GETTING FULL VALUE FOR YOUR PERSONAL INJURY CLAIM

GETTING FULL VALUE FOR YOUR PERSONAL INJURY CLAIM
by Attorney Mark Wolfe
mark@brwlawyers.com

Most people who have a personal injury claim from a car accident or a slip and fall have no idea how the insurance company analyzes that claim to determine how much money it should pay as compensation. Regrettably, many attorneys do not know this information either. This lack of knowledge often results in settlements that are not reflective of the full value of the claim.

There are two primary areas for evaluation and assessment of the value of a personal injury claim. These are liability and the injuries that are claimed to have been suffered. But before the adjuster begins the analysis of these two areas, the first thing to be determined is coverage. That is, was the at-fault party’s coverage in effect at the time of the incident and/or is the claim a “covered loss” under the policy.

If the claim is determined to be covered under the policy, the next step is to determine liability. That is was the insurance company’s customer responsible for the accident or the incident and are there any viable defenses to the liability claim such as contributory negligence by the claimant. If the claim can not be denied based upon the liability analysis then the next question for the insurance company to answer is “how much money should we pay on this claim?” This is where understanding the personal injury claim “valuation” process is critical for claimants and their attorneys!.

Every major insurance company that provides liability coverage to its customers now uses a Computer Assisted Claim Evaluation (CACE) program to assess and determine the “value” of a personal injury claim. Understanding how these programs work is critical in assuring full value for a claim. These programs have been around for over 30 years and are always being refined and “improved.” Data and information is input into the program and the program establishes a “value” for the claim. Every company has rules and guidelines for their adjusters on how much they can deviate from the CACE valuation. These programs can analyze and assess hundreds of data points. These data points are commonly called “value drivers” and they can either be positive, meaning higher value, or negative, meaning lower value. These value drivers are applied to pre-set parameters or concepts and can include hundreds of data points for consideration.

The most common and fundamental value drivers for a personal injury claim are the treating doctor’s diagnostic code(ICD) and treatment code (CPT). See: https://www.simplepractice.com/blog/icd-codes-and-cpt-codes/ for a more detailed explanation of these codes. But these codes only establish a “baseline” for evaluation and many other value drivers are analyzed by CACE programs to arrive at a final evaluation. The following example will clarify how these value drivers work and how insurance companies are constantly refining these programs.

Medications are a common value driver that are factored into the value of an injury claim. The CACE program will have a standard or anticipated “normal” medication level and duration for the CPT codes for an injury. The “value” of pain medication for the CACE program works under the pre-set parameter that the stronger the medication and the longer it was taken the more pain the claimant must have experienced. Therefore “pain and suffering” values are often correlated to the medication and usage data input by the adjuster with the ICD and CPT codes. Recently more and more insurance companies have “disconnected” the automatic pain medication value driver for certain injuries nor are they giving credit for medication simply because a medication or prescription is referenced in the medical records. Many CACE programs now require an actual receipt for the medication before the adjuster can input the medication into the CACE program for pain and suffering consideration. The insurance company’s logic is that just because a pain medication was prescribed does not mean it was taken. And if there is no proof the prescription was filled then the program defaults to an assumption it was not taken and then the computer assumes the claimant was not hurt bad enough to need the medication and therefore no enhancement for “pain and suffering” in the final evaluation. Also for example, if a pain medication had two refills but there is no proof of a refill the CACE program assumes the claimant was no longer having significant pain complaints so as to require the refills. Therefore the valuation is reflective of this assumption.

There are many other value drivers that can positively or negatively effect the insurance company’s evaluation of a personal injury claim. Issues such as a delay in care or inconsistency of care are “red flag” value drivers that quickly push down the insurance company’s evaluation. Yet often these negative value drivers can be nullified or eliminated with simple documentation or information. Some value drivers are subjective and require an adjuster to input his or her opinion about the claimant. One such value driver is “Claimant Veracity.” Insurance companies have many different ways to input this information but many use a simple numerical rating scale. “On a sale of one to five, rate the claimant’s honesty.” A strong veracity rating is important especially since many adjusters are trained to believe most injury claimants are faking or exaggerating their injury for monetary gain. Therefore they are often quick to assign a lower veracity rating to a claimant. Again, there are several simple things a claimant can do to insure a high veracity rating for the adjuster and the CACE program.

These simple examples show how complex the proper presentation of an injury claim can be. These programs are often the reason legitimate injury victims are under compensated when they try to handle their claim without a lawyer. Even if the claimant has a lawyer, he or she can still be under compensated if the attorney is not aware of how these programs and the “value drivers” can effect the settlement amount.

