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: Wed Oct 29, 2014 04:14 pm Post Subject: neglect auto accident

I was in an auto accident due to a mechanics error. He failed to tight or do something right on one of the brand new tires I had on my truck. I wrecked my truck in another state within six hours. Truck was totaled. I have been going to four doctors. My ribs did not heal properly, ive been told I have ptsd extremely bad and on the verge of a nervous breakdown. before the wreck I resign my job and was moving in the state I wrecked in. I was on my way there and had the wreck. This wreck delayed my dream and plans. I now have lost everything and had to return to my home state to see the doctors and hired a lawyer and I have already occurred medical bills over $20,000.00. I have no job, no home. I lost all income. I lost everything due to this negligent of this mechanic. im having to stay with a friend. I see all these doctors every week. This happened in July 2014. I have nothing left. I cry every single day. I lost my dream that I worked hard for and it was gone in seconds that night. I suffered rib damage, concussion, post concussion syndrome, ptsd. ive been losing weight, I don't sleep, I stay in my room all day when im not at doctors. The life I was suppose to be living has been taken away. I know ppl say its on hold...I didn't choose that. I am the one who is suffering. How do you compensate me for that. How do you put a price on that. Ive lost everything.Literally I have lost everything. I am now penniless. I have had to use all that I had saved to move there to live here and spend on medical also. Please tell me, i am not sure if this going to go to court, but i cry each day i never thought i would be in this position, it is hard to tell someone what their dream, their life their value is worth. But what should i ask for. I have lost so much. Thank you.

Posted: Wed Oct 29, 2014 05:59 pm Post Subject:

and hired a lawyer

You have already obtained legal counsel, and that's the person you should be asking for the answer to your question. It makes no difference what anyone here thinks about this now.

Posted: Mon Dec 01, 2014 10:03 am Post Subject: Questions

I was involved in an accident at work, I was driving a truck delivering steel. The truck had problems where it would "bog" down at 60 mph or at lower speeds it would completely stall out. Anyway, coming up to a red light I was preparing to brake and the truck stalled out causing the power assist portion of the braking system to not be available so basically had manual brakes on a 26,000 lb truck. Long story short, I rear ended the off duty police officer in front of me and totaled his truck. I was cited for assured clear distance. As a result of the accident I missed 3 days of work and was eventually dismissed. I have soft tissue rib injuries that I am still dealing with, the accident was about 2 weeks ago, and I am now unemployed also. Please help me understand what I need to do to from here, I have never been in a situation like this and would greatly appreciate any help at this point.

Posted: Mon Dec 01, 2014 05:00 pm Post Subject:

If you are in the United States, then your injuries are covered under Workers' Compensation, whether you were fired or not. As such, you are still entitled to medical care, and possibly lost wages. If you cannot resolve this with your [former] employer's workers' compensation insurance carrier on your own (or don't want to try), then you will need to see a Workers' Compensation attorney. There will be no charge for this, because attorney's fees are generally set by law in WC cases, and are paid from any settlement made with you..

The issue of being fired is something you need to discuss with an attorney who specializes in Labor Law/Employment Law. The WC attorney may also practice in this area or can refer you to another attorney who does. See the WC attorney first!

Posted: Mon Dec 29, 2014 10:44 pm Post Subject: rear ended

I was rear ended about a. Week ago an my leg was left swollen an i had a big bruise an it hurt to stand for long time which is my job i did go to hospital got x rays they said it is muscular sketile pain an would be better in a few days we have been found to be of no fault what should i expect in the settlement im trying not to have to get a lawyer any tips for talking to the adjuster

Posted: Mon Dec 29, 2014 10:56 pm Post Subject:

If your injury was connected to the collision, then you are entitled to have your medical expenses and any lost wages paid by the at-fault driver. As for the "pain and suffering" damages, maybe an additional $250 or $500 at most. You have no permanent injury, and no permanent disfigurement.

You have no reason to involve an attorney in this matter -- even if the insurance company were to deny your damages for pain and suffering -- unless the other driver's insurance company refuses to accept liability.

Posted: Tue Mar 10, 2015 03:28 pm Post Subject: Glass in knee

I was shopping at a large retail chain. I saw an item on the lower shelf and knelt to get it and felt terrible pain in knee. I got up and saw blood on my jeans and found a thick chard of glass in my knee. I immediately got a sales clerk and told her what happened. She told me there were some items broken in that aisle. The manager gave me some disinfectant wipes and a bandaid and took a report. There was a camera in that aisle and after the report asked me to show him. We picked upwards of twenty pieces from the rug together. I took care of this myself. I felt there was something still in my knee and found there were two pieces very thin and I had two places the glass entered. My job requires I kneel at times and I couldn't for weeks. I sent the insurance co pictures of my knee and my jeans. The adjuster offered me $300. I rejected this offer. Now they want to know my demand. What is fair? This was total negligence on their part

Posted: Tue Mar 10, 2015 04:40 pm Post Subject:

Now they want to know my demand


Were you permanently disfigured by the injury? Are you permanently disabled as a result? How much time did you lose from work? How much were your medical bills which were (a) covered by your own insurance and (b) not covered by your insurance?

Your damages are in there. If you have a permanent disfigurement (probably not), that could be worth some money. If you were permanently disabled (probably not) then you are entitled to compensation. If you lost time from work (probably not), then you can be compensated for the amount of lost income you incurred.

If your medical expenses were paid by the store, then you have been indemnified for those expenses. If your medical expenses were covered by your own insurance, then the insurance company is entitled to recover 100% of what it spent on your behalf from whatever amount of insurance company money you receive -- even if you don't tell them about it, they may find out later and sue you for it. If you had medical expenses not covered by insurance (you paid them out-of-pocket), then the amount of the charges you have receipts for are your damages.

But if all you are thinking of is collecting for "pain and suffering" and none of the expenses/compensation above, then take the $300 and be satisfied they are offering that much. Maybe they will increase it to $500 if you ask nicely.

You did not suffer a million dollar injury.

Posted: Wed Mar 11, 2015 03:04 am Post Subject:

Depends on a lot of things but if there was no medical treatment then I'd say what state the accident happened in is more a factor than anything else. If no treatment and you have had a full recovery, I'd say settlement is in the realm of $700 - $1200.

Your demand should be a little more then you want to settle at... just like the adjusters initial offer is lower then they want to pay. You may want to figure the amount you want to settle on and then come up with a number that puts it in the middle of their initial $300 demand and your initial demand. Or you may want to test the waters and ask for something like $3,000. Just understand you are going to need to come way down from that number.

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