Resolving Your Lost Income Claim , Selecting Your Health Care Provider , Resolving Your Medical Expense Claim , Resolving Your "Pain and Suffering" Claim , How and When to Select an Attorney , Conclusion

Resolving Your Lost Income Claim

Once you have cleared the hurdles of proving liability and proving your injuries, you must then prove those injuries kept you from earning your living and for how long. A statement from a knowledgeable attending physician is usually sufficient to document your inability to work and for what period of time. If you can provide such documentation to the other party's insurance adjuster, you would then be entitled to reimbursement of your lost wages. You would then have to prove how much income you have lost. A statement from your employer should do the job. However, if you are self-employed, you may be required to submit documentation much the same as you would if you were applying for a loan. You are owed reimbursement of your net income (after taxes). Under IRS code, the monies you receive from the insurance company are classified as an indemnification and are not subject to income tax.



Selecting Your Health Care Provider

The selection of a health care provider may well be even more important than your selection of an attorney. A personal injury attorney will be critical to your financial well being. But then, that's only money. Your health care provider will impact your physical well being. We happen to subscribe to the old adage that good health is worth more than money!

If you have confidence in your primary care physician, they would probably be a good place to start for a referral to a specialist to address your specific injury for your post-emergency room care. If you are in an HMO, you may wish to consider going outside their contracted doctors for your specialized treatment, as your HMO will probably complicate the handling of (and compromise the settlement you receive for) your Personal Injury Claim.

If your injuries include internal injuries, broken bones, head injuries and/or cosmetic reconstruction, you will need to be treated by mainstream physicians such as MD's or osteopaths that are specialists in their respective disciplines. However, once your injuries have been isolated to soft tissue strain, we suggest you consider chiropractic or physical therapy by a registered physical therapist under the supervision of your attending M.D. or D.O. We have seen wonders achieved by chiropractic and/or physical therapy in relieving pain, rebuilding strength and restoring range of motion. The unfortunate part about receiving chiropractic treatment without mainstream supervision is that most insurance companies will not give full weight to the treatment charges when they attempt to calculate your pain & suffering settlement. We are not saying that is right. In fact, we are saying that is wrong. However, that is the way it is.

In the selection of a health care provider, expertise and results should always be your primary consideration. However, there is also a secondary consideration. When it comes time to resolve your claim for personal injury, you will want your health care provider to be able to compose a narrative (a "medical legal") about your injury and treatment that will leave no room for challenge by the insurance company. Just as your treatment is critical to your physical well being, a good medical legal is critical to your post-treatment financial well being.

Another important aspect of selecting a health care provider is that provider's willingness to await payment until your claim is settled. Health care providers who regularly work with accident victims are used to awaiting payment. One thing you do not want to happen is to receive relief in the back office, only to be aggravated by the front office. A good, experienced health care provider will never allow this to become a problem. Like most of us, your health care provider will want some assurance that they will be paid for their services. This assurance usually comes in the form of a settlement lien. This means that either your attorney (if you have one) or the other party's insurance adjuster will promise to pay the health care provider. Personally, I would rather have my attorney dealing with my financial consequences than the insurance adjuster for the other party's insurance company.

If you have a good attorney, follow their advice as to selection of a health care provider. Even if you do not have an attorney, it would be a good idea to contact one to get a referral to a good health care provider. A good personal injury attorney will be happy to provide a free consultation and point you in the right direction even if you prefer to handle the claim yourself.

