Welcome to Law-Forums.org!   


Sponsor Links:

Discount Legal Forms
Discounted Legal Texts

Insurance Settlement

Been the victim of Medical Malpractice or fighting a malpractice suit? Discuss it here.

Insurance Settlement

Postby Alhrick » Wed Nov 23, 2016 1:49 am

Hello, I understand that this is a general question; however, I am wondering what I should expect out of my settlement. I was involved in an accident on 4/12/07. The driver turned in front of me and I hit her passenger side at 45 mph. She was faulted in the police report and also her insurance company noted that she was 100% at fault. I was taken to the ER and had bruises on my knees and arms. I also required a septoplasty so I could fix my deviated septum due to it being bent in. I also had trouble breathing after the accident. I have made 6 office visits total without counting the ER visit. Due to complications from the surgery, I was required to stay the night at the hospital. My vehicle also took 6 weeks to get back. Right now, just my medical bills are around $30,000. I have missed near a week of work as well. Her insurance company(Metlife) wants to settle soon; however, I have no idea what is fair value for a settlement. If you could give a ball park figure, that would great.
Posts: 29
Joined: Sat Mar 01, 2014 3:20 am

Insurance Settlement

Postby Giselbert » Wed Nov 23, 2016 3:52 am

Dear Josh,

Be patient with me here, as I will go thru some early comments before I address your question regarding valuation.

You wrote a question without much in the way of facts.  For starters how did your septum get deviated?  If you hit your head on something, then that can make a big difference.  Describe the pain from having your nose hit so hard.  Also, there are no facts about other soft tissue injuries one would expect in a crash at 45 MPH.  Finally, there is nothing about the prognosis.  The fact that you once already had problems with the surgery tells us that there can be more problems expected with a septoplasy.  

If you hit your head, have you ever Googled “post concussive syndrome”?  Even a couple of seconds that cannot be remembered count as a loss of consciousness.  Most people with minor brain injuries never know what is causing problems Here is how I will approach my answer.  I want to give you a full hour of my time inasmuch as I think you may have a serious case, but if you continue as you are it could be disastrous.  The answer to your main topic: “I am wondering what I should expect out of my settlement” will not please you.  Unless you change and educate yourself and take charge of this negotiation, what you can expect is to be the next poster boy for the adjuster who brags about the office on how he screwed another victim.  They don’t hand out settlement awards of any substance unless they are convinced that there is some good reason to do so.  And THAT IS YOUR JOB, JOSH.  You will bear the burden of proof, NOT the adjuster.  

That may sound pretty blunt, Josh, but rather the truth than sugar coating, right?  I have a number of topics for your answer, and here is an outline.

1.   First is my plea to TAKE CHARGE of your claim: don’t let the adjuster be the first one to put out a figure—that is a weak negotiating position.

2.   Second is the MOST IMPORTANT: it is my plea to WAIT AND DO NOT FALL FOR THE INSURANCE TRICK OF PREMATURE SETTLEMENT.  Live with your injury enough for it to mature so that at least you know what you are dealing with.

3.   Third will be general comments regarding valuation, and then some specific topics

4.   Fourth is the possibility of a policy limits situation

5.   Fifth is the advantage of using a narrative report

6.   Sixth is a collection of pages on how to make a do it yourself insurance settlement

7.   And last is a general hint on dealing with the adjuster. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

First, TAKE CHARGE OF THE CLAIMS PROCESS NOW: do NOT let the adjuster make the first offer.

Take the initiative and DO NOT LET THE ADJUSTER DICTATE THE SIZE OF THE BALLPARK you are going to play in if he makes the first offer:  Since you are way too early to think of settling, just let the adjuster know you will contact him later.  Tell him that once you see how your body handles the physical activities of summer, you will get a demand letter to him soon thereafter.  

The only exception to this is to let him know that if his insured has policy limits of less than $50,000, you will accept those, subject to giving notice to your insurance company that you are about to release the claim that it would use for a subrogation lawsuit.  There is more about policy limits below.