If you’ve been injured because of someone else’s carelessness or negligence, you deserve to get full compensation for your injuries. Yet the reality today is that the insurance companies use of Computer Assisted Claim Evaluation programs has made it difficult for victims to get full compensation on their own or with an attorney who does not fully understand the complexity of these programs. If you have a personal injury matter and would like a free consultation with Mark Wolfe or any of the BRW lawyers, please call Mark today at 251 410-7761 or text him at 251 533-9548. Consultations are free and our lawyers are licensed to practice in Alabama, Mississippi, Florida and Georgia.

 

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

 

 

 

Car Crash Insurance Claim Questions? We have the answers.

Car Crash Insurance Claim Questions? We have the answers.

The Guide for Auto-Crash Insurance Claims – Ala edition is a comprehensive 16 page booklet that provides car crash victims all the information they need to know about their auto-crash insurance claims. This consumer booklet was written by an attorney with over 30 years of experience in presenting and prosecuting auto-crash insurance claims. This free guide covers the following areas:

– What to do at the accident scene,
– The two types of auto-crash insurance claims and how the claim process works,
– The various insurance coverages that may be available,
– Property damage claims,
– Personal Injury and Wrongful Death claims,
– How insurance companies use computer programs to help evaluate claims (and what you need to know about these programs!),
– Information about consulting with and/or hiring a lawyer for your claim, AND
– What you need to know about giving a recorded statement to the insurance company.

This guide was written by Mark Wolfe of Boteler Richardson Wolfe – Injury Lawyers and has been distributed to over 5,000 people. When asked about the purpose of the guide Wolfe said, “the main purpose is to educate consumers about the auto-crash insurance claim process because it’s not as simple as people may think.” He also said, “over the years I have seen too many claims that were compromised because the claimant was trying to handle the claim without an attorney AND without knowing how the process worked or knowing their rights.”

When asked about the public’s biggest misconceptions about the auto-crash insurance claim process he said, “There are really three main misconceptions or misunderstandings. First, most people don’t realize the process is adversarial. This means the insurance company has no duty or obligation to help you present your claim. Second, most people do not know or understand the various insurance coverages that may be available to them and how to effectively utilize those coverages, and finally, many claimants do not know that they have the burden of proving every aspect of their claim pursuant to the applicable legal standards.” Wolfe says these problems can often result in the denial or underpayment of a claim and that’s the main reasons he wrote the guide.

“Not every car crash insurance claim requires the hiring of an attorney, but if you’re not going to get a free consultation with an attorney after your crash, you should at least know your rights,” said Wolfe.

The publication can be downloaded free at brwlawyers.com or a hard copy can be ordered by calling their office at 251 433-7766 or emailing Mark directly at mark@brwlawyers.com or send him a text at 251 533-9548.   CONSULTATIONS ARE FREE

 

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Be a Safe Driver This Holiday Weekend!

SAFE DRIVING REMINDER
by Attorney Mark Wolfe

According to the National Highway Traffic Safety Association there are over 6 million vehicle crashes per year in the United States. Those crashes will result in 3 million injuries and almost 37,000 deaths. Driving is dangerous. The highways are even more dangerous during holidays.

The Memorial Day weekend is considered one of the most dangerous for vehicle crashes. That’s because so many people are on the road traveling for the long holiday weekend. According to AAA more than 41.5 million Americans took to the roads over Memorial Day weekend in 2018. If you are going to be traveling this holiday weekend commit to being a safer driver before you start your journey. No texting and driving, limit distractions while driving, use your turn signals and cooperate with other drivers AND no driving under the influence! Be safe!

Here’s a quick reminder from our Guide for Auto-Crash Insurance Claims on what to do at the accident scene if you are involved in a crash.

WHAT TO DO AT THE ACCIDENT SCENE
Having a motor vehicle crash is never a planned event. Accident scenes can be chaotic with high levels of anxiety and worry. Yet being prepared and knowing what to do at the scene can make a big difference in how easy or difficult your insurance claim will be. Here are some important tips and reminders:

Stay calm. Getting upset only makes a bad situation more difficult. Maintain your composure even if the other person doesn’t.

Check for injuries and call the police. Even if the accident is minor call the police. Notify them of injuries so that they can call for medical assistance.

Don’t move an injured person – unless they are in immediate danger.

Don’t leave the scene of an accident. Even if the other driver says its okay. They could later file for injuries or you could be accused of a hit and run. Wait for the police to arrive and let them tell you when you can leave.

Try to protect the scene of the accident. Don’t move your vehicle unless it impedes traffic or it’s necessary to prevent further damage. (Have a kit with emergency cones, triangles or flares.)

Don’t blame the accident on anyone — including yourself. Even if you might be at fault, don’t say so to anyone. Give your full description of the accident only to the police officer.

