Personal Injury Accident Settlement Negotiations Fail Due to Lack of
Valid Evidence of Serious Injury*
Personal Injury
Accident Settlement Case Summary:
In this case the Plaintiff attempted negotiations
with the insurance company of a driver who had cut him off in an
intersection, causing a collision. During these negotiations,
the two
parties were unable to come to an agreement on the amount of the
personal injury accident settlement.
Frustrated with the insurance company's
unwillingness to pay the
full amount of the medical bills he incurred, the Plaintiff retained
counsel and filed a lawsuit.
Statement of Facts...
On February 1st, 2011, Gord Cheve was driving home
from work. It was
about 6:30 in the evening and the weather was clear. Cheve was
travelling southbound on a two lane highway. He was
driving close to the posted speed limit.
At the same time Raymond Bush was travelling on
the same highway
heading northbound. The traffic light
was red for both drivers. As both
drivers were coming to a stop the traffic light turned green. Instead
of slowing down, Bush sped up and attempted to make a left at the light
and get across the intersection before Cheve’s car came
through.
Bush failed to
properly calculate his speed and that of
Cheve’s vehicle. As a result, about half way into his turn, Bush
collided with Cheve.
A passerby witnessed the collision and stopped to
render aid. As he
did he called 911. The police and ambulance arrived a few minutes
later.
Both drivers appeared to be shaken. When the
airbags deployed Bush
suffered lacerations to his nose and forehead. Bush cut his hand when a
screwdriver from his toolkit was thrown forward from the back seat.
Other than that, both drivers seemed to be alright. Although asked,
both declined to be taken to the hospital for observation.
The
police issued a ticket to Bush for “Failing to
Yield the Right of Way” after speaking with both drivers
and the passerby.
The police
officer told Bush it was his responsibility to make sure the
intersection was clear and safe to cross before making his turn.
The next morning Cheve had trouble getting out of
bed to go to work.
His back had stiffened during the night and his legs were sore. His
wife called his employer to say her husband wasn’t going to make it
into work that day.
Cheve’s wife drove him to the local hospital’s
emergency room. He was seen by the emergency room doctor who prescribed
some pain medication and muscle relaxers. The physician
told Cheve
if
his symptoms
persisted he should see his family doctor.
Instead
of going to see his family doctor, Cheve decided to go to a
local Chiropractor. The Chiropractor told Cheve
he would benefit from
daily treatment. Cheve agreed, and went to the Chiropractor
daily. He
received electrical stimulation, realignment and massage therapy. He
continued to receive treatment for the next ninety days.
The Negotiations...
Shortly after the collision, and before beginning
his treatment,
Cheve contacted Bush’s insurance company. At that time a claim
was set up and a Claims Adjuster was assigned to investigate the facts
of the case.
The purpose of the investigation was to decide if
the
insurance company would accept liability on behalf of their insured,
and agree to eventually enter into a personal injury accident
settlement. The Adjuster told Cheve to let her know when he
finished his chiropractic treatment.
After
three months of chiropractic treatment had concluded, Cheve
called the Claims Adjuster. He wanted to begin the
negotiations for his
settlement.
The Adjuster told Cheve to submit copies of bills
for medical and
chiropractic treatment, his out-of-pocket expenses and verification of
his lost wages. Cheve copied the chiropractic bills, the
emergency room
bill, his prescription and over the counter medicine costs, and his
employer’s verification of lost wages for the two weeks he had
taken off during his treatment.
He made a list of those costs and added an amount
for his
“pain and suffering”. He mailed the list to the
Adjuster.
Cheve’s initial
offer:
- Chiropractor: $3,500.00
- Out-of-Pocket Expenses: $350.00
- Lost Wages: $1,200.00
- Pain and Suffering: $5,000.00
- Total:
$10,050.00
A week later the Claims Adjuster called
Cheve and
wanted to discuss his settlement
demand.
The
Adjuster told Cheve his demand was much too high; that his
injuries were not serious enough to have required the length and cost
of his chiropractic treatment; and in light of the type of injuries he
suffered, his time off work was excessive.
The Adjuster told Cheve without an MRI exam or
other medical proof
of the nature and severity of his injuries, his demand was wholly
unsupportable.
The Adjuster asserted the pain and discomfort
Cheve suffered at the time of the collision
were at most muscle sprains and sore limbs. He failed to submit any
proof of torn ligaments, disk herniation, or other medically
diagnosable injuries.
She went on to tell Cheve she had been negotiating
personal
injury accident settlement
claims for over ten years and during all
that time her company had never authorized that much money for the type
of injuries he sustained. Absent further credible proof of his injuries
the Adjuster made the below offer.
Insurance
Company’s Counter-Offer:
- Chiropractor: $1,000.00
- Out-of-pocket Expenses: $600.00
- Lost Wages: $350.00
- Pain and Suffering: $750.00
- Total:
$2,700.00
Cheve was upset and told the Adjuster his
chiropractic treatment was
necessary and legitimate. He said the amount of pain and discomfort he
suffered required the treatment he received.
Cheve
rejected the offer outright. The next day Cheve called the
Adjuster and told her he thought about her offer and was prepared to
make the following counter-offer:
- Chiropractor: $2,000.00
- Out-of-pocket Expenses: $500.00
- Lost Wages:
$600.00
- Pain and Suffering: $3,500.00
- Total:
$6,600.00
The Adjuster didn’t need time to think about
Cheve’s
counter-offer. She denied it and said she would make the following
final personal injury accident settlement offer.
The Insurance
Company’s Final Offer:
- Chiropractor: $1,500.00
- Out-of-pocket Expenses: $500.00
- Lost Wages: $400.00
- Pain and Suffering: $1,000.00
- Total:
$3,400.00
Cheve angrily refused, saying he was going to hire a lawyer and
the
insurance company “would
be sorry” for trying to
“rip him off”.
Cheve hired a
personal injury attorney and filed suit.
Important
Points...
- Although Chiropractic treatment
has been accepted by the insurance
industry, relying merely
on chiropractic bills for a personal injury accident settlement can be
dangerous.
Without
medical proof of the nature and extent of injuries, a
personal injury claim will seldom be settled by an insurance company
solely on the submission of chiropractic treatment costs.
- When in a vehicular collision,
think twice about refusing
transportation by the paramedics to a local hospital. In the majority
of vehicular collisions, injuries may not be immediately detectable.
Adrenaline produced at times of stress often masks real injuries.
Accepting
medical treatment at the time of a collision is a way to
assure your injuries can be medically documented. That is
the type of
documentation insurance companies primarily rely upon when considering
personal injury settlements.
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*This
case example is for educational purposes only. It is based on actual
events although names have been changed to protect those involved. Any
resemblance to real persons or entities is purely coincidental.
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