QUESTION: I was a passenger involved in an accident that was the other driver's fault. My arm was broken in an awkward place and my doc says it may not heal. He's ordered a bone growth stimulator to help the healing process but my care is far from being over. The doc also thinks I may have to go back to surgery in a year to remove the plates he put in. i'd be in a cast again for 6 weeks. My bills are already over 15k and I'm wondering if I can just go for the other person's limits so that I don't go into debt. I don't want to settle too soon but if there is a max that I can get anyway I would prefer to get this over with. Also, if my claim is higher than the other person's limits would the underinsured coverage from the driver of the vehicle I was in pay up to her limit?
ANSWER: First, if there was a magic formula to calculate someone's injury settlement 1) I would not have a job and 2) it would make my life easier. You can always ask for the policy limits, but they won't be released to you without 1) a signed release and 2) medical documentation showing the VALUE of your claim is at or above policy limits. If the limits are not enough to cover your damages...this is where it gets tricky.....it depends on 1) if your friend carries UIM coverage, 2) if you have an auto policy and 3) what the wording is on your friends policy & your policy. If your friend carries UIM coverage and the wording states UIM coverage is EXCESS to that of the injured parties insurance policy...then you have to go thru your auto policy first. IF the wording says PRO RATA, then your friend will only pay their share on a PRO RATA basis in conjunction with your auto policy. If you don't have an auto policy, none of this applies. Now, do you live in a state like CA where the UIM limits of your friends policy must be HIGHER than the Bi limits of the adverse in order for a UIM claim to exist? If the limits are lower than the BI limits of the adverse...there's no claim. TheUIM limits must be HIGHER than the BI limits in order for there to be a UIM claim. The key thing to remember is this: so long as the VALUE of your claim meets or exceeds the limits of the policy the limits should be tendered. If the VALUE does not meet or exceed the policy limits, they will not be tendered. Let's assume the limits are release....any UIM award is offset by the BI limits. So if the value of the claim is $100K, the UIM limit is $100, the BI limit is $50...there's only $50K possibly available to you. If your friend has Med Pay coverage, this will also offset your awad. So same example, but Med Pay coverage is $10K....now there's only $40K max you may receive.
QUESTION: 16 week pregnant @ the time of rear-ender. Nearing the end of medical treatment for soft tissue injuries (shoulder/neck pain), this took 4 months. Medical bills totaling just over $3500. Homemaker, so no lost wages. She was a passenger in the car NOT AT FAULT and the driver at fault has insurance coverage. She opened a PIP claim through her own insurance to deal w/medical bills (does this affect settlement amount?). What is a reasonable amount for her to settle for? Baby was unharmed. Is there a formula insurance will use to calculate settlement amount? If so, how does it work?
ANSWER: She opened a PIP claim through her own insurance to deal w/medical bills (does this affect settlement amount?). No, it does not affect settlement. PIP is primary payment source for treatment involving a motor vehicle accident. Once her PIP is exhausted, then her health insurance is next in line, unless the vehicle she was in also had PIP (or medpay) then they would be next in line to pay her medical bills before her health insurance. If she has medicaid or medicare and they paid any amount for treatment for her injuries, by law she has to pay them back or her benefits will be affected. She will need to set up a lien with medicaid or medicare so that the money can be paid back once she receives a settlement. Her best bet would be to hire an attorney to determine the value of your case and negotiate a demand. There is no 'formula'. There is no "3x's your medical bills". Seriously, there are a lot of factors. Like one, the property damage amount; the insurance company (some insurance companies pay more money and are better to deal with than others); consistent treatment; too many providers; gaps in treatment; etc. Hopefully, the pregnant woman did not disclose any of her medical bills to the insurance company of the at-fault vehicle. The negotiation process is a process that the adjusters are use to dealing with and on your own you will not get nearly as much as hiring an attorney who deals with this all of the time. For cases like these, attorneys don't charge out of pocket or up front fees. They get paid out of the settlement, which you will likely get more from than settling on your own. Best Wishes!!
ANSWER: Except for workers compensation, there ARE no injury tables to decide judgement amounts. That's why it's called a "judgement", it's a judgement call. It also depends a way lot, what KIND of injury, your state laws, how you GOT the injury, and how much of it was your fault. For workers comp, you'd search your state name, workers comp, and permanent disability, and it should bring up the formula for calculating the award.