Give some real thought to the weakness you put yourself in if you simply invite the adjuster to throw out a figure now.  He will always be low, and that sets the dimensions of the ballpark.  Mo’ Betta you be the one to set the dimensions with your settlement demand.  

In negotiations, once the first figure is on the table, it gains some legitimacy just by its mere existence.  In essence, it will then be up to you to move the figure: to show where he is in error.  

You should be commended for having the initiative to seek out a website such as this and to ask for help, but the most important part of achieving a successful personal injury claim HAS TO START WITH YOU, NOT THE ADJUSTER.  Do NOT let the adjuster set the parameters of the negotiation: get your demand letter out there once you are ready to settle.  It is not all that hard or mysterious to put together an Effective Personal Injury Insurance Demand Letter http://www.settlementcentral.com/page0170.htm   It does not have to be "fancy" or complex; just hit the main points and get it out to the adjuster soon. Use a Confidential Personal Injury Diary for TOP DOLLAR Insurance Claim Settlements http://www.settlementcentral.com/page0208.htm It is not too late for you to take the initiative, and I will explain how below.  But just for a second, put yourself in the shoes of the adjuster and see what you have done by letting him have all the control of the claim.  As an adjuster, he is trained by his company to reassure the injured party that he is acting in THEIR behalf, as opposed to the interests of his company—sort of like a car salesman who convinces a customer that he will fight for them versus the auto store manager.  Sure.

But both of those are relationships are to the disadvantage of the consumer, aren't they?  We would like to trust people who are in the position of the adjuster to act at least nominally in our behalf.  But it is just as much as a mistake to take a passive role here as in buying a car: you have to get up and make something happen yourself.

If I were you, what I would do right now is to become as fully informed about the insurance injury claims process as I can, with the objective of seizing the initiative in prosecuting my claim, instead of taking a passive, reactive role.  Can you see the difference in postures and how one works to your advantage and the other to your disadvantage?  

You will also gain dollars just by telling him now that you are having more episodes of pain or breathing problems following exercise, or whatever, and hence you want to wait to speak with him.  Nothing will cause him to get after an early settlement than the risk that the claim value is going up with increased exposure to physical activity.  

A settlement phone call or a meeting with the adjuster at this time is the WORST POSSIBLE THING YOU CAN DO.  What?  You are going to show him your present condition, which is of minimal pain, but then when you have real pain this summer you have to climb a mountain to get him to believe you could develop pain?  Meeting with an adjuster just three weeks following a pretty serious accident works to your disadvantage in all ways.  Plus, it shows him that you are not a “player” in the field of personal injury claims negotiations.  There is not one advantage that can be gained by such a meeting.  Satisfying your curiosity about what he would offer is not a sufficient reason to undermine the value of your claim. All of the advantage of a settlement phone call or a meeting is HIS; all of the risk of the meeting is YOURS.  Don’t do it—or, if you are so stubborn that you cannot—or will not—see what I am saying to you, at least delay that meeting for the minimum of one month—no sooner.  In the meantime, you keep track of the small pain you feel at the end of the day and make sure your medical record gets updated with your reports of how that pain is felt after certain activities and how it interferes with your life. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX


Let's just finish up this topic of early settlements so you get the full picture of the advantage to them and the risks to you.  Insurance companies like to settle early because the general damages—claims for pain and suffering—are always minimal, but continue to grow with continued medical/therapeutic care over the months.  Therefore, the insurance adjuster will try to settle before your claim merits a larger pain and suffering element.  This makes good sense for the insurance company.  A claim that is still active after 12 months, with an injured claimant still undergoing treatment, will settle for a lot more pain and suffering money than a claim that is settled after two or three weeks of treatment.

