Tag Archive for: insurance coverage

How Is Pain And Suffering Calculated?

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How Is Pain And Suffering Calculated In North Carolina (NC)? Pain and suffering is calculated differently by personal injury attorneys and insurance companies. As a result, often your attorney and the insurance company will argue about the value of your pain and suffering. As you might imagine, the insurance company’s number is always lower than the attorney’s number. This article addresses how pain and suffering is calculated in North Carolina. It attempts to help you understand the value of your personal injury claim. Keep in mind every claim is different, and a personal injury attorney can assist you with establishing your claim and fighting for a fair result.

Liability Is Key To Any Recovery

Before we ask “How is pain and suffering calculated?”, we must first establish that there was a responsibility on the party from which you seek reimbursement. In other words, was it their fault? It is a given you had injuries resulting from a car accident or slip and fall. The next step is to prove that the other party was at fault, or responsible. If you fail to prove that, your pain and suffering—in fact, your entire recovery—will often be zero.

Proving liability can be challenging. North Carolina makes it more difficult with the Contributory Negligence rule, we have written about on our website. This rule states that if you are even 1% responsible for the accident or injury, you should receive nothing. North Carolina personal injury attorneys spend their days fighting this rule for their clients.

How Is Pain And Suffering Calculated In Different Car Accidents?

Imagine a scenario where two individuals are in two separate car accidents. In Accident #1, the injured party is rear-ended while sitting at a stoplight. They suffer a concussion. In Accident #2, the injured party is injured when another driver changes lanes, and the two vehicles collide side-by-side. The injured party suffers a concussion, just like in Accident #1.

In Accident #1, liability is clear. The personal injury attorney and the insurance adjuster may end up arguing over the value of pain and suffering, which is normal. In Accident #2, the attorney and the insurance adjuster will also argue over the value of pain and suffering; however, the insurance adjuster will potentially only offer half of what they are offering in Accident #1. Why? Because there is an argument that if the case went in front of a jury, the jury might decide that the insurance company’s client was not at fault. Or, the jury may decide that the injured party was 1% or more responsible, and offer them nothing, based on the rules of Contributory Negligence.

In the instance above, we have identical injuries, yet the pain and suffering calculation for each injured party will likely be different. Here are a few other factors that affect pain and suffering calculations:

Medical Treatment Sought—A failure to seek proper medical treatment immediately after an accident can result in a lower value of your claim, despite legitimate injuries.

Time Of Recovery—If an individual takes an abnormal amount of time to recover, their pain and suffering is arguably higher than someone who recovers quickly.

Age Of The Injured Party—Children may receive higher pain and suffering than adults, to compensate for the emotional content of their experience.

Extenuating Circumstances—Therapy needed for anxiety can change pain and suffering. Also, if the accident caused you to miss your child’s wedding or graduation, this would be considered as well.

One Method For Calculating Pain And Suffering

When taken in context with the information above, some attorneys will argue that pain and suffering start with a calculation based on the medical treatment received. Insurance adjusters and personal injury attorneys will then argue about the billed amount of the treatment vs. the actual cost. The reason is that health insurance often pays far less than what the doctor billed. The same is true of Medicaid and Medicare. Lastly, these health providers may have Personal Injury Settlement Liens, and those will need to be addressed with any settlement figure reached.

A Second Method For Calculating Pain And Suffering

A method far less popular is to assign a per-day amount that pain and suffering is worth. The personal injury attorney takes that amount and applies it to the length of time from the date of the accident until the last date of treatment for the injured party. The concept is to compensate the injured party for the number of days it took for them to return to full health.

Insurance Company Pain And Suffering Calculations

Often, you will find that insurance companies try to ignore the attorney calculations altogether. Instead, they rely on advanced software designed for their industry. That software takes into account your injuries, medical treatment, lost wages, and many other factors. Importantly, the software will also take into account past jury verdicts in your area. The idea is to offer a settlement reflective of what a jury might give you. The insurance company will want to lower that number however because by settling with you, they are reducing the risk for you that a jury would give you less.

