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Settling Personal Injury Claims for Slip and Fall Accidents

Part 1: Tips for Negotiating Hard Costs...

Settling personal injury claims without an attorney can be tricky, but it can be done with a little moxy and negotiating know-how. To help you prepare, this page gives insider tips for negotiating a settlement. We present observations, opinions, and strategies used by successful personal injury attorneys when actually settling personal injury claims.

More on How to Negotiate a Settlement:

Part 2: Negotiation Tactics for "Pain and Suffering" Compensation

Part 3: More Negotiation Techniques for Slip and Falls (Sample Dialogue with the Adjuster)

We also define some insurance company jargon often used in negotiations. Taking the mystique out of confusing terms will help level the playing field between you and the claims adjuster.

The less advantage he has, the better chance you have of negotiating a successful injury settlement.

Finally, we take excerpts from actual settlement negotiations between an injured party and the insurance company’s claims adjuster. The dialogue should help you see there is nothing extraordinary about negotiations. Settling personal injury claims successfully requires mainly preparation and perseverance.

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Thousands of people slip and fall each year on water, ice, oil and other slippery substances often unnoticeable due to their transparency. Many are seriously injured with broken bones, head injuries, deep lacerations, contusions and abrasions. Some of those injured require emergency care and hospitalization, and they often endure painful recovery periods.

No one ever expects it to happen to them. If it happens to you and the injuries are serious then you want to know how and why it happened, and especially who's responsible. If you want to avoid paying attorneys’ fees (typically one third or more of your total settlement amount), you can represent yourself in negotiations with the insurance company.

There are hundreds of cases each year involving people who were seriously injured after slipping and falling in a public place. Their injuries required immediate medical attention and resulted in a long and painful recovery period. The medical bills were staggering, and the pain and suffering they endured (and will continue to endure) is difficult to describe.

Experiencing the following due to someone else's negligence should not be dismissed:

Excruciating Pain and Discomfort
Thousands of Dollars in Medical Bills
Lost Wages
Personal Losses
Long Recovery Periods, and
Future Pain and Suffering

If you were injured due to the negligence of a person or business, they are responsible for compensating you for the injuries you sustained, costs you incurred, and the pain and suffering you endured.

Settling personal injury claims for fair compensation can take hours of research and preparation. Dealing with an insurance company can be stressful, especially if you are not familiar with their terms and procedures.

Let’s start from the beginning - understanding the origin of a claim is important. We’ll reference the following example in the rest of the discussion...

SUMMARY OF FACTS:

This claim arose back on January 2nd, 2011 in a grocery store close to the injured party’s home. Susan Silverstein, a twenty five year old mother of two minor children was on her way home from work after picking up her children from the babysitter. On the way home Susan stopped at her local grocery store to pick up groceries.

A bottle of olive oil had broken and had leaked across aisle #3. The oil was nearly transparent against the off-white floor. Susan’s cart was full of groceries and they blocked any view she might have had of the greasy floor and impending disaster.

There were no caution signs, no pylons to be avoided, and no employee cleaning up the spill.

In an instant Susan’s legs gave way slipping perilously underneath her cart. Instinctively she gripped the handle of the cart as tightly as she could, but to no avail. She fell and her head struck the ground, knocking her unconscious.

Awaking to the sounds of crackling radios she heard someone shouting about pulse rates and blood pressure. Her head was throbbing as she began to feel a sensation of pain in her back. She tried reaching out, but her arm wouldn’t respond to her brain’s command. The pain was worsening, now beginning to radiate through her body.

The severity of her pain helped to clear her head. Every second felt like an hour. She was crying out in pain. As the paramedics went to move her right arm the pain in her head kicked into overdrive. Her brain, realizing the pain was worsening, did the only thing it could do, it protected Susan by shutting down, causing her to pass out.

Because she was unconscious when the paramedics first arrived, they were unable to ask her if she was allergic to any medications. If they had sedated her without knowing and she happened to be allergic to that medication, she might have become seriously ill or died.

Susan suffered a brain concussion, broken coccyx bone (tail bone) and fractured right elbow.

Settling Personal Injury Claims for "Hard Costs"

Slip and fall settlement negotiations are normally divided into two separate and sometimes overlapping negotiations.

