Do insurance companies use a formula when deciding to pay or not pay a claim against them to avoid civil?

Question

proceedings? I was involved in an accident (rear ended) on an expressway and off work for 9 days. I've had four doctor visits so far and have one next week. If there is a formula or formulas, what is the norm? I had two people tell me two different things. One said two times your lost wages + two times doctor bills + vehicle repair costs. The other said three times wages plus two times doctors bills plus vehicle repair costs. I'm interested in settling fairly without obtaining legal counsel but that is not out of the question if I feel I'm being unfairly compensated.

Answer 1

They only pay your medical bills, property damage (either to repair the vehicle or the re-sale value of the vehicle if it was totaled), and loss of earnings. If there is no police or witness report, the other driver could claim that they are not at fault and civil proceedings will follow. Nothing is doubled or tripled. Should you be left with a disability, they will calculate the loss of the body part and how it will affect your future income and offer you a disability settlement.

Answer 2

No, they do not.

But they will look at the extend of damages to the car, and the extent of damages to your person, in combination with your state law, to see if you're entitled to anything at all, or if they want to go to court.

You're best off talking to your own agent.

It's kind of surprising that you've had four "doctor" visits, no hospitalizations, and you've missed 9 days of work so far. THAT is going to raise "red flags" for a potential fraudulent claim.

Oh, you'll have to PROVE that the DOCTOR told you you can't work, and you'd better hope that the doctor isn't a chiropractor.

Also, some states severely limit the benefits you collect for minor (soft tissue) injuries, and some require you collect under your own policy first.

Answer 3

Your lost wages and medical bills have nothing to do with the value of the claim. Easy example - Bob and Tim sustain exact same injury in auto accident. Bob works at McDonalds and Tim is a CEO. Bob goes to family doctor, has xrays and is given RX. His wage loss and medical bills total $500. Tim goes to ER, he is given xrays, ct scan, and RX. His wage loss and medical bills total $8,000. They had the same injury - why would Tim be paid 16-24k when Bob only gets 1000-1500? Your vehicle repair costs have nothing to do with this what so ever.

Each claim is looked at individually. You are not going to get rich off of this. It sounds like your injuries are not that serious so getting an attorney that takes 35% of entire settlement (wage loss and medicals included) is only going to hurt you. If you have a simple whiplash (strained neck/back) injury you are only going to see 1k or so on top of meds and wage loss and that is if you even qualify for a claim under state law.

Answer 4

One thing to keep in mind is that insurance is not to get you two or three times your actual expenses paid. It is to make you "Whole". They will cover your actual expenses and lost wages, but don't expect to get "Pain and Suffering" from an insurance company. They don't (and shouldn't) pay it. If you want to sue the person that hit you for extra damages to pay for your pain, good luck. Their insurance company will likely provide the defense costs and will spend many times more than what you are suing for to defend a case like that.

You will likely loose (over 90% of all cases are won by the insurance companies-don't believe the ambulance chasers) and the only thing you will accomplish is driving up the rates for yourself and everybody else.

Answer 5

There is no formula to calculate bodily injury settlements. Each claim is evaluated on it's own merits.

Here's an example to show why:

1. Joe is injured in a car wreck. He goes to the Dr and complains of neck, back, shoulder, abdominal pain. The Dr orders CT scans of Joe's neck/back/shoulder/abdomen/pelvis. The medical bills total $10,000.00 All the CT scans are negative. The Dr gives Joe a prescription for a Lortab and sends him on his way. The sprain/strain resolves itself in a week or two.

2. Jane is involved in a car wreck. She goes to the Dr complaining of chest pain. The Dr orders chest X-rays. The X-rays show a non-displaced fracture of her sternum (crack in the flat bone that joins both sides of the rib cage - it's in the middle of your chest). The only treatment is bed rest. Jane's' medical bills are 1500.00. Every time Jane breaths - her sternum rises and falls causing her pain. Every time she moves it hurts. The fracture takes 4-6 weeks to heal.

According to the formula theory - Joe should be paid 20,000-30,000 and Jane 3,000-4500. It's pretty obvious that Jane has a claim well worth more than 3,000 and Joe's claim is worth no where near 20,000.

These are very simple examples - but go to show why each injury claim has to be evaluated on it's own merits.