How do Insurance Companies Decide on Personal Injury Compensation?

October 30th, 2015 by Guajardo & Marks, LLP

When you suffer injuries in an accident resulting from someone else’s fault, you may be eligible to file for personal injury compensation from the insurance company of the person at fault. Injuries are not limited to physical problems but also encompass mental health issues you may have consequentially suffered from the accident.

The first step in this process is to hire a personal injury lawyer to help you establish the other party was at fault. In this article, we will assume culpability has already been assigned to the defendant and analyze the factors insurance companies take into account to decide compensation in personal injury claims. Generally, insurers in a personal injury case will pay compensation for three main components (outside of property damage): medical expenses, lost wages and salaries, and pain and suffering.

Medical Expenses

After a serious injury, you will most probably need to seek the help of a professional health practitioner. Insurance companies view medical treatment by a physician more seriously than therapy by an acupuncturist or chiropractor. You should keep a proper record of your medical appointments and bills to submit them for your claim.

Loss of Wages and Salaries

Injuries after an accident may prevent you from going back to work immediately. These injuries can be obvious physical ailments or mental health issues preventing you from functioning in your normal capacity. Your claim can be strengthened if your medical doctor tells you not to return to work due to your injuries. If this is the case, ensure you maintain proper documentation proving you had to miss work due to the injuries suffered in the accident.

Pain and Suffering

Establishing pain and suffering is the most complicated part of your claim. Even after you have proved you have suffered as a consequence of, for example, a car accident, deciding on the dollar value of the damages can be a contentious issue. A personal injury attorney can be really helpful in assisting you to prove damages arising from pain and suffering and to help you get fair compensation. The longer the treatment period for your injuries, the higher the compensation could be, but if the treatment is disproportionately long for the type of injuries you have sustained, the insurance company will not fully consider the length of your treatment.

As mentioned already, injuries treated by medical doctors are considered more serious and will generally improve your chances of demonstrating pain and suffering along with netting you a higher compensation amount.

Insurance Compensation Formula

The use of a formula is definitely true, but insurance companies normally use the formula to get a general idea of how much you should be compensated and is a beginning point in the negotiations. Although insurance companies do not divulge what formula they have used or how they got to the amount of compensation offered, the amount calculated by the formula is in no way a final decision. There is always room for negotiation and a competent personal injury lawyer will tell you this much as well.

There are many factors considered by the insurance company when deciding on a personal injury claim and it can get extremely complex, especially in cases that involve serious injury or wrongful death. At Guajardo & Marks, LLP, we are experienced Dallas lawyers in the field of personal injury compensation and can help you negotiate a fair settlement. You may contact us at 972-774-9800.