- Insurance Adjusters are not medical professionals and to preserve profits they’ll ignore specifics about injuries from accidents. Especially injuries like rotator cuff tears, which can make simple life tasks more challenging.
- Rotator tears are common silent injuries that will go unnoticed until after a check is given by the insurance company.
- In a legal claim you’ll have to prove the tear wasn’t a pre-existing condition.
- Rotator injuries are often permanent injuries, insurance companies will argue that they’re not, to prevent them from paying for the future pain.
- If you fight it with an injury lawyer, and if the evidence is there, insurance companies will offer a settlement. If not enough the settlement negotiations can go back and forth unless a trial is decided (injury trials are not common).
Insurance adjusters have the job of saving money for their company. Unfortunately, this means trying to pay as little as possible on as many claims as possible. Depending upon the claim they’re dealing with, they may argue about the damage to a burned house and the number of wire-nuts it will take to repair it or the medical prognosis for a person who has been struck by a car and may never walk again. Very often, in the course of events following a car accident, insurance adjusters, who are not doctors or graduates from any medical program anywhere diagnose and pronounce a prognosis for injuries about which they know little or nothing. What’s most interesting about this is how often otherwise reasonable accident victims instantly take the words of an insurance adjuster as gospel and accept settlement offers that don’t begin to cover the damage.
In this article we will tell you the story of a fictional man and his auto accident injuries. We will help you to know about his injury, his treatment, and how those things will impact the settlement of his insurance claim. We will tell you what this man must do to prove that his injuries are the result of the accident in question even though the insurance adjustor claims otherwise. We will tell you how the amount of the settlement in this accident claim is established and finally, we will help you to understand how to choose an attorney who can effectively win a battle with a big insurance company.
In this Article…
- Griffin’s Story
- How to prove an injury came from your automobile accident
- Assessing the damage and arriving at a settlement amount
- Why is a personal injury lawyer the best advocate for this job?
Griffin is the meat-cutter at a small, family owned grocery store. He is 54-years old. Griff and his wife have three grown children. They live in the same quiet suburb in a home they have been making mortgage payments on for the last 20 years. He is a football fan, a league bowler, and enjoys grilling so much that he enters competitions regularly.
When Griff’s pickup truck is t-boned by a furniture delivery van that ignored a stop sign, he suffers a shattered wrist and a fractured femur both on his left side. After the accident he must wear a cast for 8 weeks to hold the broken bones in place. During recovery, Griffin also notices pain in his left shoulder but fails to mention it, thinking it is simply about his arm injuries and the weight of the cast on his arm causing the pain.
When the cast comes off, however, Griff notices that he still has pain and weakness in his left shoulder and is unable to that arm. Following an ultrasound procedure, the doctor tells him that there is a tear in one of the tendons of his rotator cuff. It was not diagnosed at the time of the accident because the medical attention was focused on the primary injuries to his wrist and arm. The doctor assures him that this is not unusual in arm injuries like the ones he suffered.
When the insurance adjuster arrives at Griffin’s home to discuss a settlement of his claim, Griff is surprised to hear the insurance adjuster say that his torn rotator cuff is not the result of his car wreck. The adjuster says, the only injuries reported to the company were the wrist and upper arm bone, and that it is “not possible” that the rotator cuff injury could be caused by the collision.
Griffin and his wife decide that they should trust their doctor’s assessment of the injury and call a lawyer to handle the settlement of the claim.
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How to Prove an Injury is the Result of the Automobile Accident in Question
Accident victims usually believe that insurance companies exist to promptly and happily pay for the damages done by their insured party. We’re nice people who have been raised to believe that people who have hurt someone else will do the right thing by quickly and thoroughly paying the bills. We pay our insurance premiums regularly because we want our negligence, should an accident happen, to be covered without question.
When we realize that our faithful insurance carrier is not so faithful, it is often a big, nasty surprise.
In Griffin’s claim we can already see that the insurance company won’t be easy to work with. As a matter of fact, it is often the attitude of insurance adjusters like this one that prompt accident victims to call lawyers in the first place. Attorneys for the plaintiff are not at all surprised. They deal with this kind of thing all the time.
Griffin will be forced to prove that his rotator cuff injury was not a pre-existing condition. He will do this by supplying his past medical records to show that he has never experienced problems with his left shoulder before the day of the accident.