The Importance Of Working With A Personal Injury Lawyer

Personal injury cases get complicated very quickly. It’s easy to compromise your rights by giving a recorded statement to the insurance company or signing a release. A personal injury attorney will not only protect you from these pitfalls but also help to maximize the value of your claim. You will typically find that the attorney’s fee is far outweighed by the end settlement amount, and by the peace of mind that you are being protected along the long path to recovery.

If you want to know “How is pain and suffering calculated?” or if you have questions about working with a personal injury lawyer for your car accident, call us today. You can call 704.749.7747 or click for a FREE CASE EVALUATION and we will contact you immediately When it comes to choosing a personal injury law firm, we know you have options. We hope you choose to Recover With Us.

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MRIs And Your Personal Injury Claim

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How Much Does An MRI Cost?

According to data released from NerdWallet Health, an MRI costs on average about $2,611.00. Your insurance may pay for some or all of that expense. Any way you look at it though, it’s an expensive procedure. Additionally, you’ll receive a separate charge from the Radiologist to read the MRI. If your physician requests contrast dyes in conjunction with the MRI, the price goes up further.

Is An MRI Important For My Personal Injury Case?

If your doctor recommends one, you should have one done. In any case, an MRI can reveal injuries which an X-ray will not reveal. An MRI of the brain and spinal cord can reveal brain tumors, MS, stroke, and problems with your eyes and ears. An MRI of the bones and joints reveals herniated discs, fractures, torn ligaments and tendons, and arthritis.

Put quite simply, the value of your car accident or slip and fall increases if your injuries increase. In other words, the purpose of a personal injury lawsuit or settlement is to make you whole again. As a result, the primary thing you must prove to the insurance adjuster or to the jury is that you have suffered an injury that has left you in a worse state than you were in prior to the accident. An MRI, together with a doctor’s medical notes, becomes evidence of those injuries sustained in a car accident or slip and fall accident.

Today you may be wondering how much it will cost, but if your doctor recommends an MRI and you forego getting one, you may find out that your personal injury claim is worth less than full value. Your medical bills are typically paid through your personal injury settlement, especially if they are filed as a personal injury settlement lien.

Next Steps For Car Accident Or Slip And Fall Accidents

If you have been injured in a car accident or slip and fall accident, you should seek medical treatment immediately. The primary reason of course is to be sure of what treatment you might need—allowing injuries to go untreated can exacerbate them and make them worse. Second, if you do have a personal injury claim, a delay in treatment will serve to lower the value of your personal injury claim or personal injury case.

Speak With A Personal Injury Lawyer Today

Need help or advice? That’s why we’re here. Call us today to speak with an attorney. You can reach us at 704.749.7747 or click for a FREE CASE EVALUATION and we’ll reach out to you today. When it comes to choosing a personal injury law firm, we know you have options. We hope you choose to Recover With Us.

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This Halloween Protect Yourself From Scary Personal Injury Insurance Adjusters

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Happy Halloween! Remember, in the personal injury world, it’s SCARY out there. Personal injury adjusters are not your friend. They are looking for ways to deny or de-value your car accident or slip and fall claim. The following tips can help you protect yourself in a personal injury claim and make sure you get treated fairly by the personal injury adjuster. If you’d like to speak with an attorney today, you can reach us at 704.749.7747 or click for a FREE PERSONAL INJURY CONSULTATION and we will reach out to you shortly. The call is free and we’re here to help. We know you have choices. We hope you choose to Recover With Us.

Seek Treatment Quickly

One thing that scares us is clients who fail to seek treatment or fail to finish treatment. If you don’t seek treatment soon after your car accident or slip and fall, the assumption is you were not hurt. If you don’t have health insurance, we know the cost makes it difficult to seek treatment. There are several hospitals and Charlotte Chiropractors who will treat you on a lien basis. This means they will treat you without cost and wait for your personal injury settlement to finalize before they get paid. Additionally, you may have Medical Payments coverage and your personal injury attorney can help you claim it. Lastly, your personal injury attorney can typically negotiate some of your medical bills when settling your claim. This puts more money in your pocket. By seeking treatment early, you:

Establish your injury

Increase the value of your claim

Make a clear connection between the accident and your injury

Finish Your Treatment

Even though you may feel better, it’s important to follow your doctor’s direction. This means completing treatment including follow-up appointments. This ensures you are brought back to full health, and also demonstrates the treatment was necessary. When a personal injury client stops treatment halfway through, the insurance adjuster will use that fact to claim the injury was not severe. Or, that the treatment was for the sole purpose of creating a personal injury claim.

