is my settlement offer fair?

Question

seems like there are plenty of these questions on yahoo. here's my case. accident in december of 2006. police report says im not at fault. ambulance took me to ER. extent of my injuries: broken hand (fourth metacarpal in my left (non-dominant) hand), abrasions on neck from airbag, miscellaneous brusing & soft tissue damage on head & legs. medical bills added up to over $15k. car was totaled. my hand was in a cast for 2-3 weeks and then in a splint for 2-3 weeks. 5 sessions of PT and 4-5 sessions at chiropractor's. i am 26. 6 months later today, i am basically fully healed. i still have some range of motion issues with my left wrist, but it does not prevent me from doing most tasks. my standing offer from the other party's insurance: $11.5k for my med. bills, 1 month lost wages, $3k for P&S. also, if they pay only $11.5k for my med bills, do i have to fight with the hospital or my own insurance company (prepaid a portion) to get them to accept the lower $ or do i have to pay the $15k?

this is my first post. i didn't realize answers came so quickly. a few more details since i ran out of room the first time around. the figures i have provided are the figures of the first settlement offer from the other company's insurance. the value of the car has already been reimbursed and taken care of. i am satisfied with the lost wages offer but am questioning the P&S as well as the new, lower "reasonable" medical reimbursement amount. i don't know what to make of that. i am not trying to fund my retirement with this settlement and i really do not want to get a lawyer involved. i just want to know if what's been offered is fair and reasonable. and what to do with that $11.5k reimbursement offer for my medical bills. thank you in advance.

Answer 1

My first question to you is who paid your medical bills? If it was your health insurance company the maximum you are allowed to recover is what the insurance company paid to their contracted doctors. So if the TOTAL charges are $15K but your health insurance paid $11.5 that's the maximum you are allowed to recover. Now, if you have NO health insurance....all bills to doctors/hospitals are negotiable and you would have to negotiate the bill reduction....generally you can have the bills reduced between 30-50% of the charge. So why are you only being offered $11.5? Sounds like some of the procedures are not considered b/c they either weren't medically necessary OR the fees are unreasonable for your area (which is most likely the case) when compared to other facilities for the same services.

As for the pain and suffering? Hmmm...you can get more on that at most $5000 more I would say for the bruising, the abrasions, the pain in your finger. It depends on how extensive the bruising was, how long you had the bruises, and how long it took them to heal. If you have photos showing the bruising this will definitely help you out.

Answer 2

I understand everyone throwing out "get a lawyer" because the overall offer does go up. However, once the lawyer takes their 1/3 of the money you end up on the same situation you are in now with no help in negotiating with the hospitals and such. It sounds to me as if this offer could be the company trying to "get out cheap" so to speak. I would recommend making a counter offer and if they are unwilling to negotiate ask if they are at the policy limit and make them show you the policy info to prove it. All of these are obviously scare tactics and may or may not work, but at least you will not look soft and end up accepting an offer that is too low.

The fact that they offered an amount that was lower than your ACTUAL medical bills concerns me. Either they feel that the medical professionals shouldn't have charged you as much as they did, in which case THEY should negotiate with the doctors for their fees and then pay them directly, or they think that they can push you around.

Just stay professional and don't let emotion get the best of you here. Have a chat with YOUR insurance agent who knows this situation better than we do and let them advise you on it. It never hurts to ask for as much help as you can get in situations like these.

Good luck in this, I hope we have been of help to you!

Answer 3

This offer seems low to me. It is not unusual to negotiate the cost of treatment with the hospital. They bill outrageous amounts all of the time, and both health and P&C insurance carriers pay them reasonable fees. I'm surprised that it is only 3.5k less. You should contact the hospital and see what they are willing to accept. Let them know this is being paid by an insurance company. Make sure your bill is reduced before accepting this amount.

3k for pain and suffering is low. You had a broken wrist, not a soft tissue injury. Depending on where this happened, I could see 5 to 10k.

