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UPDATED: Mar 13, 2020
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Hospital stays and doctor’s visits are not the only costs associated with injuries resulting from car accidents. Depending on the severity of the accident, individuals may require prescription drugs, physical therapy or extensive treatments in addition to compensation for time missed for work. Although all of these expenses can add up quickly, not all insurance companies will handle pay-out the same way, and you may not get as much for your settlement as you wish.
Insured vs Claimant
The way that your insurance claim is handled will depend somewhat on whether you are the insured or the claimant. Being the insured means that your insurance company is handling your injuries, and whatever payments are made will come from your own coverages as listed on your policy. Being the claimant means that the other person’s insurance company will handle your injuries, and the payment will come from that driver’s bodily injury liability coverage.
Claimants generally have more flexibility in what they can obtain for an insurance claim. First-party medical coverages are usually fairly limited, and you are bond to the limitations of your policy. For example, if you have personal injury protection coverage with a $2,000 limit, your insurance company will never be able to pay you more than $2,000 for injuries, even if your medical expenses are much higher.
On the other hand, bodily injury liability coverage generally has higher limits, and claimants may be able to get more assistance with medical expenses as the third-party insurance carrier does not want to be sued. This gives you as a patient more leverage against another insurer if you are not at fault for the accident that caused your injuries.
No Fault States
The primary exception to the above-mentioned phenomenon is if you live in a no-fault insurance state. These states, like New York and Florida, limit the amount that you are able to receive in medical benefits as a claimant; they also place limits on your ability to sue for injuries. In order to compensate, most people in these states carry better first-party medical coverages. Although these coverages do still have limitations, they are more flexible than in states without no-fault laws.
Can I Get Pain and Suffering Payments for a Car Accident?
Insurance companies will generally offer a lump-sum settlement based on all of the expenses related to the medical portion of the claim. This means that the settlement will usually include reimbursement for doctor’s visits, prescription drugs, physical therapy appointments and other medical costs in addition to compensation for missed work and general compensation for pain and suffering.
The insurance company will usually offer an initial settlement very early in the claims process, especially if the injuries reported seem minor. The reason for this is that once the patient accepts the settlement, they usually cannot qualify for additional funds. This allows the insurance company to save money on the claim as the full extent of injuries is often not noticeable until several days or even months after a collision.
This initial settlement is negotiable, and it may be in your best interests to negotiate the sum with the insurance company. Bear in mind however that the insurer does not need to honor any requests that you make, especially if those requests are unsubstantiated. If you want to get more money from the insurance company, you will need to provide proof of why you need the funds. The more documentation you have, the more likely you will be able to receive an ample settlement.
Depending on the circumstances, it may be worthwhile to hire an attorney to help you get the maximum amount available for your claim. It may be easier to get paid for pain and suffering if you file a lawsuit rather than sticking to the claims process. Additionally, the insurance company may be more likely to try and settle the claim with you quickly if they know you’re considering hiring an attorney; this could provide good leverage for obtaining the funds that you need.
On the other hand, hiring an attorney limits your options substantially. Once you become attorney-represented, your attorney must handle all communications with your insurance company. You cannot call the adjuster or handle any part of your insurance claim. This can be a massive inconvenience if the repairs have not yet been completed and the attorney is only handling your injuries; it can lead to your claim becoming locked in a stalemate where the insurance company cannot talk to you and your attorney cannot complete the claims process.
Your best bet is to carefully assess each individual situation and determine what you believe is fair. You may wish to consult an attorney without retaining one at first to determine what your best course of action should be. You can also honestly discuss your concerns with the insurance adjuster to see what your chances of receiving a fair settlement will be.