I’m going to talk about the settlement process in a personal injury case. Read the entire article so you can know all the steps that go into the settlement demand and the settlement process in a personal injury case. You must have an experienced personal injury lawyer to get your claim. Before we get into the settlement process, really quickly, I just want to say there’s a time limit to sue. For example, in most cases, it’s four years, sometimes there’s a notice of claim that you have to give earlier than four years, and in cruise ship cases, it’s limited often times to one year to sue.
If your personal injury lawyer missed the deadline to file a lawsuit, you lose your case. When thinking about the settlement, you need to make sure that your taste is ready to be settled.
The two most common events that make a case ready for settlement is once you’re finished with your medical treatment, or number two, the value of the case exceeds all available insurance coverage in the case prior to settling the case.
You need to make sure you know every single insurance company that is in place. You also need to know the insurance company limits. It’s important to know this information because if your case becomes more valuable than the insurance limits, your case is ready for settlement.
If you don’t know those insurance limits, then you’re not going to know whether your case is more valuable than those insurance limits. You need to not trust what the Insurance Company tells you the insurance limits. You need to get it in writing. You can request this in writing.
The insurance company has to provide that to you in writing. Even if the insurance company tells you that they’re just aware of certain insurance coverage, don’t take their word for it.
There are times where we’ve been able to find additional insurance even though the insurance company in writing under oath told us that there was limited coverage.
In one case, an insurance company told us that there was $100,000 bodily injury coverage from the careless driver that caused our client’s injury and it was only after pressing them that I discovered that there was an extra million dollar policy at play.
We ended up recovering an additional hundred thousand dollars from that extra million policy in addition to the $100,000, bodily injury liability insurance as soon as possible after your accident if someone else caused your injuries, you need to request every single piece of documentation in your case that includes medical records and medical bills.
Even if the insurance company sends you authorization and tells you that they’re going to request your medical bills and records. Don’t rely on them. Some of the medical bills and records you need to request.
As a personal injury lawyer, I suggest you to start from the events that happened immediately after the accident. If you take an ambulance to the hospital, you need to request those ambulance medical bills and records. If you treat it the hospital, you need to request your hospital bill and record your emergency doctors build.
Those two are going to be two separate bills. I’ve never seen them as the same builder. Always separate the emergency doctors and the hospital bill. If x-rays or ct-scans were taken of you, you’re going to need to also request the radiology bill. If blood work was done, you’re going to need to request the pathology bill and there may be other bills as well, particularly if you had surgery.
You’re going to request the surgeon’s bill as soon as possible, even though I’m going to talk about the settlement demand, which is a written demand package you’re going to give to the insurance company even though that may happen later throughout the entire claim. You are going want to come to continue giving the insurance company for the at-fault party, all of your medical records and bills.
This is so they can properly set the reserve, the amount of money to pay your claim, and so you’re just not springing it on them at the last minute, and then it takes them sometimes more time and a lot more time sometimes to get settlement authority to pay your case. Most people want to get paid as much as possible as soon as possible.
In order for this to have the highest chance of happening, you need to continuously feed the insurance company all of your medical information in order to get your case ready for settlement. You need to send the insurance adjuster all photos in your case that helps support your claim. If you are in a car accident or truck accident, send the insurance adjuster pictures of the property damage, particularly if there was a lot of damage.
The higher the amount of damage, all things equal helps the settlement you need to also, if you suffered injury, whether it’s bruising, cuts, hardware, and your body outside your body, things of that nature. Send that to the insurance company sooner rather than later. You want your file, your claim to stick out in the adjuster’s mind.
The more documents you send them, within reason, so long as they are helpful to your case, the more the adjusters forced to look at your claim, the more time they spend on your claim, the better they get to know it and the better they get to know you. You also want to take pictures, photos of the incident scene, if it’s appropriate. This photo is from a trip and fall case where my client tripped and fell on this vinyl landscaping edge and I went out to the scene very shortly after.
Unfortunately it hadn’t been changed, so I took a photo to show the adjuster what we believed was the hazard that caused my client to trip and fall and suffer stitches right below her eye and a slight wrist injury if I did not take that picture or if an accident victim doesn’t take that picture shortly after there is a chance that the insured, the person that caused your accident, does not tell the insurance company about the hazard.
