The Settlement Process (Injury, Car Accident Cases & More)

- I'm going to talk about the settlement process

in a personal injury case.

Watch the entire video so you can see all the steps

that go into the settlement demand

and the settlement process in a personal injury case.

JZ helps a Florida injury law firm.

I'm Attorney Justin Ziegler.

Before we get into the settlement process,

really quickly, I just want to say

there's a time limit to sue.

For example, in most cases in Florida,

it's four years, sometimes there's a notice

of claim that you have to give earlier than four years

and in cruise ship cases it's limited

oftentimes to one year to sue.

If you miss the deadline to file a lawsuit,

you lose your case.

When thinking about settlement,

you need to make sure that your case

is ready to be settled.

The two most common events that make a case

ready for settlement is one, you're finished

with your medical treatment, or number two,

the value of the case exceeds all available

insurance coverage in the case.

Prior to settling the case,

you need to make sure you know every single

insurance company that is in play.

You also need to know the insurance company limits.

It's important to know this information

because if your case becomes more valuable

than the insurance limits,

your case is ready for settlement.

If you don't know those insurance limits,

then you're not gonna know whether

your case is more valuable than those insurance limits.

You need to not trust what the insurance company tells you

is the insurance limits, you need

to get it in writing.

In Florida, you can request this is writing.

The insurance company has to provide that to you in writing.

Even if the insurance company tells you

that they're just aware of certain insurance coverage,

don't take their word for it.

There's times where we've been able

to find additional insurance,

even though the insurance company,

in writing, under oath, told us

that there was limited coverage.

In one case, the insurance company, USAA,

told us that there was $100,000 of bodily injury coverage

from the careless driver that caused our client's injury

and it was only after pressing them

that I discovered that there was

an extra $1,000,000 policy at play.

When ended up recovering an additional $100,000

from that extra 1,000,000 policy,

in addition to the $100,000 of USAA's

bodily injury liability insurance.

As soon as possible after your accident,

if someone else caused your injuries,

you need to request every single piece

of documentation in your case,

that includes medical records and medical bills.

Even if the insurance company

sends you an authorization and tells you

that they're gonna request your medical bills and records,

don't rely on them.

Some of the medical bills and records you need to request

start from the events that happened immediately

after the accident.

If you take an ambulance to the hospital,

you need to request those ambulance

medical bills and records.

If you treat at the hospital,

you need to request your hospital bill and record,

your emergency doctor's bill.

Those two are gonna be two separate bills.

I've never seen them as the same bill.

They're always separate, the emergency doctor's

and the hospital bill.

If X-rays or CR scans were taken of you,

you're gonna need to also request the radiology bill.

If blood work was done, you're gonna need

to request the pathology bill

and there may be other bills as well.

Particularly if you had surgery,

you're gonna request the surgeon's bill.

As soon as possible, even though I'm gonna talk

about the settlement demand,

which is written demand package you're gonna give

to the insurance company, even though

that may happen later throughout the entire claim,

you're gonna want to continue giving

the insurance for the at-fault party

all of your medical records and bills.

This is so they can properly set the reserve,

the amount of money to pay your claim

and so you just not springing it on them

at the last minute, and then it takes them

sometimes more time, and a lot more time sometimes,

to get settlement authority to pay your case.

Most people want to get paid as much

as possible as soon as possible

In order for this to have the highest

chance of happening, you need to continuously

feed the insurance company all of your medical information.

In order to get your case ready for settlement,

you need to send the insurance adjuster

all photos in your case that help support your claim.

If you were in a car accident or truck accident,

send the insurance adjuster pictures of the property damage,

particularly if there was a lot of damage.

The higher the amount of damage, all things equal,

helps the settlement.

You need to also, if you suffered injury,

whether it's bruising, cuts, hardware in your body,

outside your body, things of that nature,

send that to the insurance company

sooner rather than later.

You want your file, your claim,

to stick out in the adjuster's mind.

The more documents you send them, within reason,

so long as they're helpful to your case,

the more the adjuster's forced to look at your claim.

The more time they spend on your claim,

the better they get to know it,

and the better they get to know you.

You also want to take pictures, photos,

of the incident scene if it's appropriate.

This photo is from a trip and fall case

where my client tripped and fell

on this vinyl landscaping edge.

And I went out to the scene very shortly after

and fortunately, it hadn't been changed,

so I took a photo to show the adjuster

what we believed was the hazard

that caused my client to trip and fall

and suffer stitches right below her eye

and a slight wrist injury.

