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 May 26, 2010 09:28 pm Post Subject:

How much is my claim worth?

No one here can tell you this...But I will tell you that a pre-existing condition will lower it's value..plain and simple..Do bone spurs, and degenerating discs in your neck cause pain? Darn right they do...does whiplash hurt? Yep, can whiplash/car accident cause bone spurs and degenerative disc disease? Nope, so you may have a bit of an up hill battle to fight.

I know you said you didn't have any problems prior...the adjuster will get your medical records, and they will show if you've ever been treated or saw a doc for this, so that should go in your favor.


Few questions;
What EXACTLY was the epideral for? Wasn't for whiplash right? How long ago was that? Do you know if it has worked or not yet? What does your doc(s) say? What's your prognosis?

Has the other carrier made any offer of settlement? Are you ready to settle? You don't want to even talk about settling unless and until you are back as good as you're going to get...

Posted: Wed Nov 03, 2010 09:03 pm Post Subject: Car accident settlement

I was rear ended by another car, which resulted in a four car injury= I had a rear and front car damage/ collision. I am at no fault; my car is totaled and received $13000 for it's value and tax. My daughter is my passenger and received neck and chest soft tissue injury / bruise. She also complained of knee pain. My daughter and I visited the doctor once. I had shoulder and low back pain which I treated with cold then hot compress, and occasional ibuprofen. I was not able to work one day, and had a modified work for another day due to my injuries. My insurance adjustor is only offering $800 for my daughter's med bill and pain/ suggesting. I am being offered $1300 for med bill(200), one day loss work(500); and 600 for pain/ sufferring. Is this how much I should get considering my car was lemoned/ totaled?
Thanks for your advice.

Posted: Thu Nov 04, 2010 03:16 am Post Subject:

You are entitled to recover your actual medical expenses and other direct economic losses ("specific" damages). Whether your car was totaled or not is immaterial. Plenty of people are involved in collisions in which vehicles are totaled and injuries are minimal. If your actual medical expenses and lost wages exceed what the insurance company has offered, then argue that with them. If your daughter is still under medical care, then you may not want to settle her loss just yet. Your injuries have apparently healed without complications.

If you think you are entitled to more "pain and suffering" ("general" damages) than they have offered, you can ask the insurance company for that, but don't expect them to see things your way.

Your economic losses are minimal, and I would expect that your non-economic losses are of similar substance. No one was permanently disfigured, disabled, suffered broken bones, an amputation, or paralysis. Just bumps and bruises, which aren't terribly "valuable" in comparison to more traumatic injuries.

Posted: Wed May 25, 2011 02:55 am Post Subject: sprain neck back

i was walking and i hit by a car, i went to emergency room and was told i have a sprian back neck and shoulder which is consisted soft tissue how can i expect from i suit , need to insurance i have exhaused my medical claim

Posted: Wed May 25, 2011 02:59 am Post Subject:

how can i expect from i suit , need to insurance i have exhaused my medical claim

First, read my sig,

Second, there is no way to know as no one knows your medical treatment, all info on your injury, what state the accident happened in, if there is any comparative negligence, your age, etc.

Posted: Wed May 25, 2011 02:59 am Post Subject:

how can i expect from i suit , need to insurance i have exhaused my medical claim

First, read my sig,

Second, there is no way to know as no one knows your medical treatment, all info on your injury, what state the accident happened in, if there is any comparative negligence, your age, etc.

Posted: Mon May 30, 2011 04:56 am Post Subject: insurance

Isn't a soft tissue injury difficult to proof? I'm not saying the OP doesn't have soft tissue problems,..I'm just asking how something like this is proven.

Posted: Mon May 30, 2011 05:11 am Post Subject:

Medical treatment, MRIs, and doctors notes.

Posted: Tue May 31, 2011 09:04 am Post Subject: insurance

(Just thinking 'out loud' here..) I'm sure if you have 'pre-existing'soft tissue injuries,that would be dfficult to seperate the injuries you had then and now.

Posted: Fri Jul 08, 2011 02:47 am Post Subject: Was Rearended

I was hit in the back of my truck 6800$ damagereplacing frame was disabled just was sent back on light duty as well going to therapy for neck and lower back Lumbar and neck chronic pain still nevr had any problems retired from military wht should my settlemement offer be? :?:

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