Any experience with insurance settlements?

[mmsmom]

I was in a car accident with injuries a couple years ago & the other driver was 100% at fault (ran red light). I received a settlement offer from the insurance company which is more than I was expecting so I am pleased, however I know I should ask for more. I?m thinking 10% more but don?t want to leave anything on the table.

I did speak with a personal injury attorney after the accident and decided that I would be better off on my own. The attorney may be able to get more money but given they also take around 30%, I know I would get more on my own. I do have an attorney that will review the settlement before I sign it.

[AnnieW625]

I don?t do personal injury (MVA) insurance work but remember that personal injury attorneys (at least in California) will ask for 30% of your settlement so unless it is a high dollar case you may not gain much more if you have an attorney negotiate a larger settlement; that is why there is never a cost to the client unless they get you a settlement, but what they don?t tell you on the TV is that PIA take a ton of the settlement value. I am a claims adjuster so imho if a claimant is willing to work with me I will go above and beyond to give them as close to what they want as possible if they don?t have an attorney. Now of course like I said I don?t do automotive/personal injury but if your claims adjuster is reasonable this is the route I would take.

I would do the following:
1. Run a KBB estimate of the car (if it has to be replaced); argue that you want the exceptional sales value for your car. How do they know that your car may have only been at the middle valuation level before the accident? If you haven?t bought a new car yet you need to find the three closest cars to the one you have and submit the one with the highest price tag to the insurance company. It doesn?t matter if you change your mind you need to replace your vehicle with a comparable new vehicle.

2. Calculate all of the hours/wages you missed from work due to the injury (even if your employer covered your sick leave)

3. Calculate all of the mileage you did going to and from doctors visits, pharmacy costs, physical therapy, etc.

4. Calculate the difference in the cost of the new car vs. the cost of your old car. If your monthly payment is $250 more a month and you have been paying that since you had to buy a car ask for that amount x the number of months you have had to pay that.

5. If you had surgery, PT, regular doctor visits calculate how much those will cost in the future (based on what the provider pays and not what the insurance company has paid)


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[ahisma]

This is NOT an area that I practice in - none of this is legal advice. That said, I'd consider severity of injuries. My understanding - which is not based in experience - is that there is often a multiplier applied based on severity. Also consider loss of enjoyment of life (are there activities you can no longer do / no longer do at the same level), emotional toll, etc.

[mmsmom]

Thanks all. The property damage/car part has already been settled. This settlement is for my injuries which required 2 surgeries and I have a significant scar on my arm as well. I did research a while ago so know the offer is in line with my injuries but I also know not to take the first offer. I’ll do some more calculations to come up with my counter offer. I’m not going to use an attorney- just one to review the documents before I sign them.

[khm]

Thanks all. The property damage/car part has already been settled. This settlement is for my injuries which required 2 surgeries and I have a significant scar on my arm as well. I did research a while ago so know the offer is in line with my injuries but I also know not to take the first offer. I?ll do some more calculations to come up with my counter offer. I?m not going to use an attorney- just one to review the documents before I sign them.

Yeah, think about things like care that might be required in the future. My mom was hit and required spinal surgery. Part of her settlement was a scar across her neck that would require X months of healing before they could do cosmetic surgery and the care and medications in recovering from that, loss of ability to swallow food in the same way due to the scarring, etc.

Stand your ground. I remember talking with a neighbor who has done various insurance work over the years. She said it amazed her that people would fight tooth and nail to get the value they thought their car was worth, but for bodily injury they just agreed and moved on. Your body was damaged! Make sure you fight for the damage, visible scars, current and future issues, physical pain, emotional pain, any problems that might occur down the line, etc.

[ahisma]

One thing to consider - it is very likely that you will need to pay back your insurance company for medical claims that they paid in relation to the injury after receiving the settlement. Or, in some cases, they will be paid directly out of the settlement. Consider that when negotiating. It's called subrogation, and should be explained within your benefits guidebook.

[AnnieW625]

One thing to consider - it is very likely that you will need to pay back your insurance company for medical claims that they paid in relation to the injury after receiving the settlement. Or, in some cases, they will be paid directly out of the settlement. Consider that when negotiating. It's called subrogation, and should be explained within your benefits guidebook.

Yes definitely find out if your health insurance has filed any liens against your auto insurance company or if your health insurance wants an additional lien from you. In many cases they may have filed against the at fault party so you should be okay, but if liens were filed you need to know what they are.

Also OP your insurance company should have a range for their settlement and you are right for not accepting their first offer. The hard part is figuring out how low their offer is in regards to the range of the settlement. Did they offer you (example only!) $2,500 when their full authority is really $12,500 or did they offer you $7,500 when their authority is $12,500 and if you counter back with $15,000 you are likely to get the $12,500.


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[ahisma]

Yes definitely find out if your health insurance has filed any liens against your auto insurance company or if your health insurance wants an additional lien from you. In many cases they may have filed against the at fault party so you should be okay, but if liens were filed you need to know what they are.

Also OP your insurance company should have a range for their settlement and you are right for not accepting their first offer. The hard part is figuring out how low their offer is in regards to the range of the settlement. Did they offer you (example only!) $2,500 when their full authority is really $12,500 or did they offer you $7,500 when their authority is $12,500 and if you counter back with $15,000 you are likely to get the $12,500.


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In general, a health insurance carrier does not need to file a claim to have a subrogation right. Here's sample language from a benefit guidebook:

"The Plan has a right to be reimbursed for the amount of any benefits it pays out to you if you receive, directly or indirectly, any money from a third party (such as a person responsible for an injury or an insurance company) on account of the same injury, illness or condition for which the Plan has paid benefits (any such money is referred to here as a “recovery”). Therefore, as a condition of receiving benefits from the plan for medical or other expenses, you agree that if you receive any recovery from a third party on account of an injury, illness, or condition for which the Plan has paid benefits, you will pay to the plan the amount of that recovery, up to the total amount of benefits paid to you by the plan. For example, if you are injured in an auto accident and either your insurance company or the other driver’s insurance company settles with you, you must reimburse the plan for the benefits the plan provided to you for your medical expenses resulting from that accident, but only up to the amount of your settlement"

[mmsmom]

Thanks all. I asked for 15% more and I got it. I probably should have asked for 20% more but I believe this offer is fair.

I did some research and in my state healthcare companies cannot subrogate. But, my insurance may be under federal instead of state regulations since it is through my employer which is a global company. I am looking into the plan summary but since the accident was over 2 years ago, I think I would have received some sort of notice by now if they would be seeking reimbursement from me. It is something I would have needed to know before agreeing to an amount. I will confirm this though with the attorney who reviews the documents.

[AnnieW625]

Thanks all. I asked for 15% more and I got it. I probably should have asked for 20% more but I believe this offer is fair.

I did some research and in my state healthcare companies cannot subrogate. But, my insurance may be under federal instead of state regulations since it is through my employer which is a global company. I am looking into the plan summary but since the accident was over 2 years ago, I think I would have received some sort of notice by now if they would be seeking reimbursement from me. It is something I would have needed to know before agreeing to an amount. I will confirm this though with the attorney who reviews the documents.

Glad you are happy with your outcome.

Yes at 2 years I wouldve thought you should have received an EOB and a bill if you are required to pay any additional for your treatment.


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