In serious soft tissue cases—which this COULD BE if you hit yourself hard enough to have a deviated septum(and likely significant soft tissue injury)—the full extent of most injuries is not known immediately after finishing one early round of treatment, because the injured person has to undergo some of the wear and tear of everyday life, including the pounding his body will receive from a day's work. Even jobs that appear not to be physically demanding can be hard on an injured body. For example, have you ever stood all day with few breaks, as a store checkout clerk or a jewelry salesperson does?  Or sat all day at a computer, as a secretary or phone service center employee does?  Many jobs will interfere with healing, and you have no way to know how your body will respond until you have experienced sufficient physical exposure to load-test the scar tissue as you heal. Plus, who will pay for your medical care incurred AFTER you settle?  What if you were to settle now and three months later when you mow the grass and the pain starts to become too much, you go to a chiropractor only to discover that you can expect a course of treatment that will cost a lot of money?  

After you settle your claim, all further treatment is your responsibility.  Except in specific, unusual situations, you cannot go back and re-open a settlement: when you cash the check, you agree to close your claim in all aspects.  Check with your PIP adjuster to find out whether they will pay anything once you close the claim against the tortfeasor. Here is another page from my website that shows in detail why you should never make an early personal injury insurance claims settlement http://www.settlementcentral.com/page0211.htm And, of course, once you settle, THAT IS IT: no one will be there to pay for your future medical or chiropractic care; nor will you ever see another dime in pain and suffering money.  By the way, did you know that getting an early settlement is a favorite trick of the insurance adjusters?  Please see my website wherein we show Insurance Claim Adjuster Secret Tactics http://www.settlementcentral.com/page0092.htm

There may be a dull ache at night following some physical activity or pain the next morning.  DO NOT LET LITTLE PAINS GO UNATTENDED SINCE YOU DO NOT KNOW WHETHER THEY WILL CONTINUE OR GO AWAY.  We all hope and believe that such little pains will disappear soon.  But on the other hand, we have no way of knowing since this is the way serious soft tissue injuries can behave.  

So, when this happens, even if a couple months or more post-treatment, do not hesitate to SEE A DOCTOR AND ATTRIBUTE THE PAIN TO THE ACCIDENT WITHOUT EQUIVOCATION.  It is NEVER TOO LATE TO REPORT PERSONAL INJURIES FROM A CAR ACCIDENT http://www.settlementcentral.com/page0104.htm

According to Our http://www.SettlementCentral.Com Members, Chiropractors are Most Effective in Severe Whiplash and Soft Tissue Car Accident Injuries http://www.settlementcentral.com/page8010.htm

Managing Medical Care After Auto Accident: http://www.settlementcentral.com/page0203.htm

"No medicine: no money"; medical costs increase worth of personal injury insurance claims http://www.settlementcentral.com/page0045.htm


Third, here is an INTRODUCTION TO VALUATION—INSUFFICIENT INFORMATION to even make a guess.  But I would surely offer to settle for any policy limits of $50K or less, subject of course, to your own company with a subrogation claim approving of the settlement(more on that below).

We are not allowed to make settlement estimates for two reasons.  First, the various state bar associations contend that is the practice of law.  Second, this site does not want a malpractice suit should we steer you wrong.  NO, Josh—there is never any website or any attorney or any adjuster who could provide any ballpark figures for settlement of a claim given the lack of information you present.  

Valuation is an art, not a science, and even in our former law practice no two attorneys agree most of the time.  There is just too much difference between people and their injuries to make a formula, unless one invests $3 million as was done in the case of the Colossus software.

BTW, that is a software program that is sold to the insurance industry to systematically provide ever-lower valuations for claims. The Truth About Colossus http://www.settlementcentral.com/page0448.htm Let's take your statement about the surgery.  How can we know the value unless we know how much pain was suffered, how much swelling and bleeding did you have afterward, did you have to do nasal irrigation—if so, describe the hassle with that, have you been swimming much—and how did it impact that activitiy, how it changed your appearance, what problems one can expect long term?  