Exchange information with the other driver. This includes:
-the license plate number, make, model & color of other vehicles
-names & addresses of all drivers/passengers
-drivers license numbers (note if driver is different from vehicle owner.)
-insurance company information.
-name and address of witnesses.

Use your smart phone. Capture the following if possible:
– take photos of the scene including any skid marks or gouge marks
– take photos of the damaged vehicles including, if possible, any interior damage
– take a video or audio statement from witnesses, get their contact information
– take photographs or video of any related traffic lights to document their function

Ask the officer how you can get a copy of the police report. Get the accident report as soon as possible and review it for accuracy

If you would like a free consultation with any of our BRW lawyers about your potential insurance claim call our office 251 433-7766 or send an email us at mark@brwlawyers.com or send a text to 251 533-9548 (cell). You can also call Mark Wolfe  directly at 251 410-7761.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Using Your Smart Phone at the Accident Scene

by Personal Injury Attorney Mark Wolfe, mark@bfw-lawyers.com

After you have notified authorities of the accident you can use your smart phone to document important details about the accident. This information can be critical and is often not adequately captured by a simple written accident report.

Photograph the Following at the Scene: -Property damage, including interior photos of deployed airbags or other interior damage such as structural damage to a seat. Take lots of photos from multiple angles.smartphone image – Other driver’s proof of insurance card, registration and driver’s license. This is much easier than trying write down the information! – The accident scene including where the vehicles ended up after the collision and any skid marks or road gouge marks. Also, if there is a traffic sign such as a stop sign that is important, i.e., the other driver ran a stop sign, get a photo or two of it also. – Take photos of your injuries.

Video the Following at the Scene: – Video statements from witnesses. Make sure they give their full name, address and telephone number in addition to stating what they observed. If they are camera shy, ask them if they’ll at least give you a recorded statement via the audio recorder on your phone. – If a traffic light is part of the accident scene, you may want to video the sequence of the traffic light to show it was functioning correctly. – If the other driver is acting strange or suspicious at the scene or you suspect they have been drinking or under the influence, you may want to capture video of them at the scene. WARNING: Use good judgment with this suggestion. You do not want to elevate an already stressful situation into a confrontation with the other driver.

REQUIRED DISCLAIMERS

Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

New Study Offers Distracted Driving Insights

a recent study on distracted driving revealed new statistics on teen driversAlabama Public Radio recently reported on some disturbing findings in a well-publicized New England Journal of Medicine study about teen driving habits. While the findings might not surprise you, they should definitely give you pause about sharing the road with hormonal, inexperienced drivers. A Short But Blessed Grace Period First, here’s the good news: Teen drivers are model road citizens for the first several months of their driving careers. Before they develop an innate familiarity with the rules of the road, they’re extra-careful about signaling early, looking both ways, respecting speed limits and avoiding dangerous passing maneuvers. Over time, however, these good habits start to fall by the wayside. Within six months, teens are just as reckless as their adult counterparts. It’s possible that teens don’t fully absorb the good habits that their teachers impart. Alternatively, they may acquire dangerous behaviors by mimicking role models like older siblings and college students. Eating and Driving: Better for Adults? Eating and driving is a classic example of such a dangerous behavior. Surprisingly, this act poses relatively little risk for adult drivers who can successfully keep their eyes from wandering during the maneuver. By contrast, teens who eat while behind the wheel are involved in accidents at far higher rates than teens who refrain from the practice. Practice Makes Perfect Although the study’s conclusions weren’t crystal clear on this point, it seems likely that teen drivers engaged in risky maneuvers as a result of general overconfidence in their driving abilities. After six months of driving, the study found that teens drove distractedly at the same rate as adults in their 20s and 30s. While these drivers were no longer novices, they still hadn’t gained enough experience to react to external hazards while distracted. “It takes thousands of hours of practice to get good at driving,” notes the study’s co-author. Cell Phones: The Great Equalizer Teens aren’t solely responsible for distracted driving accidents. According to the study, adults and teens alike struggle to maintain focus while operating a mobile phone’s keypad. Although accidents in which texting is a factor occur at dismally high rates, even dialing a 10-digit phone number before completing a call can be hazardous. These findings reinforce the need to educate drivers about the dangers of using hand-held phones on the road. This requires a collective effort. While you can personally avoid texting, eating, applying makeup or performing other dangerous tasks during your commute, you can’t control what nearby drivers are doing. Fortunately, you’re not alone out there. If you’ve suffered injury or property damage in an accident that may have been caused by distracted driving, you could be entitled to compensation. To learn more about your options, contact our Mobile, AL attorney’s office at 866-975-7766 or visit our auto accident resources page.