Insurance Guys, I need help!

[WIII-60]

My wife-to-be was hit by a driver in an injury accident in which he was found at fault. She was driving my truck which, as it stands, isn't a total loss.

here's what I know: We are entilted to lost wages for days we've missed as a result. we will have some settlement for pain and suffering. We will be compensated for medical expenses. I can ask for depreciated value for my truck if it's not totaled.

Here's what I don't know: Is there a way that I can educate myself on what reasonable amounts are to negotiate our settlement? I understand that my vehicle is to be restored to "pre-accident" condition. How picky can I expect to get away with being? I have about $3500 dollars of aftermarket stuff on there. Have I missed any major claim issues to which we should/can ask for?

Can someone coach me through this process even though it may go against the, hmmmmm, ethics of representing an insurance agency?

She is O.K., thank god she was wearing her seatbelt.

[Bassn Blvd]

Seek an attorney

[Micro]

We are entilted to lost wages for days we've missed as a result.

Yes, but try to get "disability" slips from the treating doctor, otherwise you may run into an adjuster saying the missed days were not necessary.

we will have some settlement for pain and suffering.

Yes.  otherwise known as "general damages."  This is the subjective part of your claim.   Not qite as quanitifiable as the things you can add-up, like medical bills or lost wages.

We will be compensated for medical expenses.

Yes, reasonable medical bills for reasonable treatment.  If you try to run up medial bills to increase your settlement, you will have a tougher time settling.  There is reasonable treatment for most diagnoses.  Try to stick to it i possible, otherwise you will have to explain why you deviated and it will make the process harder.

I can ask for depreciated value for my truck if it's not totaled.

In most states.  If your truck is 7-10 years old or has more than 100,000 miles - probably forget it.   If not, you can probably claim this.   Be reasonable.  Don't rely on some nimrod car salesman to tell you what to claim.  There is an industry method to calculating this and it is usually non-negotiable once the company makes an offer.

Is there a way that I can educate myself on what reasonable amounts are to negotiate our settlement?

No.  it's a subjective process.  Of course, add up those things you can add up.  lost wages and medical bills.  Claim mileage for driving to and from the doctors.  General damages it the subjective part.   If you don't know what to claim, ask for an offer.  The insurance company has to make one.  Only you know if it's reaonable.  If you and the insrance company VBOTH walk away thinking you could have done better, it's probably a good settlement.

I understand that my vehicle is to be restored to "pre-accident" condition. How picky can I expect to get away with being?

If your truck is 2 years old or newer, I'd demand OEM parts.  If it's got some age, used or aftermarket parts are the standard.  Don't let anyone fool you - used parts are usually BETTER than aftermarket parts.  Used part were OEM once and they fit.  Aftermartet parts are made in China or Taiwan are are rarely as good as OEM - even if they are CAPA certified.  

I have about $3500 dollars of aftermarket stuff on there. Have I missed any major claim issues to which we should/can ask for?

 

You can only claim for what's damaged.  Be fair.  Claim what you can - but don't expect to be paid for things that weren't broken.

Can someone coach me through this process even though it may go against the, hmmmmm, ethics of representing an insurance agency?

She is O.K., thank god she was wearing her seatbelt.

Absolutley.

[KYbass1276]

Seek an attorney

x2 let them sort through it

[WIII-60]

I would prefer not to turn this over to an attorney. I have retained one, but am not really interested in sharing any money with him.

I'm looking for responses to the questions I posted from a professional in the industry. I'm not really seeking opinions on what I could or should do. Thank you for your advise though.

Thanks for your response Micro. Can I PM back and forth with you if need be?

[Bassn Blvd]

I was a professional in the indusrtry.  Don't think for a minute thet an insurance company is going to settle with you for more than an attorney could have gotten you.   Do what you want.

[Micro]

An attorney may get you 10% more.  Then he'll take 33% of your total settlement.  I love it when I make a settlement offer to someone and they run out and get an attorney, then find out the offer remains the same or that they pay more in attorney fees than the increase he got in the offer.  

If it's a simple claim, you don't need an attorney.  If it's complex, they can be helpful - if expensive.  

[Hoover]

There is an old saying:  Dollar wise and pound foolish.

Adjusters negotiate with people like you every day.  Believe me, they are at a distinct advantage.  The insurance company will low ball you and refuse your most earnest demands.  Then what will you do?  Sue the insurance company on your own?  Accept their low ball offer?  

