How Do Insurance Companies Evaluate Personal Injury Cases

Clients always want to know, what's my case worth. While there is no exact standard to evaluate the value of an accident claim, here are some of the things both the insurance company and attorneys consider to place a potential value on a case. And most importantly, if a lawyer tells you the value of your case the first time you meet the lawyer, be very suspicious. There are so many factors involved, a lawyer who would make that promise without all the facts is either lying to you to get your case, or has little experience in handling these kind of cases. I recently heard a law firm advertise that you could text their office to see what your case is worth. That's deceptive and, in my opinion, legal malpractice.

1. Liability. Be it a car accident, slip and fall or any other claim, the Plaintiff (injured party) always has to prove the Defendant was negligent in some legal manner. Without liability on the Defendant, even the most serious injury has no value. Because without liability, there is no claim. In Florida, we have what is called comparative negligence. This means that a Jury can assess liability or fault against both, or multiple parties. Whatever fault is placed on the Plaintiff means the verdict is reduced by that percentage of fault. For example, the Jury awards $10,000 but finds the Plaintiff at fault 40%. The verdict is reduced by that 40%, for a net verdict of $6,000.

2. Damage/ Injuries. Once you've proven the Defendant was at fault, the next question is what are the damages. Damages consist of things like medical bills (past and future), lost income (past or future), the nature of the injuries and pain and suffering. Cases involving surgery usually have more value than a soft tissue (whiplash) case. Age may be a factor, in that the longer a person has to live with the injury may determine the value. If you have lost wages, can you produce documentation like pay stubs or tax returns. People who work for cash may have a hard time proving lost wages. People who don't file tax returns are unlikely to be compensated by a Jury for lost wages.

3. Property Damage. If you are in a car accident, one of the biggest factors is the amount of visible damage to the vehicles. Insurance companies, and usually Juries, are very reluctant to believe a person can be seriously injured in an accident if the damage to the car was barely visible. That of course isn't necessarily true, but it's how they think. So the offers will often correspond to the amount of damage. The more visible the damage, the higher the offer or award will usually be. That is why you need to take pictures of your car before it is repaired.

4. Prior Medical History. Insurance companies will try to obtain your prior medical records to see if you ever had prior treatment for the same injuries you are now claiming from the accident. If so, they will always try to claim that your injuries were from a prior accident or condition and not as a result of this accident.

5. Timing of Treatment. Insurance companies will look to see how soon you sought medical treatment after the accident. The later you wait to seek medical attention, the more the insurance company will argue that the injury was caused by something other than the accident. They will also look to see when you first complained to a Doctor about the specific injuries you now claim from the accident. If you received immediate medical attention but didn't complain of a specific injury until months later, they will also argue the accident was not the cause of that injury. So it's very important to seek medical attention ASAP after the accident and tell the Doctor each and every symptom you are experiencing.

Keep in mind that these are not every factor that attorneys look at to evaluate the case. And there is no assurance that your attorney and the insurance company will agree as to the value of the claim. That is why we have Jury trials, and the Jury makes the ultimate determination of the value of the case. But if you have two experienced and reasonable attorneys on the case, most cases will settle without a trial. So make sure you hire an experienced, Board Certified Attorney to handle your case.


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At Greene & Tischler, we can discuss the details of your accident, explain to you your rights, and let you know what you can expect in the upcoming claims process. We provide consultations free of charge, so take this opportunity to learn your options and what we can do to help - with no obligation or financial commitment.

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