Tell Your Personal Injury Attorney The Truth

Your personal injury attorney is your best ally in a personal injury claim. Anything you tell the attorney is protected under attorney-client privilege. By arming your personal injury attorney with the facts—both good and bad—your attorney can strategize how best to support your personal injury claim with applicable law.

Here are some examples of ‘bad facts’ which can be often be overcome by your personal injury attorney. Again, what’s most important is making sure your personal injury attorney knows all the facts:

Whether you were taking medication at the time of the accident

Whether you had any alcohol the day of the accident

Prior or pre-existing injuries which may be discovered later

Whether you have filed previous personal injury claims

Keep Good Notes

One thing we encourage clients to do when they’ve been in a car accident or a slip and fall accident is to keep notes about the accident. This should include what you remember about the facts leading up to the accident. It should also include the injuries and pain you’re feeling following the accident. These notes can be brought to the doctor’s office so that you don’t forget to mention them. Your injuries are typically documented by your medical records. If you don’t tell the doctor about the full extent of your injuries, the personal injury insurance adjuster will attempt to discount them. Again, the assumption is if you were really hurting, you would have told your doctor.

Further Reading

Supporting Your Personal Injury Claim

Don’t Settle Your Personal Injury Claim Without An Attorney

Speak With A Personal Injury Attorney Today

We firmly believe you’re better off with a personal injury attorney than without. Our experience has been that clients receive more fair treatment from insurance companies when working with an attorney. We can help you navigate working with a personal injury insurance adjuster. We’re happy to discuss your accident at no cost. There’s no pressure to hire us. You can reach us at 704.749.7747 or click for a FREE PERSONAL INJURY CONSULTATION and we will reach out to you shortly. The call is free and we’re here to help. We know you have choices. We hope you choose to Recover With Us.

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Medical Payments Coverage For Car Accidents

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Medical Payments Coverage

Medical Payments coverage is coverage you may have on your own auto insurance policy. If you have Medical Payments coverage, it will cover some or all of your medical bills incurred as the result of a car accident. This is true whether the accident was your fault or not. Medical Payments coverage can make all the difference for you as an injured party. First, you may not have health insurance, or may have a high deductible; if so, Medical Payments coverage will pay for bills which your health insurance may not cover. Second, the Medical Payments coverage can supplement any health insurance you do have and can help you recover co-pays and out-of-pocket expenses. Lastly, even if the accident is not your fault, you may not be able to recover from the at-fault driver. In that case, the Medical Payments coverage will help absorb some of the financial impacts of the accident.

The Reasonableness Factor

The language of your auto insurance policy will govern what your Medical Payments coverage will pay. It’s not always as easy as simply submitting your bills to your insurance carrier. Insurance companies often limit their responsibility to reimburse only those medical treatment expenses they deem to be “Reasonable”. Our experience with handling Medical Payments claims has revealed that insurance companies will often exclude the following from reimbursement:

  • Experimental treatments which are not designed to serve a medical purpose;
  • Acupuncture
  • Purchases of equipment that not primarily designed to serve a medical purpose, such as a home gym for rehabilitation

In addition to the treatment being reasonable, the cost of the treatment must also be reasonable. It is not unusual to receive a response from an insurance carrier indicating they will cover a percentage of a chiropractor’s fees, and a refusal to reimburse for the remainder. Quite often, the insurance company will “red line” the chiropractor’s treatment notes, indicating what the insurance carrier believes to be unreasonable treatment. Similarly, they may red line the chiropractor’s bill in an effort to indicate what they believe to be excessive treatment. If you have questions about chiropractic treatment, our article on Charlotte Chiropractors may help answer those questions.

