Personal injury cases are never the same. Even when the claim seems pretty straightforward, one twist of events is enough to swing the case partly or entirely in favor of the defendant. Here are some good examples.
Determining the Exact Cause of Surgery
As mentioned earlier, the job of an insurance claims adjuster is to reduce your settlement amount, even when their client is at fault. They'll do everything to reduce what you're entitled to as compensation even if you needed surgery after the accident.
Using the example of Andrew and Sherry above, let's look at the car accident from a different perspective.
- Andrew stops at the stop sign.
- Sherry is driving behind Andrew, fails to stop, and hits his car from behind.
- The police report shows that Sherry was on her phone when she hit Andrew, whose car had stopped at the stop sign at the time of the accident.
- Andrew is admitted to the hospital, and his doctor recommends surgery.
From the example above, it's clear that Sherry was at fault for distracted driving, which caused the accident. Her insurance company is obviously expected to compensate Andrew, but not without a fight.
Suppose the insurance claims adjuster discovers that Andrew had a pre-existing problem that required surgery for years. In that case, the adjuster might claim that the accident wasn't the only reason the claimant needed surgery.
Although the insurance company will still have to pay Andrew, this new discovery could reduce the settlement amount.
This also explains why it's essential to contact a personal injury attorney as soon as you can.
Unnecessary Surgery Won't Increase Your Settlement
Going for surgery that a doctor doesn't recommend won't increase your settlement during a personal injury claim hearing. On the contrary, the defendant could raise this issue to the jury or your attorney, citing insurance fraud.
The decision to opt for surgery shouldn't be based on your personal opinion. The jury or insurer will always believe a professional doctor in such a situation. So if your doctor doesn't recommend surgery, chances are you don't need it.
Cost of Surgery Exceeds the Defendant's Insurance Coverage
Using the hypothetical case of Sherry and Andrew as an example, let's assume that Sherry's insurance coverage only offers a limited liability coverage of $50,000. This money is meant to be spent on the medical bills of the other party involved in the accident due to Sherry's negligence.
However, if Andrew's surgery cost is $100,000, Sherry's insurance company will only pay $50,000, which is the maximum amount covered under her specific plan. And, as a result, Andrew will have to find a way of settling the remaining $50,000 needed for the surgery.
Although the surgery might proceed as expected, it will probably cause more financial burden to Andrew than Sherry.
Post-Surgery Recovery Period
The length of the post-surgery recovery period also influences the settlement amount in two ways. Firstly, you may be entitled to a higher settlement if you need a longer period to recover from surgery.
After every surgical procedure, the doctor usually writes a report stating the details of the operation and the expected recovery time. Therefore, the longer the recovery time, the higher the settlement in the form of economic and non-economic damages.
Using the same logic, the settlement could be lower if surgery was needed, but you recovered quickly and didn't experience any pain or suffering afterward. If the doctor determines that you've made a full post-surgery recovery, you may not be able to sue for lost wages after the recovery process.