QUESTION:
There is a potential lawsuit involving an auto accident. The other side claims he had 10 fractured ribs on the left, fractured left shoulder, right leg behind the knee injury. His attorney said his medical bill was over $400,000. I don’t think it is out of pocket expense. He is 74 years old and should be covered under Medicare and possibly private medical insurance. How do you determine the damage they can go after? Is it non reimbursed bill he paid out of pocket or it can be reimbursed expenses by medical insurance company? He didn’t provide any medical bills to my insurance company yet. If he had the above injuries, how much approximately can they go after? What type of documents does he need to provide to prove his injuries?
ANSWER:
The time when an accurate evaluation of damages can be made always varies with the nature of the case. (i.e. short-term injuries are more readily evaluated for damage purposes than disabling injuries.) However, usually a general evaluation can be made at the initial client interview (from claimant’s account of injuries sustained, review of medical expenses incurred to date, etc.); thereafter, the task is one of refining the evaluation … through fact gathering and analysis of the applicable law. The initial damage evaluation should never be the last. Injuries which
appear to be minor often develop into a major physical detriment with long-term effect; in such event, the value of the claim will be much greater than that determined from the initial evaluation. Accordingly, in each case, the damage evaluation should be ongoing; reevaluation will usually be needed on a quarterly, or similar periodic basis. Also keep in mind that the “value” of plaintiff’s claim ultimately depends on evidence to support it. Plaintiff’s naked assertions as to pain and suffering, medical expenses, loss of earnings and earning capacity, etc. will have little effect on an insurance claims representative or jury without corroborative proof. When evaluating plaintiff’s claim, the adverse party’s insurance representative, his or her attorney, and ultimately the judge or jury tend to give great weight to medical bills incurred. Hence, the full value of the claim which is economic damages, plus consequent pain and suffering and other general damages may be realized only if the client continues to receive necessary medical attention while the symptoms persist or until a competent physician advises that further care and treatment would be of no real benefit.
All insurance companies owe their insureds an implied duty of good faith and fair dealing. Should the carrier fail to honor its implied contractual obligations e.g., unreasonable refusal to pay medical benefits under the terms of the policy; unreasonable refusal to defend; delay in negotiating reasonable settlement “without proper cause”, the insured may have an independent “breach of implied covenant” cause of action against the carrier for emotional distress and other consequential damages and, in an appropriate case, even punitive damages.
Documentation of injuries is essential to recovery of damages; and procrastination in seeking necessary medical treatment can reduce the value of the claim. The items bearing on damages sustained are medical and hospital reports, medical bills, repair estimates or bills, documentation of lost earnings to date (e.g., statement from employer), documentation of all other “out of pocket” expenses incurred (e.g., car rental costs, towing charges, photographer’s costs, etc.). It would be best to seek personal assistance from a lawyer in order to guide you with your personal injury claim.
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