Don’t take this bawling out too personally: most people have NO IDEA how to settle their own claims until they get some guidance, which I will provide below.  One GOOD THING, however, is that you have taken the time to research your topic a bit by asking at this website, and hence that might give you a bit of additional information. I want you to become informed about the process of personal injury insurance claims, and to have a little insight on how to proceed.  You might want to consider the advantages of hiring an attorney instead of doing a self help personal injury claim.

Many people do not have the time to present their own claim.  Nor do they like to get involved with negotiations with an insurance adjuster.  And, of course, if their claim involves any significant legal issues, most people would prefer to hire an attorney, and we advise that they do so.  

Likewise, if there are significant injuries, which will translate into significant personal injury damages, then we recommend that the claimant get professional advice or representation from a competent personal injury attorney.

Otherwise, most people with medium($50,000) and less claims can and do settle their own claims, and they do a good job of it.  I suspect that you fit into this category by the way you have presented yourself, so maybe you will try to do this yourself first.  By the way, it can be pretty easy to settle those low limits cases without an attorney.  If the tortfeasor has only $50K limits, a blind dog with a note in its mouth could settle your claim for that—so why hire an attorney?

On the other hand, if the tortfeasor has $300K limits, then an attorney is going to be needed to get as close to full value as possible.  


We consider the damages in three categories: special damages, general damages, and future damages(which will be both special and general).

Special damages are things that are capable of ascertainment by calculation or documentation.  These include such topics as medical and chiropractic expenses, appliances(the gauze plugs for your nostrils, a crutch or dental appliance for a jaw joint claim), physical therapy, lost wages, transportation to and from medical appointments, hired chore and personal help, and the like.

General damages are for pain and suffering, loss of enjoyment of life, severe emotional distress, and the like. Usually general damages are the “wild card” in the settlement, and that is where the negotiation centers.  Assuming that they agree to the special damages, what is left is to argue about the value of the claim for the suffering that you have and will endure.

Future damages(which will be both special and general) will be paid ONLY UPON A FIRM COMMITMENT by the doctor.  Your doctor cannot just state that you will need some additional care in the future.  NO, he has to make it an unambiguous statement of need: a firm prediction that you will need revision work and state its risks and costs.

What about valuation of your claim?  How does one figure out what to ask for?  
Posts: 39
Joined: Mon Apr 14, 2014 2:28 pm

Insurance Settlement

Postby Caw » Thu Nov 24, 2016 7:02 am

Hello, I understand that this is a general question; however, I am wondering what I should expect out of my settlement. I was involved in an accident on 4/12/07. The driver turned in front of me and I hit her passenger side at 45 mph. She was faulted in the police report and also her insurance company noted that she was 100% at fault. I was taken to the ER and had bruises on my knees and arms. I also required a septoplasty so I could fix my deviated septum due to it being bent in. I also had trouble breathing after the accident. I have made 6 office visits total without counting the ER visit. Due to complications from the surgery, I was required to stay the night at the hospital. My vehicle also took 6 weeks to get back. Right now, just my medical bills are around $30,000. I have missed near a week of work as well. Her insurance company(Metlife) wants to settle soon; however, I have no idea what is fair value for a settlement. If you could give a ball park figure, that would great.
Posts: 51
Joined: Fri Feb 14, 2014 4:30 am

Insurance Settlement

Postby Fionn » Sun Nov 27, 2016 8:39 am

: get as much as you can.  Figure out what would make you happy, and increase that amount by at least 50%!

SHORT ANSWER: A common theme among those who still think a formula will put you in the valuation ballpark is to multiply the medical specials times a number from TWO to FIVE(depending upon factors, some of which I will give you later—or all of which are listed in the members' side of my website, www.SettlementCentral.Com).  Then that figure is the total value of the personal injury portion of the claim.  Of course there is a long list of factors to consider for adding or deducting from the total. Let's start with geography.  Values differ from state to state, and within each state.  City values are often different than rural values on claims. Next, the seriousness of the injury, and of course, whether or not the injury can be proven by objective evidence(that scar), or whether the only proof is subjective(your statements that you feel pain).

