Insurance Settlement

[kork13]

I've never done this, so I'm not sure how to go about arriving at a reasonable insurance settlement for an accident of which my wife & 2 boys were the "victims" (no fault on DW's part, rear ended & totaled the car DW/DKs were in). Appreciate any guidance, experience, or advice anyone may be able to offer.

Accident happened in Feb 2020. DW/DKs were visiting me at a stateside "deployment" in SC, in SIL's borrowed minivan. SIL was already made whole for her totaled minivan, but DW/DKs have been receiving chiropractic & physical therapy treatment since the accident. Very little traumatic injury (no broken bones or anything), mostly it's for whiplash type soft-tissue injuries... DW got the worst of it (to the point of numbness & stabbing pain in her neck/back/arms), and the boys only to a lesser extent -- thank heaven for quality child carseats. While significant progress has been made, we're expecting that they likely will require continued treatment to varying extents for roughly the next 1-2 years. Because we're in the military & have moved around alot in the last 2 years, they've been treated by over a dozen providers in 5 cities across the country (AK, ID, AZ, UT, TN), and some of those providers are (very understandably) starting to ask for payment. So DW is starting to work with the at-fault driver's insurance about finalizing a settlement -- USAA, gratefully, which I've always found & known to be quite reasonable with insurance claims.

To start with... we really don't want to involve a lawyer, because lawyers are......lawyers.
My initial thought is to build a requested settlement as a total of:
(1) All medical costs -- don't know exactly what those are, but we're estimating around $10k/yr chiropractic & $12k/yr physical therapy (~$45k total the last 2 years)
(2) A reasonable amount of future medical costs (we're thinking to basically replicate what the bills have been for the last 2 years... So if the last 2 years have cost $45k, ask for another $45k to cover the next 2 years).
(3) Some reasonable amount of "pain & suffering" ... which in our mind, should also compensate for the time spent in treatment, indirect costs like childcare & transportation so that DW could go to treatment, and the aggravation of having to deal with it all. Our VERY rough thought on this is somewhere around $10k-$20k.

So those rough figures would point to around a $100k-$110k requested total settlement. That's probably the high end number... Minimum acceptable would probably be closer to $50k.

Another factor we don't know how to consider/account for is how our health insurance factors in. I'm active duty military with Tricare, which covers 100% of doctor-recommended physical therapy... And she's a military retiree with VA benefits. Most of the PT they've received has been fully covered by my health insurance, and some of DW's chiropractic care was also covered by her own VA benefits. Would we be obligated to repay those amounts? Or should we just accept that VA/Tricare have covered it, don't worry about them, and just remove those costs from our requested settlement?

Once again, never done this, and don't really know how to go about it beyond laying out the above reasoning and having a good-faith discussion. Any better ideas or suggestions?

[Jluke]

I did a quick google search for accident pain and suffering calculators and found several hits. Here’s one that seems to match your thinking but there is something called a multiplier in the calculation that you may not have included. 1.5 to 5x your number

https://www.alllaw.com/articles/nolo/personal-injury/two-ways-calculate-pain-suffering-settlement.html

even though you probably don’t have a claim through your own insurance have you considered contacting your own insurance for advice?

[disneysteve]

Under no circumstances should you or your wife be communicating with the insurance company to negotiate a settlement. Who do you think is handling their end? LAWYERS! Any communication between you and them should be going through YOUR LAWYER. You need to get legal representation TODAY! I can’t possibly stress this strongly enough. What you are proposing is representing yourself in a very serious legal proceeding. That is an absolutely awful idea. The difference in the outcome could literally be hundreds of thousands of dollars over your children’s lifetimes. Please find a top notch personal injury attorney ASAP.

[Like2Plan]

Kork,
Since there are ongoing injuries, I agree with Disneysteve. I can sympathize about how you feel about lawyers, but you don't know what you don't know. Also, some states have a surprisingly short statute of limitations on settling these cases. It's already been 2 years. (I just googled SC--according to the internet it's 3 years, but obviously a lawyer would be better able to guide you)

Regarding the Tricare-I'm surprised you haven't already been asked to fill out a DD form 2527 (Statement of Personal Injury- Possible Third Party Liability). I don't know how that impacts your situation, but you could ask your JAG office.

[QuarterMillionMan]

Agreed that a lawyer is the only way you should be dealing with this. Never on your own. Lawyers will take 33% roughly but most work on contingency.

[disneysteve]

I posted my earlier response while I was still in bed because I wanted to get something out there immediately.

Just to comment further, you've used words like "reasonable" and "good faith" but you need to understand that those concepts don't exist on the insurance company's side. They have ONE job and that is to pay out as little as they possibly can. You need someone fighting for you to get every penny possible.

