How to formulate pain and suffering amount?

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PostPosted: Thu Jan 08, 2009 4:11 pm   Post subject: How to formulate pain and suffering amount?  

I was involved in accident back in july where car ran red light and hit me as i was passing through my GREEN light. I was injured and set in ambluance till my son arrived then he took me to hosiptal. Had sore chest and side from impact and air bag and seat belt. SO my doctor 3 days later with pain more serve gave me pain pills and stay out of work for week. Went back to work and by the end of that week was in very bad pain from back muscle spasms. Went back to doctor he did xrays gave me more pain pills and muscle relaxers. Have seen him 3 more time and he sent me to physical therapy which i went to 7 times. ( hard to do when you have no car and have to beg for rides!) My car was totaled ($6,456). Was out of work for a total of 6 days ($593). Total of medical bills and physical therapy was $2340.

Was finally released 5 months later so insurance adjuster offered me medical ($1990)lost wages ($472) and pain and suffering of $2014. I told that was not acceptable because to begin with she didnt have my med. bills correct and my lost wages were not correct . I told I would get back to her with the correct information she needed. I sent her a demand letter attaching all the correct information and asked for $18,000 ( I know this is high but just a starting place) for pain and suffering .

Any suggestions on a meet in the middle amount!! Im thinking around $9,000? Thanks for any advise with this.


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katwalkr 1
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PostPosted: Thu Jan 08, 2009 4:43 pm   Post subject:   

Well, I'd have to say that I find your plan to be pretty much perfect.



I can't speak for the $9000 as many other factors come into play, especially the location of the accident (where you live). If I had to take a wild guess I'd say it would be difficult to get close to $9000 as the treatment is for a soft tissue injury and probably has little to no permanency to it. If it did, then I'd say $9000 would be in the right range. My _guess_ is that the adjuster wants to be closer to $5000 to $6000. That is, with $3000 in meds and loss wages. I _think_ anything above that would be a battle.

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PostPosted: Fri Jan 09, 2009 12:40 am   Post subject:   

Tscope, If your boss sends in a form stating your lost wages doesn't the insurance company have to pay you the full amount or are they allowed to try to bargain? If so then his boss could fill out a form and get what is due to him.

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PostPosted: Fri Jan 09, 2009 2:39 am   Post subject:   

I would think that the insurance company would have to pay what the boss is reporting as lost wages, I don't think this part of a settlement is negotiable.

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PostPosted: Fri Jan 09, 2009 5:39 am   Post subject:   

Dear tcope, I'd rather think that the $5000-6000 would be a good deal had it not been the additional visits, associated check-ups and those 7 phy. therapy sessions. How much do you think would then be worthy of it had there been no phy. therapy at all?


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PostPosted: Fri Jan 09, 2009 9:26 am   Post subject:   

katwalkr, IMO one should ask 3 times of the total medical bills for pains and sufferings at the beginning of the bargain. I'd agree with Tcope, with total medical bills worth of $2340, getting $9,000 towards the claim would be an uphill task. You may find it hard to convince the adjuster that you feel that 9k is the right amount to compensate you.


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PostPosted: Fri Jan 09, 2009 10:25 pm   Post subject:   

I was told by the other insuracnce company after a wreck that it is a common misconception to figure the value of a claim at three times the medical bills. I don't know if they were just telling me this to keep the demand down. I have also heard it to be three times the amount. It is said that this is where to begin negotiations. Does anyone know the truth behind this?

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PostPosted: Sat Jan 10, 2009 12:09 am   Post subject:   

A person can have an MRI for $1000 and 2 x-rays for $250 and walk away from the ER with a $3000 bill and be perfectly fine. Another person could have a soft tissue injury or a broken ankle, be in pain and have $3000 in medical expenses. Who should be paid more for their "pain"? Are both injuries worth the same $9000/3x the meds, settlement?



I'd like to think that adjusters and attorneys use some other means to determine what an injury is worth other then taking the medical bills and hitting a few numbers on a calculator.

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PostPosted: Sat Jan 10, 2009 12:21 am   Post subject: re:  

Compel us, kat, why do you think your claim is worth $9,000? If you can convince this forum, I'm sure you can convince the adjuster.

