Personal Injury Claims: What Are “Value Drivers?”

Today most major auto-crash insurane companies use some form of Computer Assisted Claim Evaluation Program to help them establish a “value” for a personal injury claim. These programs evaluate data about the injury claim and then provide the adjuster with a value or compensation amount they should pay the victim. Depending on the company, adjusters may have to strictly follow the evaluation or they may be able to offer more than the program’s “evaluation.”

Central to all of these programs are value-drivers. These are certain facts or factors that are input into the program. A value-driver can be either positive or negative. Meaning they can either increase the amount of compensation the victim receives or reduce the amount of compensation the victim receives. These programs can evaluate thousands of different value drivers. Even for a simple auto-crash injury claim there can be over 100 value drivers analyzed by these programs.

Obviously the diagnosis code for an injury is an important value driver but so are the treatment codes as well as the timing of the treatment. The “value” of a diagnosis code may also depend on what type of doctor made the diagnosis. A delay in care or a gap in treatment can be a negative value driver as well as inconsistent pain complaints in the medical records. Many times these negative value drivers can be limited or overridden by the adjuster but he or she has strict criteria or guidelines on what documewnts and/or facts must be presented to limit the negative value driver.

If you have a serious injury claim from a car crash, you need a law firm that understands Computer Assisted Claim Evaluation programs and knows how to properly document all of the positive value drivers and limit the negative value drivers. At Boteler, Finley & Wolfe we’ve been helping car crash victims present and prosecute their insurance claims for over 30 years. We know and understand Computer Assisted Claim Evaluation Programs better than most attorneys. We can help you. Give us a call today: 251 433-7766 or email Mark Wolfe at mark@bfw-lawyers today for a free consultation.

Reading the Fine Print on Lawyer TV Ads

Recently there have been numerous TV commercials for lawyers where someone brags about how much money the lawyer recovered for them. These people generally appear fine and gush about what a financial windfall the lawyer got them for their injury claim. The problem is the fine print disclaimers that accompany many of these commercials scroll across the screen so quickly, or are so small, you can’t read them. Many people don’t even see them let alone read them. Here’s a compilation of some of these disclaimers from some recent TV lawyer ads:

– Not an actual client testimonial or based upon a specific case.

– Dramatization: Not an actual case.

– Actor portrayal, not a real client.

– The monetary result referenced is not from an actual case.

– The monetary recoveries referenced are not typical of most injury claims and [law firm name omitted] in no way guarantees or promises similar results for specific injury claims.

–  Not a typical injury case recovery.

–  (Lawyer name omitted) will not be the lawyer responsible handling your claim or case and the financial recoveries referenced herein are generalizations of atypical injury cases. No warranty or     guarantee of a specific monetary result is made herein.

–  Not a real client or case result.

–  Not an actual case result or recovery. [Law firm name omitted] processes claims and cases via a referral to an affiliate law firm. Referral law firms are solely responsible for claim and case presentation and remit a portion of the attorney fees to [law firm name omitted.]

–  Actor and/or spokesperson is compensated for services and any reference to financial recoveries  are of non-typical personal injury matters.

–  Actual results may vary. Not licensed to practice law in Alabama.

Legal? Maybe. But doesn’t this smell of deception? A commercial runs with a “client” boasting of a huge financial recovery but hidden in the commercial is one of the above fine print disclaimers stating the results are not true or not typical.  Seems like the old bait and switch sales tactics used by shady salesmen of days gone by.  Trust between an attorney and his or her client is critical to a good relationship. Clients must rely on and trust their attorney to help them through a difficult time. If the initial basis for that relationship is based upon a deceptive TV ad, can the client really be confident that the attorney has the client’s best interest at heart?

So how else besides TV can you find an attorney? AVVO.com is an excellent attorney rating service that has lots of information about local attorneys and rates attorneys on a scale of 1-10. There’s also biographical information about the attorney, client reviews and professional achievements. Also, most personal injury attorneys offer free consultations so you can consult with more than one attorney before deciding what attorney you are most comfortable with.

Seven Driving Safety Tips for the 4th of July!

The Insurance Institute for Highway Safety (IIHS) reports that the 4th of July holiday is the deadliest driving day of the year. An average of 144 traffic fatalities happen each year on the 4th of July and almost 300 additional deaths for the other days around the 4th of July. The IIHS offers the following suggestions for safer traveling this 4th of July:


1. FOLLOW BASIC SAFETY PRACTICES.

“If everyone buckled up, didn’t drink and drive and obeyed the speed limit, July Fourth would be a lot safer,” says IIHS spokesman Russ Rader. And it may sound obvious, but if you’re riding a motorcycle, always wear a helmet. “Motorcycle crashes also play a significant role in the deaths that occur on the Fourth,” said Rader. “If you’re considering buying a bike for the first time or getting a new one, make sure it has antilock brakes, which are increasingly standard on motorcycles. ABS can reduce your risk of dying in a crash by nearly a third.”

