MCCARTHY, ROWDEN & BAKER

How Insurers Value Cases


In many situations, insurance companies, in the form of managers and adjusters, hold the hypothetical purse strings that will determine settlement or trial valuations for personal injury lawsuits. These cases involve a myriad of actions including premises liability or motor vehicle collisions where parties hold and maintain insurance policies. Often insurance companies also provide legal counsel for defendants in these lawsuits, but a good Decatur personal injury lawyer can be more beneficial.   Though amounts of valuation differ from case to case, the general determination of how an insurer values a claim follows a general formula.

 

Categories of Damages

First, it is important to ascertain the types of damages for which you as a plaintiff can claim compensation.  In personal injury suits, these damages may include: past medical expenses resulting from the accident, medical expenses to be expected in the future, and permanent physical disability or disfigurement.

Plaintiffs may claim pain and suffering damages. Mental pain and suffering involves feelings of fear, embarrassment, anger, humiliation, depression, and other emotions that may hinder the enjoyment of life as a result of the accident and its aftershock. Physical pain and suffering includes the trauma and pain experienced by the plaintiff at the time of the injury, and any pain and suffering experienced while in the recovery process. Many times, accident victims will demonstrate the inability to perform physical activities as well or as often as they used to. For example, an injured party may claim he cannot run three miles daily as he used to because of his knee injury, or perhaps cannot lift groceries and is required to hire private help for assistance.

Emotional distress damages can also be claimed for the psychological impact their injury has had on their daily life. The physical manifestations of emotional distress include fear, bouts of crying, sleep loss, fright, depression and anxiety. The damages for emotional distress vary from plaintiff to plaintiff, as one person’s reaction to an accident is not necessarily another’s. Examples of emotional distress are also reflected in changes in a plaintiff’s everyday life, from strains on familial relationships ranging from the inability to supervise their children to interference with sexual relations with a partner.

The ideal means of proving up your emotional and pain and suffering damages is by showing insurers records of medical treatment from licensed clinical social workers, psychologists, psychiatrists, life coaches or other mental health provider. Many times, your Decatur personal injury lawyer can recommend one of these individuals to you for further assessment and help. This type of documentation is key to demonstrating the extent of your emotional harm to insurance companies. Similarly, many individuals also keep journals, diaries or logs in order to record aspects of their lives affected by the accident.

An injured party can also claim lost income damages resulting from any time that was missed from work to attend doctor’s visits, undergo surgical procedures and recover from injuries as a result of the accident. Your lost income claim will ultimately be determined with financial documents from before and during the time of the accident. Through discovery, an insurer will likely request federal tax returns and individual wage history reports, which includes number of hours worked, hourly wages or salary, gratuities, and bonuses. It is important to prepare an evaluation of what these lost income damages will be so your demand to an insurer is supported by records.

Many times, in an automobile accident, property damages are claimed. Courts have held that that an auto collision policy provides that the insurer is required to repair or replace a damaged vehicle with another of “like kind and quality.”  Value his can be proven through simple Blue Book valuations and receipts of any additions, and if you have one, an appraisal of your vehicle prior to the accident.

 

Valuation Formula

No two cases are the same, but insurers often use a simple formula to value a claim. Because it is easiest to place an amount on liquidated damages (those amounts that can be proven up through a written instrument), the insurance company will usually begin by totaling the medical expenses incurred due to the accident.

Using this as the foundation for damages, the insurer will then value the nonmonetary damages such as pain and suffering, emotional distress and permanent disfigurement based largely on your expert’s reports (reports written by doctors and mental health experts demonstrating these damages and placing a dollar figure on them). When a plaintiff’s injuries are relatively minor, the insurer will usually multiply the amount of proven medical expenses by 1.5 or 2.

When the injuries have been proven to be permanent and painful, the insurer may multiply the amount of special damages by up to 5. The lost wage income will be added to create the final figure. While this is not a hard and fast formula, it may be used as the preliminary point to open settlement negotiations.

This formula provides a range of how much your injuries may be worth, but only after you determine fault in an accident can you gauge the insurer’s valuation of a claim.

To retain an experienced Decatur personal injury lawyer to help you with your claim, contact McCarthy, Rowden & Baker at 800-373-6050.