Fortunately for the injured party, there is a presumption of reasonableness in North Carolina, established in N.C.G.S. Sec. 8-58.1. While an insurance company can rebut this presumption, your personal injury lawyer should be able to persuade them that making full payment on the Medical Payments reimbursement submission is preferable to facing a lawsuit over Medical Payments coverage.

Your Responsibilities

Your insurance policy typically requires some responsibilities or duties which you must uphold. You will be asked to cooperate with any investigation into the claim. You will also be asked to assist the insurer should they request medical records to substantiate the Medical Payments request. You may also be asked to sign a HIPAA release in the event your insurance provider wants to obtain medical records and billing on their own.

Speak With A Personal Injury Lawyer

If you were in a car accident, or if you were injured by a vehicle as a passenger, pedestrian or cyclist, you may be entitled to Medical Payments coverage. We recommend you consult with a personal injury lawyer today. You’ll get your questions answered and we’re happy to help. We can be reached at 704.749.7747 or you can click to request a FREE PERSONAL INJURY CONSULTATION, and we will reach out to you shortly. We know you have options. We hope you choose to Recover With Us.

 

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Underinsured and Uninsured Motorist Coverage

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We talk with injured individuals every day who ask about Uninsured Motorist Coverage. If you’re injured in an automobile accident and the other driver does not have insurance, you may think you can’t be compensated for your injuries. Generally, this is not true. This holds as well for individuals insured as pedestrians, cyclists, and motorcycle accident victims.

In North Carolina, motorists are required to carry minimum insurance coverage. That coverage requires $30,000 for bodily injury, $60,000 for total bodily injury for all persons in an accident, and $25,000 for property damage. Lastly, they are also required to carry Uninsured Motorist Coverage and underinsured motorist coverage of $25,000.

Uninsured Motorist Coverage

Uninsured Motorist Coverage is exactly what it sounds like. If someone without insurance injures you in an auto accident, your Uninsured Motorist Coverage will pay for your property damage and bodily injury. Placing a claim with your insurance company in this manner will not affect your insurance rates. If you’re hit by a hit and run driver, you should also be able to access your Uninsured Motorist Coverage—be ready though, your insurance company will want to know plenty of details about the accident and the hit and run driver before they will provide coverage. The reason is that insurance companies are fearful that drivers make up hit-and-run stories as a way to create fraudulent claims.

Underinsured Motorist Coverage

Underinsured Motorist Coverage plays a different role than Uninsured Motorist Coverage. If your injuries cost more than the coverage the other driver has, you can access your Underinsured Motorist Coverage. However, there’s a catch—your Underinsured Motorist Coverage must be more than the coverage of the driver who hit you. Essentially, your policy will get a ‘credit’ for whatever has been paid. Take, for example, a situation where the at-fault driver has a policy of $30,000 and you have a policy of $50,000. If you reach a settlement for $30,000 with the at-fault driver’s insurance company, you potentially have access to an additional $20,000 from your carrier ($50,000-$30,000).

Stacking Your Coverage

North Carolina has an anti-stacking statute. In states that allow stacking, the purchased coverage can be multiplied by the number of vehicles in the insurance plan. In an insurance plan that has $30,000 in Underinsured Motorist Coverage, if there are 3 vehicles in the plan, you would have access to $90,000 in Underinsured Motorist Coverage. North Carolina does not allow this mechanism for determining the amount of Underinsured Motorist Coverage available to you.

Separate Insurance Policies

If you have two separate insurance policies in your household, you may have the ability to ‘stack’ your Underinsured Motorist Coverage and your Uninsured Motorist Coverage. Where your damages exceed the coverage of the at-fault party, you can access one or both of your auto insurance plans to be fairly compensated for your injuries and lost wages.

Call A Personal Injury Lawyer Today

As you can see, insurance issues are complex. Having a law firm with the experience to understand the coverage available to you and your family is critical. If you would like to speak with a personal injury lawyer about a car accident, call us today at 704.749.7747. Or, click here for a FREE PERSONAL INJURY CONSULTATION and we’ll reach out to you quickly. We know you have options. We hope you choose to Recover With Us.

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