Here is a listing of factors that will affect both the multiplier you will use, as well as the value of the claim inasmuch as they will increase or decrease the product of your multiplication. 1. LIABILITY DISPUTE & comparative negligence This is a big one because it most dramatically affects value: minus if you have any fault.  This is a plus for you.

2. Trauma suffered The value of your claim increases with a bigger crash, and decreases with a low damage fender bender. Why? Just human nature.   You had a good hard hit—another plus for you, Josh.

Therefore, the total value of the property damage(e.g. cost to repair or replace a motor vehicle) becomes significant.  Plus for Josh

3. Medical special damages Cost of medical and related health care expenses; higher costs usually equate to an increase in value(excepting, of course, cases of gross overtreatment).  Plus for Josh.

4. Type of injury Where does the injury fall within the insurance industry's "hierarchy list" of valuing injuries? Irrespective of which injury may cause more pain, injuries are valued according to seriousness, tendency to be persistent or permanent, and whether or not they need objective proof to be believed(e.g. a broken bone versus soft tissue strain). 5. Type of medical care Where does the medical care fall within the insurance industry's "hierarchy list" of valuing medical care?  Orthopedists at the top, chiropractors near the bottom.

6. Prognosis- future care—permanency of injury or pain and suffering—or were you done treating one week after the accident? Your claim value gets a boost if your doctor specifies that you will need some future medical care. 7. Your medical and claims history, prior accidents, prior injuries or treatment of the same area of the body. 8. Impairment of quality of life.  Josh needs to build this up.

9. Quality and persistence of pain suffered.  Ditto above, Josh

10. Quality and thoroughness of your medical records. 11. Lost wages. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Fourth, consider the strong possibility you have A POLICY LIMITS CASE FOR THE TORTFEASOR(and maybe for your own UIM)

The value of your claim is likely AT LEAST TWO TIMES THE MINIMUM LIMITS IN YOUR STATE.  Hence, you may HAVE A POLICY LIMITS http://www.settlementcentral.com/page0451.htm INSURANCE INJURY CLAIM

You will need special instructions and letters to safeguard your rights to collect under your own coverage for Underinsured Motorists(UIM).  

Also, you should make every effort to defend any insurance subrogation http://www.settlementcentral.com/page0459.htm  payback attempt.  



It sounds like you may not have a lot of personal stories of pain and problems to tell.  In that case, it can be helpful to use a narrative report wherein the doctor can tell about all of the problems people have with this surgery, along with a discussion of your own prognosis.  

Before you send in your demand letter, look at the medical records to make sure that they mention all things of importance that occurred in conversations with the doctors.  When applicable, consider asking for a narrative letter to assist in settling the insurance claims.

Have you seen any of the doctors' records that went to the insurance adjuster?  If not, it is easy enough to get a copy so you can make sure that everything of importance you discussed is included therein IN READABLE FASHION.  

Cryptic notes may be medically significant, but why make the insurance adjuster struggle to figure out the significance of the injuries?  A narrative report or letter spells things out so the adjuster can see, read, and understand the doctor's diagnosis and prognosis and her record of the problems and pain and suffering you have endured. Plus, narrative letters can tie together the trauma and its after-effects in the lives of you and your wife in a way that is authoritative.

We recommend that claimants almost always include some type of typewritten medical information to accompany to computer coded medical records and/or handwritten records. That is the first clue as to when to use the narrative report: if you are asking the adjuster to evaluate your claim on the basis of handwritten records and/or computer coded records that indicate diagnosis and treatment codes, then you need to supplement the record with a narrative report.

We have a lot of free legal tips on insurance claims settlements using doctor narrative reports http://www.settlementcentral.com/page8003.htm  You can get information there as to how to ask for a narrative letter and what it might cost.  Talk to the doctor's office manager about it.