This claim involves personal injury, a complex matter in terms of legal issues.   The facts you present do not give much information about the extent of injuries suffered, the property damage and other issues.

The first question you need to ask yourself is:  How much money am I willing to leave on the table?

[Micro]

The insurance company will low ball you and refuse your most earnest demands.

: You listen to too many lawyer ads.  Unfortunately, so do a lot of people.  Most demands I receive from unrepresented clamaints are absurdly high.  Many people run out and hire an attorney thinking that are being taken advantage of.  Turns out, in many cases, even the attorney agrees their demands are too high and they end up settling for less.

Here's a trick for anyone that hires a lawyer based on their grandiose T.V. claims - see what the attorney is willing to guarantee you, and if he gets less, see if he will waive any fee.  And if you do extract an offer out of an insurance company on your own before you hire an attorney, get the attorney to agree only to base his fee on that amount he gets you IN EXCESS of the original offer.   See if he puts his money where his mouth is.

[Bassn Blvd]

How would the average person know if he was getting a good deal or lo balled w/out an attorney.  If you settle for 100k then you'll probablly get 75-85k, depending how well you know your attorney.  Goes to trial then he gets more but so do you usually, if you win.  

They also say that any man who represents himself has a fool for a client.

[burleytog]

Having attempted to deal with an insurance company on my own, I will say that it is foolish to not hire a lawyer.

If I am ever involved in another accident, I will be calling my lawyer ASAP.

[Micro]

Well, they certainly won't get a good idea of what is a reasonable settlement if they listen to the plethora of attorney ads on television - promising "cash, cash, cash," and huge settlements.  That's one of the problems today.   Attorneys set obscene expectations - and rarely deliver.  More often than not, the client walks away the loser - having received less than they would had the attorney never been involved.

Here is the cold hard fact - the value of a claim doesn't increase because someone hires a lawyer.  If a claimant wants to give away part of his money to some attorney, that's between his lawyer and his client.  Don't expect an insurance company to increase its offer just so you can pay some lawyer.   And if they do increase for some reason or another, they rarely increase enough to cover attorney fees.  Again, more often than not, the client walks away worse off then had he left the lawyer out of the picture.  

What's a fair value?  Hmmm.  If an attorney is involved, the anwer is invariably "more."  The real answer is that no one really knows what's fair.  Only a jury can make that determination.    If you think it's fair, if you walk away happy, who is to say you're wrong?  

Hire an attorney if you want to.  Go ahead and pay him that which si rightfully yours.  But don't expect much.  Don't expect him to live up to his TV image.  It's rare that that ever happens.  

'Has a fool for a client?"   I prefer...

"Persuade your neighbors to compromise whenever you can. Point out to them how the nominal winner is often the real loser - in fees, expenses, and waste of time. As a peacemaker the lawyer has a superior opportunity of becoming a good man. There will always be enough business. Never stir up litigation."  - Abraham Lincoln

That's an axiom lost on the plaintiff's bar these days.

[KYbass1276]

No offense Micro but to me your makeing the case for hiring a attorney all the more by saying not to hire one.   Typical insurance company tatic.  While I think there are alot of people out there who try to screw the insurance company, I also think there are alot of insurance companys out there that try to screw over people.  Insurance companys are like any other business they try to save a buck wherever they can.  

 In any case attorney wise shop around no one said you can't get second opinions from different attorneys before you hire one.   Talk to one then go see a couple more and see what they have to offer and let them know your getting other opinions from other attorneys  might help keep them honest if there is such a thing with attorneys

[Hoover]

While I think having Micro provide advise is a little like inviting the fox into the hen house, he does make a very good point that W-III obtain his best offer from the insurance company and then ask the lawyer to take his percentage over and above the offer.

Micro, I could take offense to your off the hand comment that I watch too many lawyer ads in that I happen to be a business litigation attorney who is presented with claims against insurance companies for business losses, etc. from time to time.  I agree that claims have to be reasonable and fair for both sides so long as the injured party is made whole.

I think we all agree that we have insufficient facts to know even if the insuries suffered are worth the typing effort.  Nevertheless, you have to agree that his fiance may suffer from soft tissue injury which may not show up for months.  We do not know if his truck is unusual in some way which would give it more value.

Sum and substance, the purpose of insurance is to make sure that that the injured party is made whole for his damages and injuries.  It was not her fault.  Thus, she should be adequately compensated for her loss and his loss (property damage).