They may tell their own insurance company there was nothing wrong and they may fix it, and then the insurance adjuster may have no choice but to believe them. If you can get the adjuster photos as soon as possible, if they’re helpful to your claim like this one, it can help settlement.
This case settled for $18,000 and there’s a strong likelihood that without these photos, the case may have not have settled for that much and may have settled for much less or may have not settled at all. You want to send the insurance adjuster ct scans and x rays and MRIs if you have them of your injuries.
If there was something wrong with you. For example, this image is of the large lower bone, the Tibia, and it shows a fracture. In this case, we requested this from the emergency room and we quickly sent it to the insurance company for the careless driver that hit my client while he was a pedestrian.
What it does as I’ve discussed before, is it forces the adjuster to look at the picture. He sees the significance of my client’s injury, and that helps them possibly assign more money to the case. If you’re going to need more medical treatment in the future, be sure to have a doctor write down the type of medical treatment that you’re going to need in the future, how often you’re going to need it, and the cost of it.
I had a case, I settled for $445,000 where an 18 wheeler hit my client, the tractor part of the truck hit my client and we asked the doctor to write down what he thought my client’s future costs would be and every time I’d spoken spoke to the adjuster.
I would tell him this is the surgeries my client is going to need in the future and this is the cost of them that may have helped us secure that $445,000 settlement with my client, fractured the lower large bone right beneath his kneecap and had surgery.
I use a spreadsheet to list the dates of treatment of my clients, the type of treatment, the total bill charges, which the general rule of thumb is the higher your total bill charges. All things equal, the higher the settlement, the amounts paid by health insurance, Medicaid or Medicare, the out of pocket charges that my client owes, as well as the amounts that were paid. In Florida, for example, you’re entitled to recover the out of pocket medical charges.
If your health insurance company or Medicaid or Medicare paid for some of your medical bills, you’re also entitled to recover that money and then you, later on, have to reimburse them at least a certain percentage of it. I’ll get into that in a little bit. You need to have this spreadsheet because it allows you to know all of your medical bills and everything and if one of them changes and you later get an update from one of your medical providers that the bill has been reduced or adjusted.
All you have to do is change one little cell and it adjusts everything. You want to have this spreadsheet so that when you’re talking with the insurance adjuster, you’re on the same page because these insurance adjusters are very busy. They want you to be prepared. The more prepared you are, the better it looks for your claim and you need to know exactly what you’re out of pocket, sir.
So you can estimate the fair value of your claim. If you happen to have health insurance or Medicare or Medicaid or some other type of major medical plan that’s going to pay your bills, you need to know how much they paid because likely they’re going to assert and lean, they’re going want claim from their recovery of your personal injury case, and you need to start early talking with them about how much they are willing to discount the amount that they’re going to make a claim against your settlement.
Sometimes they’re generous. Medicare, for example, allows reduces by attorney’s fees and costs. Medicaid in Florida has a particular settlement formula. Health insurance, it’s going to depend on whether the plan is self-funded if it’s through your employer or not and there are many other exceptions.
There are also certain letters that you need to get out to the health plan and if you’re working for a large business that is self-funded, you want to make sure that this letter goes to the plan administrator. They can incur certain penalties by not timely responding to your request for their lien, and that can result in huge savings.
As I tell people, there’s generally two big parts of the personal injury case. One is reaching a settlement with the outfall parties and number two is the on what I call the back end, getting all your health insurance bills and everything knocked down.
We generally ask for it just over the phone and we want to know how much the health insurers are going to seek from the recovery so we can estimate the amount that the client will be receiving.
It’s very important to know the health insurance lien. For example, let’s say you settle your case for 100,000, but your health insurance paid $100,000 in medical bills and they want to. They want to recover dollar for dollar. You may have issues if that means that the entire settlement.
Now that would likely happen if you work for a huge employer that is not willing to reduce its plan, but you need to know exactly how much the health insurance lien is. I talked about the demand letter earlier on. That is essentially a letter and a package where you’re going enclose all of your medical bills, records and everything of that nature.
Even if we’ve provided the insurance company with medical records, bills, and photos earlier on, we still include it in the demand package. You’re generally going to want to give the insurance company a time limit to response so that they put it in the calendar and they respond within that time limit.