A final consideration (as discussed here) has to do with the scope of treatment and the fees charged by your health care provider. More and more insurance companies are implementing a procedure known as "peer review". This is where a health care provider, employed by the insurance company, reviews your treatment and charges. It is not unusual for the in-house doctor at the insurance company to take exception to the scope of your treatment and the charges there for. In fact, that is the whole point of the Peer Review program. If the in-house doctor did not find fault with your treatment or charges, there would soon be a new in-house doctor. The whole Peer Review program is designed to imply you have failed to meet your obligation to mitigate (minimize) your damages. FOR EXAMPLE: You actually incurred $5,000.00 in treatment expenses, but the Peer Review says you should only have had $3,500.00 in treatment. The insurance company will attempt to reduce your medical expense reimbursement by $1,500.00 AND reduce your pain & suffering settlement proportionately. It is important that your health care provider be able to justify both the scope of your treatment AND the charges incidental thereto. A good medical legal (as discussed above) will help minimize the effects of a Peer Review evaluation. If you are going to handle the Personal Injury Claim yourself, be prepared to deal with the Peer Review obstacle that will be placed in front of you! Remember, if you do not have an attorney representing you, the health care provider will probably have a lien on your settlement for the full amount of their bill. If you are unable to overcome the Peer Review obstacle, your health care provider will be paid the full amount of their bill, but the amount you collect will be substantially reduced. You will better understand the true meaning of "substantially reduced" when you read the Resolving your "pain & suffering" claim section coming up.



Resolving Your Medical Expense Claim

As a consumer, this is where you may find some good news for a change. In many states, you are allowed to submit your claim for medical expenses to BOTH the other party's insurance company AND your own auto insurance company (if you have "Auto Med-Pay" coverage on your policy). This is euphemistically referred to as "double dipping". This means that if you incurred $5,000.00 in treatment expense (for your auto accident related injuries) and you have at least $5,000.00 of Med-Pay coverage on your own auto policy, you can potentially collect that $5,000.00 from your own insurance company AND the other party's insurance company. The days of double dipping are numbered. Gradually, the auto insurance companies are rewriting their policy verbiage to make their own Med-Pay coverage subordinate (secondary) to ANY OTHER valid and collectible insurance and/or are incorporating subrogation rights into the Med-Pay coverage. This will effectively eliminate your right to collect twice for the treatment expenses incurred. You need to review your auto insurance policy (or have it reviewed by an expert) to determine whether you have the right to double dip. Remember, your auto insurance company cannot increase your premium rates for claims submitted which do not involve negligence on your part. So, if you can collect twice, we encourage you to do so.

Your own auto Med-Pay coverage notwithstanding, you are entitled to recover from the other party's insurance company for all "reasonable" expenses incurred for "reasonable" treatment of the injuries you sustained in the auto accident. Again, this is assuming you have already proven liability, proven injuries, proven expenses, and overcome the Peer Review challenge. The amount you can recover is limited only by the extent of coverage afforded by the other party's insurance policy.

If the insurance for the other party is not sufficient to cover your medical expense AND an appropriate amount to cover your Pain & Suffering settlement, you may have to turn to the Underinsured Motorist Coverage of your own auto insurance policy and/or your own health insurance coverage. If the other party were at fault in your accident, but had no insurance, you would have to turn to the Uninsured Motorist Coverage of your own auto insurance policy and/or your own health insurance coverage. The difficulties of coordinating benefits from multiple policies, ESPECIALLY HEALTH INSURANCE COVERAGE, can drive you nuts. If your claim involves coordinating benefits from multiple policies, we strongly encourage you to talk with a Personal Injury Attorney !



Resolving Your "Pain and Suffering" Claim

Of all the subjects discussed in this page, this will probably be the most popular. Of all the E-mail we receive from consumers around the country, the overwhelming majority are asking "What is my claim worth?". As you can see by what you have read above, there is no easy or standard answer, only generalities. The major portion of most Personal Injury Claims has to do with the Pain and Suffering Settlement, which is directly related to the type of injury, the medical expenses incurred, the add'l medical expenses projected, the extent of your recovery, and the physical pain and suffering that is directly related thereto. There is also the credibility of your injury and the expenses incurred to address those injuries. To be perfectly blunt, there is no way we can be specific in answering these questions over the Internet. In addition to us knowing the actual expenses and/or financial damages you may have incurred, we would also have to be familiar with the credibility of those who have charged you for their services, as well as your own credibility. This does not usually happen unless we can speak directly with you . . . face-to-face is always best. However, you did not come to this portion of this page to be told only the reasons why we could not help you. You came here in search of some guidance.
Following is a general formula that could be used and could, just as easily, be departed from based upon individual circumstances.