At the end of the day, whether W-III comes out ahead will depend upon the facts of his particular case.  

I respect what you have to say and it certainly is one side of the insurance claim business.  However, I do not need to watch attorney ads to know how insurance companies operate.  Their operations are not looking to offer fair settlements at the out set.  Typically, it is the threat of punitive damages that gets insurance companies to pony up for the damages actually suffered and damages anticipated to accrue.  Even you concede that while the initial damand from the injured party is unrealistic, the attorney can present an offer grounded more in reality, but certainly significantly more that the initial insurance company offer.

By my response here, I don't want to have this discussion deteriorate into an attorney bashing or insurance company bashing thread.  My comments are really for the benefit of our member who asked a question about his damages to his truck and personal injuries to his fiance.

As in every court case, there are 2 sides to every dispute.  And the settlement rate of those disputes prior to trial is at about 95%.

[Pond Hopper]

Having attempted to deal with an insurance company on my own, I will say that it is foolish to not hire a lawyer.

If I am ever involved in another accident, I will be calling my lawyer ASAP.

I agree, when I was 19 I was in an accident with a hit and run(drunk) driver (that was never proven) and thought I was tough because I negotiated with the insurance company myself.  I got a nice check but based on circumstances had a friend of the family(my lawyer now) who told me I should of got 10 times that amount.  Although I guess they paid for 4 doctors visits and 38 chiro appointments :

Like others said if it is routine stuff, I may not call the lawyer, but anything serious I would let them handle it.  

[WIII-60]

Whoa.....

In response:

bassnblvd: Don't get upset man. I don't know if you used to work in insurance or were a sword swallower before you did whatever it is that you do now. Either way, you didn't answer any of the questions I asked. I thanked you for your response and clarified what it was I was looking for. I apologize that intonation cannot be expressed in the written form. If that won't suffice, you're free to beat your chest on another thread.

Micro: Before I get into this anymore. Do you work for American Family? Is your name Judy? If so, this may be a conflict of professional interest for you.

Hoover: Thank you for your well written response.

In general: The vehicle is worth roughly 21K prior to the accident. It will not be a total loss, so there will be diminished value. What is a fair number to expect being that the vehicle will be EXTREMELY difficult to sell with an accident on a carfax? How should I support this number with concrete data. The injuries involved sprained wrists, a sore foot, whiplash, chest contusion, and airbag burns to the forearms. There was an ER visit that documents injury. She has seen a chiro who is also documenting treatment. five total days of lost wages between us which is, from what I understand, a basic dollar for dollar transaction assuming that it was necessary that we both miss that time. The repair to the vehicle is being done at a reputable shop that I trust. Because of factors that I would prefer not to discuss on a public forum, I'm confident that my vehicle will be in better condition than it was before the accident, so it's really a non-issue there. Overall, the pain and suffering and diminished value are what I think to be the seriously negotiable figures, correct?

I would prefer to handle this myself for a couple of reasons

1. Because of what I do, I have a general distrust of legal council (no offense hoover), my opinion is one-sided and based only on my personal experiences within the criminal justice system, which is flawed as a result of their influence (ask OJ). Couple that with the fact that they make more money than they need to for doing what they do (ask a teacher). My ethics as a person are more important to me than a paycheck (again, no offense hoover) and I don't want to be a part of his/her profit.

2. I don't intend to get rich from this. Overall, I loath people who abuse any system for their own personal gain. If I walk away from this feeling like I've gotten mine then I'll be happy. I'd just like to know as much as possible about my opponent before we sit down to hash this out.

sorry for the wordiness.

[Hoover]

WIII, thank you for your thoughts.  I am not offended in the least.  It is certainly your right to pursue whatever course you choose to follow.  I was only providing some thoughts that may cause you to consider one path over another.  I wish you good luck and a successful resolution to your claim.

Tom

[Micro]

Hoover, I understand your position, but respectfully disagree with some of your assertions. I have been doing this for many years and have directed the litigation of many, many cases. I continue because I am successful. I know more than a few plaintiff attorneys that would agree with me.

Insurance companies are regulated by the state. They must practice in good faith. Companies must give consideration to a claim, make an offer, and give a reasonable explanation for the basis of that offer.

Your assertion that companies don't want to make fair offers is not supported. It's a myth perpetuated by the plaintiff's bar to make the claimant feel as if he will be taken advantage of, and to generate business for attorneys.