Then, Griffin will demonstrate that his ability to function normally is impaired since the accident – he cannot do many of the things he did before. Even though Griffin is right-handed, his everyday life is more difficult since the accident. He has trouble with lifting the large sections of meat he works with at his job. His left arm is easily tired and often trembles because of strain or use. This creates a dangerous situation when he is using meat-cutting equipment like the band saw.
Since the fractures of his left arm and wrist healed he has noticed that his bowling game is off because of the weakness in his left side. Attorneys for the defense might well suggest that the activity of bowling has actually contributed to Griff’s shoulder injury, but there will be testimony from psychical therapists to refute this.
Griff’s doctors will be interviewed to testify that torn rotator cuffs do happen in car accidents, how they occur, and that they sometimes are not diagnosed until after the initial treatment for other injuries is well underway. They will offer expert opinions to prove that Griff’s shoulder injury was, indeed, the result of the accident.
The victim and his wife and friends may testify at depositions about the activities Griffin took part in before the accident including his regular attendance at the gym where he lifts weights and does strength training. Trainers from the gym may be required to testify to Griff’s new limitations and compare them to his performance before the accident.
In addition to proving how his abilities have changed since the accident, Griffin’s lawyers will submit actual costs associated with the injuries he sustained. This will include everything from the initial ambulance ride to the hospital to the tests and other treatments he endured. The cost for physical therapy, the hours of work he missed and didn’t get paid for, and all other costs that came about because of the accident including items like paying the neighbor kid to clean the gutters because Griffin could not.
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Assessing the Damage and Arriving at a Settlement Amount
When all of the evidence has been gathered and the opinions of the experts have been given, it will be up to the lawyers to arrive at a settlement. At this point, the insurance company will try to down-play Griffin’s damages and will argue that he is not seriously impaired. They will say that this is not a long-term or permanent problem. Because Griffin is expected to recover completely, they will say that paying for future pain is not necessary. Reports from Griffin’s doctors that he will have a permanent impairment will be used to prove the true extent of the injury.
Eventually, after a period of negotiation, the insurance company will make a settlement offer. Depending upon whether or not it actually covers the injuries sufficiently, Griffin’s attorneys will either suggest that he accept the offer or refuse it. Sometimes this back and forth will continue for several rounds. Sometimes no agreement can be reached and one side or the other will make the decision to file suit or go to trial.
In a perfect world, the sooner and more thoroughly the insurance company pays for the victim’s injuries, the better for all concerned. Unfortunately, adjusters and highly paid insurance company lawyers are often unwilling to make a reasonable settlement offer until a victim gets an attorney and can prove willingness to overcome all of the defenses being raised. Insurance adjusters and defense lawyers get paid to keep the settlement amount as small as possible, so they can stretch matters out for months. Ultimately, a settlement is usually reached, and going to court is far less common than you might imagine, but some cases to require a Jury trial.
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Why is a Personal Injury Lawyer the Best Advocate for this Job?
It’s important to understand that the defendant in cases such as Griffin’s have the luxury of expensive lawyers who do nothing all day but defend negligent clients for insurance companies. The insurance company’s idea of a “win” is to avoid paying you less than a claim is worth, or anything at all, and they will do everything in their power to do just that.
Unless your injury is very simple or minor, it often makes sense to hire a lawyer who can anticipate the tactics of the opponent and is already prepared to answer the sometimes-outlandish excuses an insurance company will offer. You are more likely to enjoy a good outcome.
A lawyer who spends all day every day working on personal injury claims is far better equipped to successfully present your claim than, say, a family or real-estate lawyer. A personal injury lawyer has the best chance of winning against the insurance company’s “big guns” simply because he’s properly prepared.
Before you settle any personal injury claim, understand that it is in your best interest to discuss your injuries with an experienced personal injury specialist. Remember always that insurance adjusters exist to settle claims for the least amount of money possible. He is not working for you – he’s working for his company.
Without a competent legal team to advocate for you, you might not be justly compensated for your injuries – worse, you might be forced to pay for future treatment on your own, which is an expensive and unnecessary consequence of hiring the wrong law firm.
At the Millar Law Firm, personal injury is our specialty. We only take personal injury claims. We are totally focused on getting you every penny you need to be made whole again – that’s our commitment to the clients who trust us with their cases.
If you have been injured by the negligence of someone else, or been told that your injury is not related to the accident in which you were involved, call us today for your free case evaluation. Why settle for less than the best?
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