This could easily turn out to be the worst financial mistake you have ever made. You may walk away with a check for $100,000 thinking you "won" not even aware that a decent attorney could have gotten you $2 million or more.

You said your wife is starting to work with the insurance company. You should put a stop to that right away. No further communication. If any conversations have already occurred, there's a possibility she has already said something that could jeopardize the case.

Again, this is a LEGAL PROCEEDING. You need to treat it as such and get proper representation.

My wife and daughter were in an accident 20 years ago. My daughter was injured. We sued and got what we felt was a satisfactory settlement which compensates my daughter for the rest of her life (with an annual COLA). There's no way that would have happened without our legal team. And 20 years later, she is still receiving therapy for issues that stem partly from that accident.

My point is that 2 years out, you have no way of knowing what long-term effects this accident will have on your wife or kids. You're looking at the next 2 years. You need to be looking at the next 50.

GET A LAWYER!

[Fishindude77]

I posted my earlier response while I was still in bed because I wanted to get something out there immediately.

Just to comment further, you've used words like "reasonable" and "good faith" but you need to understand that those concepts don't exist on the insurance company's side. They have ONE job and that is to pay out as little as they possibly can. You need someone fighting for you to get every penny possible.

This could easily turn out to be the worst financial mistake you have ever made. You may walk away with a check for $100,000 thinking you "won" not even aware that a decent attorney could have gotten you $2 million or more.

I might get an attorney working in my behalf to get things settled fairly, but can't agree with the above line of thinking.
Don't know the details about the accident or injuries, but so long as you get fairly compensated for your damages and medical costs, I see no reason to make a bunch of lawyers wealthy dragging this thing out, and try to hit a home run massive settlement off of an unfortunate accident.

Just because you can get by with something doesn't mean you should. Follow the golden rule is good policy.

Not all insurance companies are out to put the screws to you on a settlement. They are often quite fair about things.
This idea of trying to make big windfalls due to something like this, is why insurance is so darned expensive to start with.

[rennigade]

Yikes, what ever else said, lawyer up. I hope you or your wife had minimal dialogue with the insurance so far. They record everything and will use it if they have to.

Ive been in a lot of accidents, none major. They always ask the basic question, was anyone injured, etc etc. They almost always ask from a scale of 1 to 10, how do you feel, 10 being the worst. I was always told to never answer any of these questions. How the hell can anyone know on a scale how they're feeling? Its a loaded question. Get a lawyer asap.

[disneysteve]

I might get an attorney working in my behalf to get things settled fairly, but can't agree with the above line of thinking.
Don't know the details about the accident or injuries, but so long as you get fairly compensated for your damages and medical costs, I see no reason to make a bunch of lawyers wealthy dragging this thing out, and try to hit a home run massive settlement off of an unfortunate accident.

The bolded part is what's important here. Is just getting your estimated costs for the next 2 years fair? What if they still require treatment 3 or 4 years from now, or 10, or 20? What experience do you have knowing what "normal" is in these types of cases and injuries? The fact that they're still needing treatment 2 years after the injury suggests a chronicity that will be with them long-term, possibly the rest of their lives.

I'm definitely not a fan of suing just for the heck of it or just to see what you can get, and I didn't mean to imply that at all. But I'm also not a fan of letting the insurance company decide what is "fair" because their interests are very, very different than yours.

[Like2Plan]

"Third-Party Liability
The Federal Medical Recovery Act allows TRICARE to be reimbursed for its costs of treating you if you are injured in an accident that was caused by someone else. "

Here is a link for you : https://www.tricare.mil/FormsClaims/...PartyLiability
It also states in the instructions, "Do not execute a release or settle any personal injury claim you may have without notice to a military claims officer"

(This is only for recovery of the medical costs and has no bearing on any legal action you are pursuing in regards to your injury.)

[QuarterMillionMan]

The insurance company will give you a low ball offer maybe like you suggested at your bare minimum of $50,000. Then you might counter offer let's say $100,000. They might meet you half way at $75,000 or accept your $100,000 and pay you the full amount you requested. A lawyer instead will only take slam dunk cases which your's sounds like a slam dunk. They may win a $1 million case for you and take $333,333, leaving you with $666,667. Slam dunk.

[disneysteve]

The insurance company will give you a low ball offer maybe like you suggested at your bare minimum of $50,000. Then you might counter offer let's say $100,000. They might meet you half way at $75,000 or accept your $100,000 and pay you the full amount you requested. A lawyer instead will only take slam dunk cases which your's sounds like a slam dunk. They may win a $1 million case for you and take $333,333, leaving you with $666,667. Slam dunk.