For instance when I evaluate a claim, that evaluation takes into consideration all that I mentioned earlier (and much more), to include the history of the venue and the likely outcome at trial. For the most part, claim evaluations take this into consideration. An offer that is generally consistent with the settlements of similar claims, as wells as the outcomes of trials involving similar claims, bespeaks fairness, though it may not be what some attorney wants. Nevertheless, what an attorney wants isn't the definition of fair.

Neither you nor I am able to say what a claim's true value is - we can only offer our best guess. A claim's true value can only be determined by a jury. Any settlement reached prior to trial is merely a compromise. But insurance companies take pains to evaluate claims fairly. I've worked for two large companies and part of my duties included training adjusters to evaluate claims. I know that thorough, fair evaluations are the norm. Often times, adjusters know the cases better than the attorneys that present them.

I also disagree vehemently with one of your statements (though note I am not making a commentary on WIII's claim): "Nevertheless, you have to agree that his fiance may suffer from soft tissue injury which may not show up for months." There is nothing in credible medical literature that supports that statement (though some chiropractors may want you to believe otherwise). Soft tissue injuries do not manifest themselves spontaneously months after an accident. Injuries, it goes without saying, are traumatic. People know if they are injured. Medical literature suggests soft tissue injuries will become symptomatic within days of an accident - not months. If you had said that the full extent of an injury or its final prognosis may not be know for months, then you would be correct.

Anyway, WIII, good luck with your claim.

I'll give you last word, Hoover.  Since I come to this site to get away from work, I'm done here.  

[Bassn Blvd]

I did answer your question which shouldn't of even been asked by anyone with half a brain.  If your one of those people who would hire an attorney based soley upon advertisement then you deserve to get screwed.  If you  feel so confident about proceeding without an attorney, especially if it goes to trial, then go ahead.  I'm not an attorney nor do I care for a lot of them but there are times that you may have to have one.  So instead of looking for some one to back up your ignorance, you too can go pound something and i'm not talking about your chest either.   Good Day Sir.

[johnkook73]

Hello WWIII-60,

A few years ago I was working (Police Officer) on a traffic stop and got hit by this girl that had her learners permit. I was outside my vehicle when she hit me. My injuries were a concusion and back, shoulder pain.

I consulted with her insurance company and they wanted to settle out of court for about 2500 bucks.

Just from that past experience you are probably better off talking to an attorney to get more back for you. Yes they do get a good chunk but I think you get more if you handle it with an attorney compared to yourself. Ive seen it plenty times happen that way in civil court. Its alot of paperwork involved and it takes time.

Good luck and pm me if you have any questions.

John.

[WIII-60]

If your one of those people who would hire an attorney based soley upon advertisement then you deserve to get screwed.

I believe it's "you're" and not "your". I only have half a brain though.

johnkook: Did your department not help you out on that? I don't know any better, but I would think that some kind of workers comp claim would have been valid there?

Anyways, I'm guessing that the clock is ticking on this one since it's turned into a pi**ing contest.

[Grey Wolf]

I'm surprised this kind of stuff would be allowed to festor on a fishing forum.  This type of personal problems should not be aired here. JM0

[Tokyo Tony]

I think it's a good thread with some good info. Good posts Micro and Hoover.

And Micro - I work for a large insurance company (in the annuities side though), and I agree with you. Most people think insurance companies are out to screw them, and although I guess that's sometimes the case, I'd argue that it's rarely if ever the case when you deal with large reputable companies. Their reputation is worth far far more than any individual claim, and if word gets out that they screwed someone over, you can bet the consequences would be huge for that company.

[johnkook73]

If your one of those people who would hire an attorney based soley upon advertisement then you deserve to get screwed.

I believe it's "you're" and not "your". I only have half a brain though.

johnkook: Did your department not help you out on that? I don't know any better, but I would think that some kind of workers comp claim would have been valid there?

Anyways, I'm guessing that the clock is ticking on this one since it's turned into a pi**ing contest.

Yes my department payed for the workermans comp. When I hired a lawyer, the insurance company that we sued payed for all of my medical bills and workmans comp back to county.

[WIII-60]

I don't know about every other state, but in MO there is a move over law that should require that everyone get over for officers during a traffic stop. It's not always enforced by municipal court judges though. That and you can't fix stupid.

Too bad this thread petered out. I guess it only takes one d-bag to ruin it for everybody. At any rate, thanks to everyone who tried to help out.