Fall Causes Fractured Jaw...

by Donna
(Morristown)

I fell on someone's property causing injuries. I had 2 mandible fractures and a permanent titanium plate placed about 2 weeks ago. My jaw is banded shut and my teeth are going to require braces after I get out these bands. I can't eat solids until at least the end of august. I'm also going to have ambulance bills and two hospital bills, etc. I haven't made a claim yet, but I do have questions...

I wanted to know if my medical expenses are paid, will I get the leftover money from what my insurance already paid, or does it automatically go to my insurance company?

Also, I'm just not sure how much pain and suffering, etc to ask for. I am a nurse and I still can't speak so I'm not working. Any ideas?

Disclaimer: Information provided in your response is not formal legal advice, it is generic legal information and is based on the very limited information given in your question. You should always get a formal case evaluation from a licensed attorney.

ANSWER for "Fall Causes Fractured Jaw...":

Donna:

From the facts you present it would seem that immediately after the collision your medical bills, or commonly called “Hard Costs,” were paid by your own insurance company. Many times this occurs after an automobile collision where the victim is seriously injured and usually taken by ambulance to the hospital.

When this happens often the victim does not have immediate access to the at-fault driver’s insurance information. When being admitted into a hospital, we all know very well without insurance you may be directed elsewhere. The hospitals don’t discriminate between at-fault drivers and victims. They just want to be paid.

Once released from the hospital and able to begin taking care of insurance matters the victim normally contacts the at-fault driver’s insurance company, or sometimes the at-fault driver’s insurance representative contacts the victim.

Presuming there is clear liability, the at-fault driver’s insurance company will take over the medical bill payments. Often when payment for the medical bills is assumed by the at fault driver’s insurance company there still remains those medical bills which have already been paid by the victim’s insurance company. This is where we entered into your case.

Your insurance company will want to be reimbursed for the monies they have already paid. You do not have to be concerned with this because your insurance company will not look to you, but to the at-fault driver (and her insurance company) for payment.

This is called “Subrogation.” Your insurance company “subrogates” against the at-fault driver, and her insurance company demanding reimbursement for the monies they have already paid. When that happens the at-fault driver’s insurance company reimburses your insurance company directly and fully. Of course, when that happens you do not receive any of those funds.

Pain and Suffering normally includes not only that which you have already suffered, but which you will probably suffer into the future. It also includes your out of pocket expenses, including, but not limited to, medicine, bandages, nursing and therapy care you may need, and more. It will also include any of your wages lost as a result of the injuries.

Because there is no exact and objective way to determine all of the future costs, the traditional manner of settlement is an extrapolation of the medical bills. The extrapolation is usually a multiple of anywhere from 1x-5x, or sometimes all the way up to any multiple which can be justified by the injuries.

In most “everyday” collision cases which include less severe injuries the multiple may be by 2x or 3x. In more serious cases such as yours the multiple may be closer to 5x and more.

Since laws change frequently and across jurisdictions you should get a personalized case evaluation from an attorney licensed in your state (if you haven't already). Find an experienced local attorney to give you a FREE personalized case review here.

Best of luck,

Law Guy

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