2. TAKE PREVENTIVE MEASURES.

Have a trusted mechanic check over your car before a long road trip or at least check your oil level, tire pressure and make sure your coolant level is correct, since cars can overheat when stuck in traffic.

3. PLAY AROUND WITH YOUR TRIP’S TIMING IF POSSIBLE.

While the days around July 4 are also dangerous, it is a bit safer to travel a few days before and after July 4 than on the day itself. TODAY’s Dylan Dreyer recommends leaving Friday before 7 a.m. or Saturday before 11 a.m. According to traffic and navigation app Waze, the worst time to travel is Thursday and Friday between 3 p.m. and 8 p.m. And for the return trip, avoid driving Monday from 6 p.m. to 10 p.m.

4. MIND THE GAP.

Use the 3-second rule to establish a safe following distance from the car in front of you.

5. KEEP YOUR EYES (AND MIND) ON THE ROAD.

Try to minimize distractions in the car, from family disputes to loose items like sunglasses, phones and other items left on the dashboard, which can obstruct the driver’s view or fall startlingly to the floor.

6. KNOW WHERE YOU’RE GOING.

Familiarize yourself with the route by checking the map and printing directions ahead of time. During the drive, have a capable passenger alert the driver to turns, exits and the like to minimize distractions. Avoid gazing at directions on the phone while driving.

7. GET PLENTY OF REST.

Perhaps you’ve been burning the midnight oil to wrap up projects before your vacation. But while a long car ride may mean a chance to recover as a passenger, it’s no place to let your guard down when you’re behind the wheel. Plan on taking frequent breaks, and rotating drivers whenever possible.

Read more from the Insurance Institute for Highway Safety about traffic safety and traffic statistics:
http://www.iihs.org/iihs/news/desktopnews/independence-day-ranks-highest-in-average-daily-crash-deaths

Some Personal Injury Attorneys are Continuing to Overcharge Clients

Despite an Ethics Opinion from the Alabama State Bar prohibiting “double dipping” on contingency fees, some Alabama personal injury attorneys appear to be continuing to overcharge their clients.contract-image Several years ago, a number of personal injury firms in Alabama (not Boteler, Finley & Wolfe) began charging an additional contingency fee on the “back-end” of a claim or case for negotiating a reduced repayment on behalf of the client for medical bills or insurance subrogation claims. These claims were asserted against the client’s settlement money by hospitals, medical providers or health insurance carriers. The attorneys would charge a 30-45% contingency fee against the gross settlement amount and then an additional 40-50% of the amount of any reduction or waiver resulting from the lawyer’s negotiating work after the settlement of the claim or case. For example: A person is injured in a car wreck and has a liability claim against the at-fault driver’s insurance. He or she hires a lawyer and agrees to a 40% contingency fee from the gross settlement amount. The client incurs $5,000 in medical care for the injuries. Medical liens and/or subrogation claims in the amount of $5,000 are asserted against the settlement funds. The attorney is charging an additional 50% fee against any negotiated reduction of those asserted medical claims. The claim settles for $15,000 and the lawyer then gets the $5,000 medical claims reduced to $2,000, a “savings” of $3000 to the client. Under the above scenario, the attorney fees charged would be $7,500. Which is $6,000 on the “front end” and $1,500 on the “back end.” Or half of the settlement! The problem with this scenario is that negotiating and handling repayment of medical claims has traditionally been encompassed as a part of the lawyer’s obligation under the initial contingency fee agreement! Any negotiated reduction is a benefit that should pass 100% to the client. In 2015 the Alabama Office of General Counsel issued Ethics Opinion RO-2015-01 which prohibited “double dipping” as described in the example above: “Absent extraordinary circumstances, a lawyer may not enter into an agreement for, charge, or collect an attorney’s fee based on the gross recovery or settlement of a matter, and in the same matter charge an additional contingent fee for the negotiation of a reduction of third party liens or claims, where the liens or claims are related to, and to be satisfied from, the gross settlement proceeds from that matter.” The opinion went on to say even if the client “agrees” to such an arrangement in writing, it is still not permissible because negotiating repayment is part of what the lawyer is being paid for from the front end contingency fee: “[A] lawyer may not, even if in writing and signed by the client, enter into an agreement or agreements which call for an attorney’s fee based on the gross recovery or settlement of a matter and in the same matter charge an additional contingent fee for the negotiation of a reduction of third party liens or claims which are related to, and to be satisfied from, the gross settlement proceeds from that matter. This is because the negotiation of a reduction of third party liens and claims is incident to normal personal injury representation. Frequently necessary to reach a settlement of a client’s personal injury claim, this service is a routine element of case management.” Even though this procedure was deemed improper and unethical in 2015, we have recently seen two fee contracts executed in 2016 from different lawyers and/or law firms still containing the “double dipping” clause. In both situations, the clients had become dissatisfied with the lawyers during the course of representation and discharged the lawyers before the claim was settled so no illegal fees were actually charged. However, since this unethical practice appears to be continuing, personal injury victims should be aware of this practice when considering hiring an attorney. If you or a friend or family member, have been the victim of this type of improper fee arrangement, you can contact the Alabama State Bar Association for more information about how to file a grievance and seek a recovery for the excess attorney fees: 1 800-354-6154 (toll free) or follow the following link: ASB Grievance Procedure. Or contact Mark Wolfe at Boteler, Finley & Wolfe for more information: mark@bfw-lawyers.com or 251 433-7766.     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.