The first phase of negotiations is to get compensation for Hard Costs. These payments consist of the monetary costs incurred, whether directly or indirectly, as a result of injuries sustained.

The second phase of negotiations is to get compensation for Pain and Suffering. These payments are designed to compensate you for the non-quantifiable pain you felt, and the suffering you endured as a direct or indirect result of your injuries.

Although there is no list stating clearly what is and what’s not a Hard Cost, consider every penny you paid which would not have been paid but for the fall and your injuries as a Hard Cost. These can include ambulance fees, medication costs, emergency room and doctors’ bills, and even the cost of gasoline used to drive you back and forth to doctors appointments and therapy.

If your claim has reached this point most of the Hard Costs have already been paid by the claims adjuster.

When settling personal injury claims, there will almost always be some costs the insurance adjuster refuses to pay. Those bills usually include additional MRIs, CAT scans, X-Rays, chiropractic bills and extended hospital stays. It’s important to deal with these issues at this point in the negotiations before your case is settled. Once it’s settled and the papers are signed, any bill not paid will become entirely your responsibility.

There have been cases where people were settling personal injury claims with the adjuster and bills were inadvertently overlooked in the final settlement agreement. The only person at fault was the injured.

Remember, it's your responsibility to make sure the adjuster has copies of ALL bills related to your case. If he doesn’t have them, he can’t pay them. The last thing an adjuster is going to do when settling personal injury claims is remind the injured party to give him copies of all the bills.

As an example, let’s assume negotiation is necessary because the adjuster declined to pay for several tests ordered by the attending doctors. He considers them unnecessary and repetitive. The tests included an additional MRI, two additional CAT scans and an additional set of X-Rays. The total cost for these tests is $6,800.

You are about to negotiate payment for those hard costs. We’ve assembled the following tips to help you get payment for those costs and negotiate the highest possible settlement. The importance of this negotiation cannot be overstated. Any bill left unpaid will become your responsibility.

These tips have been excerpted from multiple past claims negotiations. They address important issues inherent in almost every personal injury case and will assist you with the coordination, preparation and presentation of your claim. With these skills in hand you should be able to successfully negotiate your claim.

Tips for Settling Personal Injury Claims...

Tip #1. Do Not Become Complacent...
Just because you finished your medical treatment and none of the medical providers have sent you a bill, don’t presume that bill (or any other bill) has been paid by the insurance adjuster. It’s not uncommon to have settled a case and a month or so later receive a bill from one of your medical providers. Their bookkeeping can be sloppy and a bill can get lost in the mail. Remember, if the adjuster doesn’t know about a bill, he can’t pay it.

If something like this happens and the overlooked bill would have been paid by the adjuster anyway, some insurance adjusters will get authorization to pay it even after the case has been closed (but this can be a tough process). Then there are adjusters who after settling personal injury claims won’t pay another dime, even if the medical bill was one in which he would have paid during settlement negotiations.

None of this is necessary if you don't get complacent, thinking the adjuster will take care of everything. Make sure you've accounted for every bill before you sign the final settlement agreement.

Tip #2. Save All Receipts...
Every receipt is important when settling personal injury claims. If the adjuster questions one or more of the bills listed in your demand letter (like tanks of gasoline used driving back and forth to doctors’ appointments) you will be able to produce the receipts.

Tip #3. Every Bill or Receipt Should Be Dated...
Make sure every receipt, invoice, or bill is dated. Without a date the adjuster may not pay it. Even if he believes you, he still can’t pay you. He has to account for every penny he’s paid out in your claim.

Tip #4. Prepare an Inventory...
Make sure you can account for every bill, invoice or other evidence of monies you paid from the day of the injury through the present day. Prepare an inventory of all expenditures since the time you were injured.

Go back in your mind to the paramedics, ambulance ride, and the hospital emergency room. Make sure you have a bill from each medical provider. If you don’t, call them to be sure their bill has been paid in full. If it hasn’t, ask them to promptly fax or mail one to you. Because of federal HIPAA laws (Health Insurance Portability and Accountability Act), you may need to sign an authorization for release of medical information before any providers will release records to you.