If you don’t give them a time limit, there’s a higher chance that they’re going to sit on the settlement and wait to make you an offer longer. The demand package and letter is your time to explain how this incident has affected your life. You’re going to want to include before and after photos if there’s been a significant change in your appearance or the things that you can do.
If you’re a runner, for example, and now you’re unable to run or you have difficulty running since the accident, send the insurance adjusters some pictures showing that you were able to run and all the marathons are the awards that you received, and then show them perhaps a short video of photos of you that you have difficulty walking.
Now that can again help your case, stand out in the insurance adjusters mind and it can show you that your life has been affected in Florida, for example, if you can show that someone else’s carelessness caused your injury and you lose enjoyment of life, you’re entitled to recover that in certain cases like auto accident cases, the standard is higher. You need to be permanently injured in many but not all cases.
Everything matters every bit that your life has been affected. You want to make sure the insurance adjuster knows this. You can put it in writing. You can also communicate it with them over the phone, in the demand letter.
In certain cases, you’re going to want to say that this demand is contingent depends on there being no other insurance available coverage or in Florida, for example, if you’re making a claim against the bodily injury liability insurer, I usually include language in there that says, this demand is subject to the uninsured motorist.
Ensure waiving their right of subrogation. Now comes the part that everyone wants to know about the negotiation process. You want to make a high demand, but you don’t want to make too high of a demand. I’ve had cases where my clients insist that our demand was very high and that can delay settlement.
For example, if you make a $500,000 demand, but your case is only worth $195,000, so there’s a chance that the insurance adjuster, let’s say he offers you a hundred and 30,000 and he tells you he doesn’t have any more room to increase his offer, there’s a chance, not always, but there’s a chance that the adjuster really does have more money to offer you, but because your demand is so high, he says in his head, why am I going to increase my offer when they may not even decrease their offer? Or even if the claimant decreases the offer, they’re still going to be so far apart.
So making the right demand is very important. In a case, you don’t want to go too low because you should never be willing to settle for your first demand. In most cases, in most cases, you should typically demand above what you’re willing to settle for. This gives you room to negotiate also when you’re negotiating with an insurance adjuster, do not believe what they tell you.
I’ve heard insurance adjusters for the careless party tell me that they were giving me their final offer and then a week later they had $5,000 or $10,000 to that offer. Do not believe what they tell you. Also, if you’re hitting a wall with the insurance adjuster and he won’t increase his offer.
Sometimes you want to speak with the claims manager, but understand that personal injury claims for the most part involved in negotiations, meaning the first offer that the insurance adjuster gives you will not be his last and exception to this as if they’re offering you their policy limits and that’s all the money that’s available.
However, even in those cases, you may be able to squeeze out a little bit about more money from their insured. Assuming you reached that happy place where you’re able to settle the case and you’re ecstatic. The insurance company, generally speaking in Florida, is going to send you one settlement check. They’re generally not going to send you piecemeal or multiple settlement checks.
They are going to require you to sign a settlement release. Essentially that release says you’re never making a claim against our insured for the rest of your life. I, for example, use my own proposed settlement release. There are a few things you don’t want to give up. You don’t want to give up your right to sue any other parties.
For example, let’s say you have surgery and the doctor put in hardware inside your body and Florida. If you just sign the insurance companies released, you may be giving up your right to sue. If that product turns out to be defective or if a doctor medical malpractice to you or other things of that nature, you also don’t want to give up your right to make claims against your health insurer or Medicare and Medicaid and things of that nature, so treat the release very, very seriously.
After you settle with the insurance company that’s the time to finalize your liens with your health insurance company and other insurers. If you fail to pay Medicare or Medicaid, for example, you can be thrown in jail and face huge penalties.
Your health insurance company could possibly reverse the payments that they’ve made or cut off your future health insurance care if you skip them, but as I talked about earlier on, you should have started talking with your health insurers about how much it will accept as their final lien amount so that when the case settles, you’re in a better place to negotiate it.
You don’t want to settle your case, have no idea how much the health insurer will take, and then you lose all your leverage because they may say, we’re not going to reduce it a dime. Whereas if you would have talked with them earlier on, you can make the threat of, I’m not going to continue my personal injury claim unless you give me an off the record that you’re going to accept less than your lien.
I hope you enjoyed this article. Please like it. If you have any other question about personal injury lawyer, you can read an article what does a personal injury lawyer do?