Sixth, if you think you can do this yourself, you will be wrong UNLESS you educate yourself about personal injury insurance claims on a self help basis.  Learn how to submit and settle your own personal injury insurance claims—DO IT YOURSELF SETTLEMENTS.  Here is a series of pages that you can review.  Take what makes sense to you and don't worry about the rest.  Just get a flavor of how the system works without spending a ton of time right now. Overview Tort Law Personal Injury Legal Claims http://www.settlementcentral.com/page3000.htm

Managing Medical Care After Auto Accident: http://www.settlementcentral.com/page0203.htm

Medical Care Documentation-the Key to Successful Personal Injury Insurance Claim Settlements http://www.settlementcentral.com/page0217.htm

Keys to a MAXIMUM INSURANCE INJURY CLAIM SETTLEMENT http://www.settlementcentral.com/page0089.htm

Use a Confidential Personal Injury Diary for TOP DOLLAR Insurance Claim Settlements http://www.settlementcentral.com/page0208.htm

Outline of questions to be expected from insurance claims adjuster http://www.settlementcentral.com/page0190.htm

Detailed listing of questions to be expected from insurance claims adjuster http://www.settlementcentral.com/page0207.htm

By the way, did you know that getting an early settlement is a favorite trick of the insurance adjusters?  Please see my website wherein we show Insurance Claim Adjuster Secret Tactics http://www.settlementcentral.com/page0092.htm

Responding to Settlement Offer From Insurance Claims Adjuster http://www.settlementcentral.com/page0244.htm

Do It Yourself Advantages, or do these claims need an attorney?  As for an ATTORNEY, this does not seem to be a case that involves any legal issues in dispute nor any large or complex damages.  Why should you pay someone one-third to do what you can do yourself?  Do-It-Yourself Personal Injury Claims; Eliminate Personal Injury Attorneys' Fees; Save Thousands of Dollars Settling Your Own Insurance Claim http://www.settlementcentral.com/page3011.htm

Without having to join my website, I have given a lot of free information on handling insurance claims without having to join as a member.  Read the module at "5 Easy Steps to Do-it-Yourself Insurance Claim Settlement" http://www.settlementcentral.com/page0102.htm

This stuff is not rocket science, but it will take some effort on your part to read and cut and paste letter examples and to communicate.  But hundreds of people are doing it each day, and they are getting good results.  

What if you get only two-thirds the way to your settlement goal?  Well, you can get as big a settlement as you can and then turn it over to an attorney and save a lot of fees.  Thus, you could go it alone just to get an insurance settlement offer, and then take that insurance settlement offer to a personal injury attorney, thus exempting the amount of the offer from her fees.  Do It Yourself Personal Injury Settlement Offer Reduces Personal Injury Attorney Fees http://www.settlementcentral.com/page0109.htm



FINAL TOPIC: Effective communication with insurance claims adjusters.  Establish Firm, Professional, and Positive Relationships With the Insurance Injury Claims Adjuster http://www.settlementcentral.com/page0059.htm

Always communicate with the adjuster in writing, showing your own analysis of value. It is OK I guess to have one call or so, but no more.   Always have your information and ammunition in writing to give to the adjuster. Let him know that you are FIRM IN YOUR RESOLVE to get what you are demanding(NOT "asking", since that invites a counter-offer, but instead "demanding" as fair and reasonable compensation) by asking him what the options are to resolve the matter fairly should he not agree to a reasonable claim value. In other words, let him know that you will go through with a court filing if need be. Remember these tips, do your homework, print out your evidence, show resolve to get your fair settlement, and you will DO JUST FINE. I trust that my extra time here has produced some information that has been of value to you, and thus I would respectfully request that you take the time to locate the FEEDBACK FORM on this site and leave some feedback for me.

Best Wishes, Dr. Settlement, J.D.(Juris Doctor) http://www.SettlementCentral.Com
Posts: 51
Joined: Wed Jan 01, 2014 6:06 am

Return to Medical Malpractice


  • Related topics
    Last post