Most medical offices will have their own release forms for you to sign. In case they don't, here is an example of a simple letter you can use to request your medical records:

Date: January 10th, 2011

To: James Whitmore, MD (Write in Medical Provider’s Name)

From: Susan Silverstein
Date of Birth: 02/25/1981
Social Security#: 046-25-3XXX

Re: Release of copies of medical records

My name is Susan Silverstein, I have been treated by Dr. Whitmore. This letter is my official request for copies of my medical records. Please prepare copies of all my Bills, Memoranda, Medical Records, Charts, and any other documents related to my treatment.

If there is a fee I will pay it when I pick them up. I will come by your office on January 15th to pick up the documentation. If you have any concerns please call me at phone#:632-565-XXXX.

Thank you,

________________________
Susan Silverstein

Tip #5. Prepare Your Presentation of Unpaid Bills...
Once you’ve made a full inventory of bills and you finally know which bills were paid by the adjuster and which were not, separate the unpaid ones and develop legitimate reasons why they should be paid by the insurance company.

The adjuster may have already decided to pay them but just hasn’t sent the money. Do not be passive. It’s up to you to make sure your medical providers are paid. By preparing a presentation you’ll be ready to convince the adjuster now, rather than have to negotiate later on.

If you stay on top of the adjuster it's more difficult for him to decline a payment. Let him know you are fully aware of all bills and that you expect him to pay each one.

Tip #6. Don’t Forget Out-Of-Pocket Expenses...
Although the adjuster may have copies of all the bills from your medical providers, he probably won’t have copies of receipts for all your out-of-pocket expenses.

Save every receipt from the date of the injury through the date the settlement agreement is signed. From gasoline to parking receipts and more, if you don’t get them to the adjuster then you won’t be reimbursed.

Tip #7. Be Vigilant and Monitor Your Credit Report...
The process of settling personal injury claims for slip and fall injuries can be prolonged and difficult. Many injured parties have an above average credit rating before their injury but notice it drop after a few months of dealing with their claim.

While deciding whether or not to pay your costs, the adjuster may wait thirty, sixty, ninety days or more before making payment. As a result your credit rating may decrease substantially.

Make sure you receive copies of bills from each medical provider, and that you get them in real time as they are generated monthly in the normal course of business. Also inform them that you are negotiating a personal injury claim for payment of all bills - hopefully they'll be understanding and won’t send any overdue bills to collections. Then be sure to keep on top of the adjuster.

---- SIDEBAR ----

Insurance companies are some of the richest companies in the world. They literally have billions of dollars at their disposal on any given day. They withhold paying medical providers as long as they can, because of something called “the float.”

Here is how it works: A slip and fall claim is being negotiated. The insurance company has impliedly accepted liability and has agreed to pay the medical bills. It's the end of the month and, as agreed, two more medical providers send their invoices to the adjuster. Clearly stated on each invoice are the words “Payment Due Upon Receipt.” Let’s say the total of this invoice is $1,200.

The adjuster does not pay the invoices immediately as required. He has been instructed to hold invoices for sixty days before paying.

That means that $1,200, instead of going to pay your medical providers, remains in the insurance company’s bank account for an extra two months. During that time interest accumulated. Two months - $1,200 - that’s about $15 interest. No big deal right?

Well just imagine that all over the world there are other adjusters working for the same insurance company, settling personal injury claims and doing the same thing - holding back money as long as they can. Your $15 is added to thousands of other $15 from other claims.

And on top of that the same insurance company has other settlement money earmarked for medical or other service providers, not for $15 but instead for hundreds of thousands of dollars in much larger settlements from cases all over the world.

So in the end, by keeping their money in the bank an extra couple of months, the insurance company has been able to generate millions of dollars in interest they would have lost if they had paid thousands of claims on time. This is how insurance companies stay rich, and get richer every day, using money that’s not really theirs to enrich themselves. It’s the float.

---- END SIDEBAR ----

So be vigilant! Make sure the adjuster pays your bills on time. He can, but usually won’t unless pushed. Don’t let him ruin your credit. The last thing the insurance companies are going to worry about is your credit rating.

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Settling personal injury claims, as with most negotiations, is a give-and-take. It helps if you've got prior negotiating experience, but it's not absolutely necessary. For more tips and strategies on settling personal injury claims, read this page about negotiation tactics.

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