Why Is The Insurance Company Low Balling Your Injury Case?
Whether you hire an attorney or try to settle your case on your own, do not be surprised if the insurance company does not value your case like you or your attorney. Insurance companies are in business to make money. They do this by paying as little as possible to resolve injury claims. After representing insurance companies and their insured for almost 20 years, I am very familiar with this and the reasons companies give for evaluating your claim so low. Here are some of them.
No or very little property damage to one or both vehicles.
If there is very little or no property damage to both the vehicles in your accident, you can expect the insurance company will offer very little money to settle your claims, regardless of the injury you know (or believe) you suffered in the accident. These cases are often referred to as MIST (minimal impact soft tissue) claims or MIP (minimal impact) cases and once so identify, insurance companies do not take them seriously until they are forced to -- which often means a lawsuit is filed in the case is tried to a jury.
Unfortunately, there is a good reason for insurance companies taking this position. Insurance companies have learned, and I know this firsthand, that juries have a very hard time awarding any damages, much less significant damages, if there is no or very little damage to both vehicles. Don't get me wrong, I truly believe individuals can suffer serious injuries in low impact/low property damage accidents, and I have represented numerous individuals where this has happened. Unfortunately, insurance companies rarely believe this is possible.
Insurance companies will also tell you your case has little value if there is little or no damage to only one of the vehicles, but moderate or significant damage to the other vehicle. In this situation, your claim probably won't be classified as a MIST or a MIP, and insurance companies may eventually pay the appropriate amount after trying to pay you very little at first
You have “pre-existing" injuries to the same part of your body that were injured in the accident.
If you are actively treating for injuries to your neck, back, knee, etc., and you are now claiming injuries for the same parts of your body, do not expect the insurance company to pay much, if anything, for those injuries. This is not surprising, especially if the only evidence of your injuries are your claim to the doctor after the accident that the situation has been aggravated or is more painful. Without an objective finding (i.e.., a broken bone or a herniated disc), that the injury was caused in the accident, juries often times do not compensate for these types of injuries.
What is surprising, however, is that insurance companies often take the same view if you had a similar problem in the past, but completely recovered years before the accident issue. If given the ability (i.e., you sign a blanket authorization for the insurance company to get all your medical records both before and after the accident -- which you should never do -- or get the records by subpoena once a lawsuit has been filed), the insurance company will search your medical records for prior injuries and complaints of neck, back, knee, shoulder, etc. They will then use the fact that you had these prior problems to say your claim is not as valuable as you or your lawyer thinks it is. This is really a problem if you give a deposition and testified you never had any such problems -- even if you testify this way because you honestly forgot. It is also a real problem if your medical records after the accident indicated that you did not tell your doctors about the prior problems.
Prior claims and lawsuits.
If you have had multiple claims/lawsuits over the years expect the insurance company to think very little about your current claims. Again, the insurance company will be relying on a conservative jury to feel the same way and are often vindicated for taking this view.
Gaps in treatment.
There are several versions of this excuse to keep the value of your claim low. In the first, if you wait five days to see a doctor because your neck was sore after a rear-end accident, you can expect many insurance companies to tell you that it is questionable that your neck problems were caused in the collision. They will tell you that if you were injured, you would have gone to the emergency room the day of the accident. The fact that you knew you had no broken bones and had to wait five days (God forbid two weeks), to get in to see your doctor, will mean very little to the insurance company.
Another version of this excuse is that you have a course of treatment by going to the emergency room, following up with your family doctor, and you have 15 visits of physical therapy your family doctor prescribed. You are then released from physical therapy, you're feeling better, but are not completely healed. At this time, you are given home exercises, which you do diligently. Unfortunately, after four months of diligently doing the home exercises, you are not getting any better, in fact, you are getting worse. Accordingly, you resume treating with your family doctor, begin treating with an orthopedist and have another course of physical therapy. Here, the insurance company will almost always cut your claim off when you stopped seeing the physical therapist before the four-month gap in treatment. In this situation, it is almost impossible to get the insurance company to consider the post-gap medical bills, lost wages, pain and suffering, etc., short of getting a jury to force the company to do so.
Overlapping treatment.
If you are treating with a chiropractor and getting physical therapy prescribed by your primary doctor or your orthopedic at the same time, you can expect the insurance company to take a dim view of your case. They will claim you are over treating and excessively running up bills.
Expensive treatment.
Believe it or not, if the bills for your treatment seem high, insurance coverage may tell you they will not pay you that amount. Forget that you have absolutely no say in what your orthopedic, pain specialists or physical therapist charges you, the insurance company will tell you it was too costly and they will pay only a portion of the bill.
Most of your bills are just for diagnostic testing.
Again, through no fault of your own, nor at your direction, your treating doctors direct you to have x-rays, an MRI, a nerve conduction study, a CT scan, etc., all of which come back normal. In this situation, expect the insurance company to contend that some or all of the diagnostic studies were not required and that the bills for these tests will not be considered when evaluating your claims.
Your medical bills were paid by health insurance or some other third party.
If your medical bills were paid by your employer health insurance, medical payments coverage under your automobile policy, workers’ compensation or any other third party source, it is very possible the insurance company will tell you that it will not pay you again for those bills. This is true even though Georgia law does not allow evidence of collateral source payments of bills to be presented to the jury as a way of defending against the amount of the claim for the entire medical bills at trial.
Your medical provider referred you to your lawyer or your lawyer referred you to your medical provider.
This really does not need any discussion.
Your doctor did not provide you with a work excuse or specifically take you out of work.
If your doctor did not specifically keep you out of work because of your injuries caused by the accident, do not expect the insurance company to compensate for your lost wages. Forget that you know though there is no way you could have done your job, if you do not have a work excuse from your doctor, there is a good chance the insurance company will not pay you for your time away from work.
Your sick time and/or vacation time paid you while you were away from work.
Insurance companies will also claim that because you took sick leave or vacation time when you were out of work because of your injuries and that therefore, you are not out of pocket for your missed days from work, you are not titled to any compensation for lost wages. Even though this proposition is also not supported by Georgia law, insurance companies often make this argument in support of not considering the wages in evaluating your case.