As for the comment about the insurance company not being able to tell you the policy limits, I have never heard of that. When dealing with a low limits policy, and an injury that could exceed this limit, the adjuster often notifies all parties of the situation. This allows you to get your UIM carrier involved early so that they can do their investigation and don't hold up the final settlement.

Answer 4

You have enough damage to car and yourself that even a good legal aide could win your case. The courts generally award enough to support all your lawyer fees regardless. The police report carries the weight. The sizable medical bills were no fault of your own and have to be covered by their insurance. You evidently, or they realize you don't have any legal representation and are worming their way out of an obligation of fault. Your age was the only reason why you recovered so fast. Make sure you have a clean bill of health now or it will haunt you as you get older.Try to get a Legal aide or one of those advertized lawyers that does pro bo no publico - (Latin -for the public good: for the benefit of the public.) You don't turn the other cheek so to speak when injuries sustained to this degree. If all costs were paid,car,medical , loss of wages, etc. plus a little sum for yourself it would have been a different story. Find a good mouth -piece to represent you. They are taking advantage of you.

Answer 5

Caleb,
It sounds like you have a good grasp of your situation and the claim. Why give an attorney 1/3 of your settlement when you have done the 'work' up to this point? A lawyer will take another year to settle the claim. You can get it done now. Find out if your own insurance company (auto or health??) wants paid back for their portion. Find out if the hospital will take less than the total bill if you pay them in a full lump amount.
Then, If I were in your shoes, I would let the insurance company make an offer to settle first. Your figures are in the ball park, in my view.

Answer 6

Get an attorney. Assuming you are collecting from the other driver's insurance, your offer should be no less than 5x your expenses for ain and suffering. An attorney should get 10x in an out-of-court settlement. I'm not giving legal advice here, so get an attorney. If your claim is against your own UI coverage, then I would counter for 100K, because they would pay more than the 17K difference to hire an attorney to press the case forward. You may want to ensure that your medical insurer is not going to push for reimbursement from your settlement, or you will not end-up with much of anything for your pain. I wish you a speedy recovery. As for your lost wages, I hope that you did file a claim with State Disability Insurance. If the other driver has been identified, get an attorney if there is any chance of recovery from them. Good luck to you.

Answer 7

Depending on what state you're in and what actually occurred in the accident, just because the accident report says you're not at fault doesn't mean that there isn't any negligence on your part. This is probably why they are only offering only partial on your meds. They could be withholding for negligence on your part for improper lookout, speed, etc. which could have contributed to the accident. This depends on your states liability laws. You should ask either your own insurer or the other insurer just to clarify.

As far as your own insurance company - the other company should work with them on their amount due so it shouldn't be something you need to deal with.

Instead of getting attorney (which would mean you would get a lower settlement because the atty would take 1/3 of the settlement) I would just counter with an amount you think is reasonable and fair for your injury. Don't hestitate to negotiate until you can get to a reasonable amount that you and the other insurer can live with.

Answer 8

First, police do NOT determine fault. But it looks like they're accepting liabiltiy, which is good.

Second, you could WELL be looking at damages over the policy limit - the insurance company won't pay more than the policy limit, period.

It's a very, very small P&S offer. But if you're at the policy limit (which you very well could be), they can't tell you - they'll just refuse to negotiate. Then you have to sue the driver, your lawyer gets 1/3, and they STILL don't pay out more than the policy limit - YOU have to try to collect hte difference from the person who hit you.

Answer 9

I was in an accident and my lawyer negotiated for 3-4x the amount of the medical bills, of which he got one-third. If they're not even fully paying the medical bills, I would fight that. A lawyer can tell you what you can get and won't cost you unless you win, AND won't take the case unless s/he thinks you can win.

Answer 10

suggest contacting a lawyer, most give you an hour free consult. since the accident is not your fault, I would fight to have all of your medical expenses covered and more for injuries because you really don't know what the extent of the damages are until some time later.