How insurance companies evaluate claims
Personal Injury claims have two basic components that are utilized in evaluating your claim. LIABILITY or who caused the accident, and DAMAGES or how have you been injured.
DAMAGES are basically evaluated the same for the different types of personal injury claims. They consist of:
- Medical bills you have incurred.
- Related expenses incurred for your medical treatment or injury such as costs associated with transportation to the doctor, or assistance required for keeping up your household during your treatment and recovery.
- Lost wages you incurred during your treatment and recovery.
- Lost earning capacity as a result of your injuries, if any.
- Compensation for any scarring or disfigurement you have suffered.
- Compensation for any physical disability you have suffered
- Any past or future pain and suffering you incurred as a result of your injuries.
The judicial system is not capable of turning back the clock or removing your injuries. It only has the ability to attempt to compensate you with monetary damages for your losses. The more severe your injuries, the more damages you are entitled to. Obviously death, dismemberment and paralysis are catastrophic cases which require large sums of compensation. Injuries requiring surgery or broken bones are can also receive significant compensation. Those accidents in which soft tissue damages occur are also compensable.
LIABILITY, or the proving responsibility or fault on the other side, requires some different steps in automobile versus premise liability cases.
The fact that you were injured does not guarantee you receive compensation. Frequently the attorneys hardest job is proving the other side is responsible for your injures. Unless you prove liability, the insurance company is not responsible to pay for your damages no matter how severe your injuries.
Premise Liability cases do not require a “permanent injury” in order to pursue a claim. They do however require that the property owner have either actual or constructive knowledge, or “Notice”, of the defect that allegedly caused the injury you suffered. This notice requirement can at times be difficult to prove. It often takes an experienced and skillful attorney to prove that the owner had actual or constructive notice of the defect. The type of defect often affects the value of the claim. It is more difficult to prove notice when the cause of the fall is a transitory substance such as a spill or debris. On going defects, such as leaking pipes, are easier to prove constructive notice and therefore liability is easier to prove. Consequently those type of situations increase the value of the case.
In automobile cases frequently the party at fault is well established by witnesses and physical evidence. Insurance companies often admit liability and defend these cases based on the doctrine of “proximate cause” and the fact that Florida Law requires the injured party to have a “permanent injury”. Proximate Cause means that the injuries the person is seeking damages for must result from this accident, and not a prior or subsequent event. The insurance companies go to great lengths to discover your prior medical history in an attempt to place the blame for your damages on unrelated events.
The No Fault law requiring a permanent injury means that the auto accident must leave you with a problem that was caused or aggravated by the accident. In addition the effects of that problem must be permanent in nature and remain with you for the rest of your life. In evaluating your claim the insurance company will take into account many facts including but not limited to the following:
- Force of Impact and Property Damage to your vehicle
- Contemporaneous medical treatment
- Consistent medical treatment history
- Loss time from work
- The amount of your medical bills
- Diagnostic tests
- Surgery performed and recommended
- Your disability
- Prior injuries
- Prior claims history
Please contact our office at Email: email@example.com or Call: 954-474-4244 or Toll free: 877-741-8209 so that we may assist you in evaluating your claim.