company In The Process Of Doing That She Was Telling Me I Dont Have To Call The Police She Will Take Care Of My Car.I Called The Police Anyway To Make A Long Story Short She Ended Up Getting A Citation For Following To Close.This Was 11am On A Friday.I Didnt Feel Sore Until I Want To Say 12 To 1.A Member Of My Church Reffered Me To An Attorney,She Gave Me The Name Of A Chiropracter To Go To.I Went In And Basically I Went For 3 Months At 3times A Week.To Make A Long Story Short My Car Damage Was 559.78 .My Lawyer Said That Usaa Doesnt Believe That The Damage To My Car Was Bad Enough For Me To Be Hurt.If I Wasnt Hurt I Would Have Never Went Threw The Process Of All Of This.My Lawyer Asked Me To Contact My Insurance Company To See How Much Is My Med Pay.Ok To Make Another Long Story Short My Entire Bill With The Dr Was 3,692 And Some Change,My Med Pay Paid My Entire Bill So I Am Ok With That Portion,My Lawyer Put A Demand To Usaa For 16,000.I Understand I Am Not Going To Get That Much Back.Usaa Is Offering 4,225 That Is Too Low And My Lawyer Already Said She Is Going To Put In Another Demand.My Question To You All Is What Is The Most I Can Get From A Soft Tissue Injury Settlement Claim.If You All Have More Advice For Me Feel Free To Reach Me On Yahoo Messenger My Id There Is Kai30034 I Need All The Advice I Can Get.

Total Comments: 97

Posted: Fri Jul 08, 2011 03:33 am Post Subject:

Well, you make a demand they make an offer.

No way to know. Not enough info. You could have $500 in medical bills... you could have $50,000. Obviously they would warrant different settlement amount.

Posted: Thu Nov 24, 2011 10:15 am Post Subject:

My son was in an auto accident where a car rear ended a car and came over in his lane (head on and my son went on the shoulder to avoid the car) and was t-boned where 3 oh his door air bags saved his life. The impact also caused the tweeter from his stereo to come out the door and hit him in the mouth chipping his 2 front teeth. The car was totaled which was a 2006 mazda rx8. He luckily walked away from the accident. He went to the ER by my husband and was diagnosised with a concussion. He had to go back to the ER two days later due to dizziness and headaches and was told he still was suffering a concussion and would take some time to recoup. We have finally finished with his treatments which only totaled 9k. The other persons insurance company says they can only offer us 3k plus med bills because his injuries were not serious. Need advice if I should settle or not

Posted: Thu Nov 24, 2011 10:53 am Post Subject:

First of all START A NEW THREAD TO GET A REPLY FROM AN EXPERT.

if you could give more details, it would be better.
You say your car was totaled, how much was offered for that, only 3k?
You say that they are offering med bills, how much for it? since you've already spent 9k.
Start a new thread along with full details.

Posted: Fri Nov 25, 2011 12:37 pm Post Subject:

We have finally finished with his treatments which only totaled 9k. The other persons insurance company says they can only offer us 3k plus med bills because his injuries were not serious. Need advice if I should settle or not


I assume by $3,0000 + Medical Bills, this has nothing to do with the value of the vehicle -- that the $3,000 is for "pain & suffering" (AKA: general damages). Whether to settle for that amount or not is up to you. If you feel that is a decent amount of money, fine, if not, demand more.

If you are unreasonable in your demands, then the insurance company will stop negotiating the claim and you'll have to take the AT FAULT PARTY (not the insurance company) to court.

That will mean hiring a personal injury attorney who will want 30%-40% of the final settlement, which most likely would mean that the attorney will end up with more money than you.

So weigh your options and proceed accordingly.

Posted: Sat Jan 07, 2012 01:02 am Post Subject: auto

Both my wife and I were injured in a "serious" collision, deemed serious by insured’s company bc of speed and damage. We both have cervical sprains and neck and back pain that we have been treating for over a year and a half. My specials are approaching $12,000, of that only $5000 is NOT subject to subrogation and $1200 out of pocket for treatments not covered by our IBX plan. AllState offered $3400 to settle my side.... we didn’t even bother to listen to them for my wife's side. We are both still treating and expect from our diagnosis that we will need pain treatments for the foreseeable future. Our statute expires soon and we have tried to settle but we are way too far apart. On top of medical costs are the hundreds of hours in PT, doctors’ offices. As anyone else would feel, my time is valuable and this time away from my daughter, wife, friends, whatever can never be recovered.
Obviously it looks as though we are going to have to go through attorneys, but just wanted to show that sometimes it’s not a logical or fair process.

Posted: Sun Jan 08, 2012 07:13 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.

Posted: Sun Jan 08, 2012 08:37 am Post Subject:

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.

Posted: Sun Jan 08, 2012 08:37 am Post Subject:

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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