Auto Damage Claim (100%)
Auto Diminished Resale Claim (repaired vehicles only)
Misc. property damage (personal property other than vehicle)
Rental vehicle expenses (reasonable)
Medical expenses (reasonable)
Lost wages (reasonable)
+ Pain & suffering allowance (1-3 times the medical expense if fully recovered)
-----------------------------------------------------------------------------
Full value of claim

REMEMBER: The above formula is simply a general rule of thumb for most typical circumstances. The value of having a good personal injury attorney is realized in defining what is "reasonable", as referenced above and in the negotiation of your pain & suffering allowance. By retaining a good Personal Injury Attorney, you can also avoid the mistakes, pitfalls and stress of having to deal with the insurance company yourself. How's that for a segway into the next section of this page?



How and When to Select an Attorney

If you believe the advertising attorneys you see on TV and/or in the TV Guide, you'll want to call them on your cell phone from the accident scene. However, as a general rule, I avoid dealing with any individual that spends $1,000,000.00 a year to advertise on television (that is NOT an exaggeration). We personally know of law firms that spend 2-3 times that annually just to advertise on television.

I'm inclined to believe that anybody good does not have to spend a lot of money to advertise. Their reputation brings in enough referrals to keep them busy. However, there is an unfortunate side-effect of having some law firms with massive advertising budgets. Some really good personal injury attorneys are losing potential referrals to these large advertising law firms. Consumers are going to advertising law firms where their claim is actually handled by some clerk instead of an attorney. If I'm going to pay to have an Attorney represent me . . . I want an attorney to represent me!

If you believe the insurance adjuster, you don't need an attorney. They will probably ask you something to the affect of "Why give away part of your settlement if an attorney is not going to collect any more than we are already willing to pay?". The unfortunate part of that statement is that it is sometimes true. If you have your claim handled by a clerk, the adjuster is probably right. Later on, when the claim becomes difficult (after they have already gotten what they want out of you), they will probably expect you to go to an advertising attorney and the insurance company will expect to settle your claim for what they were willing to pay all along. Remember when we discussed why an insurance company may DRIVE you to an attorney in the understanding adjusting techniques portion of this page?

As for the "how" and "when" to select an attorney, let us address these in reverse order. When? The sooner the better. If you have read all the above text you'll understand why we make this recommendation. IF you are going to get an attorney at all . . . THE SOONER THE BETTER! As for the "how" . . . GET REFERRALS FROM SOURCES YOU CAN TRUST. You can contact your State Bar Association for referrals. You can contact your State Trial Lawyers Association for referrals. You can check with the Better Business Bureau and the Bar Association for any records of complaints on an attorney you may be considering. You can ask for references from an attorney you may be considering have represent you. Ask your potential attorney who will actually be handling your file, the attorney or a clerk. Finally, you can visit our Local Attorneys page to see what good personal injury attorneys have joined the Insurance Consumer Advocate Network. ALL the personal injury attorneys listed in our Local Attorneys page will be happy to provide a free consultation to address your concerns. If you are involved in a Personal Injury Claim, you are probably entering an arena in which you have little or no experience. The primary concern of our member attorneys is seeing to it that you receive proper treatment and are not taken advantage of in the claim settlement process.



Conclusion

In this page we have attempted to make you more aware of what you may be facing if you are involved in a Personal Injury Claim. If you choose to represent yourself in the handling of your claim, we suggest you print this text and keep a permanent record of what was discussed herein. This could help in your dealings with the insurance company(s). Even if you choose to have an attorney represent you, keep a copy of this text to refer to when you are asking questions. After all, the more intelligent questions you ask, the more you are going to understand about the process in which you are involved. We hope the information on this page helps you understand the process and avoid the problems!