Personal Injury Claims: Three Things We Know About Your Claim

Three Things We Know About Your Personal Injury Claim That You May Not Know insurance-claim-approved At Boteler, Finley & Wolfe we’ve been helping personal injury victims present and prosecute their insurance claims for 29 years. We’ve helped thousands of victims recover the full and complete compensation they are owed and most of these claims were settled without ever having to file a lawsuit! Why is that? Because we know and understand three very important factors for recovering full and complete compensation for personal injury claims. Those factors are: Reserves, Computers and Attitudes. Knowing and understanding these three factors allows us to insure our clients get the full and complete compensation they are entitled to! RESERVES: In insurance jargon “reserves” is the amount of money an insurance adjuster estimates will be required to settle an injury claim. Because money held in reserve to pay claims is not invested in the stock market or bond market, adjusters are under a lot of pressure to keep reserves low so investment profits can be maximized by the insurance company. Yet if an adjuster has “under” reserved a claim, there’s a very good chance the claim will not settle for its true value. At Boteler, Finley & Wolfe, we understand how and when reserves are set and adjusted and we know what information is needed by the adjuster to adequately set the reserves for our clients’ claims. COMPUTERS: Or more specifically computer assisted claim evaluation programs. Almost every major insurance company uses a computer program to “assist” with the claim evaluation process. Adjusters are required to input data known as “value drivers” into the program. These value drivers can push the “value” of the claim up (positive) or down (negative). Most insurance companies use similar programs and have similar value drivers and most have specific requirements as to when the adjuster can or should input a value driver. These input requirements can be technical and stringent.  This is especially true if the value driver adds value to the claim. Negative value drivers can be overridden or deleted if certain information is included with the claim material. Mark Wolfe at Boteler, Finley & Wolfe has been lecturing and teaching lawyers and medical providers about computer assisted claim evaluation programs for over 15 years! His expertise in this area allows us to make sure all positive value drivers are identified and included in the claim material for our clients and any negative value drivers are minimized or excluded. ATTITUDES: Did you know insurance adjusters are trained to believe that almost all personal injury claimants are lying, faking or exaggerating their injuries simply to recover “undeserved” compensation? Adjusters go to classes and seminars on “opportunistic fraud” so they can learn how to identify these fraudulent claims. They are given factors to look for when handling a claim to rate the claimants “veracity.” This rating is then factored into the evaluation process. Obviously, if the adjuster thinks a claimant is not honest, the settlement offer will reflect that belief. The truth is many of these veracity factors are so open and vague, it allows adjusters to lump honest claimants in with the dishonest claimants. At Boteler, Finley & Wolfe we only want to represent honest claimants who are truly deserving of compensation for their injuries. To that end, our claim presentation protocol includes several things that accentuate the honesty and truthfulness of our clients and the legitimacy of their claim. So there you have it! Three important factors that can be the difference between getting full and complete compensation for your injury claim and just taking what the insurance company offers. If you don’t have a lawyer who understands these factors and knows how to utilize and incorporate them into your claim, you may be shorting yourself of the full benefits you are owed. Call us today for a free consultation. 251 433-7766 or get more helpful information about personal injury claims from our web site: www.bfw-lawyers.com (Note: our new and improved web site is under construction. In the interim, please visit our old site.)   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.