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PostPosted: Sat Jan 10, 2009 2:21 am   Post subject: insurance  

I would think WHATEVER amount you ask for (Medical, Pain and Suffering, etc.) you would have to have SOME kind of proof. I mean,.......what ever your Medical bills are, can the Insurance Adjuster 'go from that' how much Pain and Suffering was involved? Your Dr's bills, etc......that should tell them, as well.

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PostPosted: Sat Jan 10, 2009 9:31 pm   Post subject:   

My aunt was rear ended, she went to physical therapy and pain clinic, two years after the accident the insurance company wanted to settle for $7500, she ask what if she refused it, they said that it would go to court and she would probably lose. Well, she refused the offer, about two weeks later they came back and offered her $25,000, so in her case it worked out.



Seems like $7500 is the standard offer for any injury these days. Do you find that to be true?

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PostPosted: Sat Jan 10, 2009 10:30 pm   Post subject: re: $7500  

She refused $7,500, waited 2 weeks and they offered her $25,000?



No, that's not what happened. That range is extremely unlikely. Also, it doesn't go to court if the offer is refused. It goes to court of she sues the insurance company or the other driver/vehicle owner. Since you didn't indicate she filed suit, there would be no motivation for the insurance company to come back with an offer more than 3 times the original.



In general, what the insurance company offers you for your injury will be fair. There is no formula and perceptions of the value of pain vary. Every claim has a range, whether it's $100-200 or $22,000-$26,000 and there is nothing wrong with negotiating to the higher portion of the range.



There are ranges which will be less than what is fair, but those cases are more often the exception than the rule.

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PostPosted: Sat Jan 10, 2009 11:40 pm   Post subject:   

Quote:
I was told by the other insuracnce company after a wreck that it is a common misconception to figure the value of a claim at three times the medical bills.
You were told correct this is a common mis-conception, however, in the 'good old days' this was a starting point but no longer....





OP I agree with the other adjusters, I think 9k is too high, (given the information we have)...a lot goes into figuring out an injury settlement...specials or actual bills (loss of wage, medical bills etc) are a given but as to the 'pain and suffering' portion many many things go into that...location is a big one, age, prior health, prior fitness (or lack of), prior injury or simply age degeration, also were there any 'gross' negligent factors with the accident..since pain and suffering are subjective, this is where the real negotiation comes in, as well as looking at each claim on it's own merit...



I've had people with fractures including vertibrae, that never missed a day of work...and others with soft tissue injuries not work for months... go to p.t. or chiro, every day for six months....so you see there is much more to it than figuring it from the bills etc.



Most soft tissue injurys will (in truth) resolve themselves within 30-60 days or so...you can treat and feel better or maybe get over it quicker with some p.t. etc. but typcially if you are in good health and age hasn't started to get to you yet, or your healing process (sure has got to my 'healing' ability, I'll tell ya! Rolling Eyes )...soft tissue injuries are not permanent.



IMO, given the information we have I would think your claim (including specials) would be in the 4500-6k range...
Quote:
I don't think this part of a settlement is negotiable.
It's not, loss of wage is pretty black and white it is what it is...



Good Natured, your aunt's claim had more to it than just waiting two weeks...(for sure) there may have been some medical bills not received by the carrier, or more than likely some doc reports that moved her injury value way up...hard to say without seeing the claim, but I'm sure the adjuster got some (new) information in that two week period that changed the value of the claim.


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PostPosted: Sun Jan 11, 2009 1:38 am   Post subject:   

Lori, What does location have to due with a matter? This one really stumps me. Is it like car insurance and how rates are hugher in one area?

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PostPosted: Sun Jan 11, 2009 1:54 am   Post subject:   

Yes fireyone, car insurance can be higher in some places versus others, I just went through this and is what made me change insurance companies. My rates went up because of all the medical claims in my area, or that is what my insurance company said. Any way went to a bigger company that said they could absorb the cost and give me a lower rate. At least that is the way that they explained it.



I guess they factor in the area, how many claims are filed, what the laws are (tort laws) and then factor the rates that way. correct me if I am wrong or elaborate, that is the way that I understood what they told me on the phone.



Lawsuits differ by area also, my husband was hit head on and if it would have been in the bigger county the attornies told him it would have been a million dollar lawsuit, since it was a smaller county it was worth $280,000 minus attorney fees.

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