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After you have been involved in an accident and have been to the emergency room, you will begin to wonder how to pay for everything, and who will. Some states are considered “no-fault” states, but Missouri and Illinois use a “comparative negligence” method to determine how much a plaintiff will receive in compensation. An insurance adjuster will investigate your claims by conducting interviews of witnesses and the claimant, reviewing the police report and medical records submitted, and will go out to visually inspect any property damage, such as to your vehicle or a structure. They will use this information to determine the company’s liability and what they will pay out. They will then use a secret formula, and while the exact formula won’t be disclosed to you, this article will explain at least the basis for what your formula might be.
Are there some things insurance companies must pay?
Yes. When you have been injured in a car accident and have sought medical treatment, then you are entitled to compensation for the following:
- Your medical care and expenses
- Income lost from either being unable to work or from the time the plaintiff was recovering and actively being treated
- Missed educational opportunities that you would have had
- Missed family, social, and career opportunities and activities
- Property damage
- Permanent physical disability or disfigurement
- Pain and suffering
The last point, pain and suffering, includes both physical and emotional suffering, the latter often referred to as a “non-economic damages.” Notice how some types of damages are easier to put a total cost on because you can easily add up the dollar amounts spent. But when it comes to pain and suffering, claim adjusters rely on a different formula.
What is the formula claims adjusters use?
A claims adjuster will never tell you what their exact formula is. But there is a general guideline as to how compensation is calculated. First, the adjuster adds up the total medical expenses related to an injury, otherwise known as “medical special damages” or “specials.” Then they multiply that number by a number between 1.5 and 5. If you sustained serious, life-threatening or permanent injuries, then your number will be closer to 5, or higher. Some factors that are used to determine the severity of your injuries include how much the other driver was at fault, how long the recovery period will last, and the proof from doctors, family members, and others who can attest to your pain and suffering.
Let’s look at an example using a hypothetical situation: Adam is injured in a car accident with no permanent injuries, but he did incur some medical costs amounting to $800. When using the formula for his claim, an insurance adjuster will come up with $1,200 (1.5 x $800) and $4,000 (5 x $800). He missed a few days of work due to the accident, which resulted in $500 of lost income. The insurance adjuster will look at other factors before determining a total amount of compensation to pay Adam. The adjuster will not tell Adam exactly which formula they used or how they came up with the number. Adam’s attorney contacts the insurance company and negotiates a better deal. You can learn more here at hm-attorneys.com.