This exactly!

[ua_guy]

So, having worked for the claims industry before, specifically automotive, you have an open BI/bodily injury claim with them that has not been settled. The claim is probably with a senior BI adjuster who is not a lawyer and they also have an interest in settling. The longer a claim goes unresolved, the more money it costs. Typically when claimants lawyer up, the BI adjuster then works with the lawyer as they present settlement figures, etc. Legal counsel for the insurer typically only gets involved when there is formal suit and/or if there is an issue with injury limits with regards to the insured's policy. Remember, if they only have 25,000 per person limits and $50,000 total per accident, even if your claim totals more, the insurer will fight to the death to settle at no more than 50,000 in defense of their insured. If you're lucky enough to have someone hit you who has 250,000/500,000 limits, you might be looking at $125,000 per person divided equally, or more for the more injured person and less for the others. But being represented can be advantageous both for the insurer and the claimant. They should never discourage you if you want to be represented. The costs the insurer spends to defend the limits of their insured's policy is not included in the settlement figure, those are costs the insurance company eats above and beyond. Typically the insurer will not disclose anything to you about the insured's policy or limits, only if there is valid coverage and acceptance of the claim. If the other insurer doesn't have enough policy limits to cover the loss (they will try to settle within that number), that's when most people lawyer up, and also get their own insurer involved for any un/underinsured coverages for you and your family. Edit: To actually answer the question, you can start with a discussion but if it's not going the way you need it to, it might be time to talk to an attorney.

In 2020 I got blasted from behind while stopped and waiting to turn left across a 50mph road, I was the unlucky third vehicle involved and couldn't get out of the way completely, despite trying. The at-fault driver was uninsured and his truck was totally undrivable. The second car was wadded up, trunk and rear floor pushed clear through the back seat, and the front end shortened after being pushed into my truck. I got away with almost no damage - it scuffed the bumper but my spare tire and hitch took the brunt of the impact. Had it inspected and the shop and they said nothing was bent, but to repair the bumper they can only buy the whole assembly. So they wrote it for that, I took the check and called it a day. I think I could have gotten a lot more money had I claimed uninsured coverages through my policy and gone to the doctor and all that. We shook it off and haven't had any trouble. Talk about luck.

[kork13]

Wow... Not quite what I expected the response to be. Maybe I made the situation out to sound worse than it is. The boys weren't hurt significantly (gratefully), we've mostly just had them evaluated periodically & a few months of treatment when deemed appropriate. Yes, my wife was definitely injured, and was in serious pain for a while. That has mostly gone away, and she only occasionally gets those significant symptoms at this point. From the time of the accident, she feels roughly 80-90% better. That's why we're thinking to just plan for 1-2 more years of treatment as a fair expectation. And as a physical therapy grad student, I'm inclined to trust her judgement. Though we're planning to get an evaluation letter (or similar) from her current PT to back up that estimate to justify it to the insurance company.

BTW, some have mentioned talking to our insurer about it -- it's actually the same company (USAA). So it may be a little pointless to go that route. Though as I said, I've generally found USAA to be pretty reasonable when it comes to paying out claims.

We're kinda leaning toward showing the costs, explain our reasoning for the rest, and requesting the $110k-ish figure to see what they say to that. Then only engage a lawyer if they balk & try to low-ball it. Though I guess we'll first talk to Tricare -- thanks for that info Like2Plan!

Especially because things are mostly resolving, we have no desire to milk this for as big a payout as we possibly can. That just seems dishonest & unreasonable to me.

[disneysteve]

Wow... Not quite what I expected the response to be.

I still say you are undervaluing this case.

The fact that after 2 years she is not 100% better means, pretty much by definition, that she has permanent injuries. Hopefully her treating providers are willing to certify it as such. This is stuff that she may continue to be troubled by for the rest of her life. That doesn't necessarily mean she will need formal treatment forever, but she may have pain from time to time, or develop arthritic issues prematurely, or have some, however mild, limitations on physical activity. Even if it just means she has to pop a couple of Advil now and then, if it's due to the accident, that counts.

As for it being pointless to talk to the insurer because they also insure the at-fault driver, that's not how it works. They represent each of you independently. For my wife's accident, both she and the other driver had Allstate. The lawsuit was literally Allstate vs. Allstate.

Again, I'm in no way suggesting milking anything or doing anything dishonest. I am very much suggesting being appropriately compensated for what sounds like permanent injuries. It's not like she had 4 or 6 weeks of PT and was pain-free and good to go. She's been treating for 2 years and still has symptoms. Very different situation deserving of a very different settlement.