If I did not take that picture,

or if an accident victim doesn't take

that picture shortly after,

there's a chance that the insured,

the person that caused your accident,

does not tell the insurance company about the hazard.

They may tell their own insurance company

there was nothing wrong and they may fix it.

And then the insurance adjuster may have no choice

but to believe them.

If you can get the adjuster photos

as soon as possible, if they're helpful

to your claim like this one, it can help settlement.

This case settled for $18,000

and there's a strong likelihood

that without these photos, the case

may have not have settled for that much,

and may have settled for much less

or may have not settled at all.

You want to send the insurance adjuster

CT scans and X-rays and MRIs

if you have them, of your injuries,

if there was something wrong with you.

For example, this image is of the large lower leg bone,

the tibia, and it shows a fracture.

In this case, we requested this from the emergency room

and we quickly sent it to the insurance company

for the careless driver that hit my client

while he was a pedestrian.

What it does, like I've discussed before,

is it forces the adjuster to look at the picture,

he sees the significance of my client's injury

and it helps them, possibly, assign more money to the case.

If you're gonna need more medical treatment in the future,

be sure to have a doctor write down

the type of medical treatment

that you're gonna need in the future,

how often you're gonna need it, and the cost of it.

I had a case I settled for $445,000

where an 18-wheeler hit my client.

The tractor part of the truck hit my client.

And we asked the doctor to write down

what he thought my client's future cost would be.

And every time I spoke to the adjuster,

I would tell him, this is the surgeries

my client is gonna need in the future,

and this is the cost of them.

That may have helped us secure that $445,000 settlement

where my client fractured the lower large bone

right beneath his kneecap, and had surgery.

I use a spreadsheet to list the dates of treatment

of my clients, the type of treatment,

the total bill charges, which the general rule of thumb

is the higher your total bill charges,

all things equal, the higher the settlement.

The amounts paid by health insurance,

Medicaid or Medicare, the out of pocket charges

that my client owes, as well as the amounts that were paid.

In Florida, for example, you're entitled

to recover the out of pocket medical charges.

If your health insurance company,

or Medicaid or Medicare paid for some of your medical bills,

you're also entitled to recover that money

and then you later on have to reimburse them

at least a certain percentage of it.

I'll get into that in a little bit.

You need to have this spreadsheet

because it allows you to know all of your medical bills

and everything and if one of them chances

and you later get an update from one

of your medical providers that the bill

has been reduced or adjusted,

all you have to do is change one little cell

and it adjusts everything.

You want to have this spreadsheet

so that when you're talking with the insurance adjuster,

you're on the same page because these

insurance adjusters are very busy.

They want you be prepared.

The more prepared you are,

the better it looks for your claim.

And you need to know exactly what your out of pockets are

so you can estimate the fair value of your claim.

If you happen to have health insurance

or Medicare, and Medicaid, or some other type

of major medical plan that's gonna pay your bills,

you need to know how much they paid.

Because likely, they're going to assert a lien.

There gonna want a claim from their recovery

of your personal injury case and you need

to start early talking with them about how much

they are willing to discount the amount

that they're going to make a claim

against your settlement for.

Sometimes they're generous.

Medicare, for example, reduces by attorney's fees and costs.

Medicaid in Florida has a particular settlement formula.

Health insurance, it's gonna depend

on whether the plan is self-funded,

if it's through your employer or not,

and there's many other exceptions.

There's also certain letters that you need

to get out to the health plan.

And if you're working for a large business

that is self-funded, you want to make sure

that this letter goes to the plan administrator.

They can incur certain penalties

by not timely responding to your request for their lien,

and that can result in a huge savings.

As I tell people, there's generally two big parts

to the personal injury case.

One is reaching a settlement with the at-fault parties,

and number two is what I call the back end,

getting all your health insurance bills

and everything knocked down.

We generally ask for it, just over the phone

and we want to know how much the health insurers

are going to seek from the recovery

so we can estimate the amount

that the client will be receiving.

It's very important to know the health insurance lien.

For example, let's say you settle your case

for 100,000, but your health insurance

paid 100,000 in medical bills

and they want to recover dollar for dollar.

You may have issues, that may eat the entire settlement.

Now that would likely happen if you work

for a huge employer that is not willing its plan

but you need to know exactly how much

the health insurance lien is.

I talked about the demand letter earlier on,

that is essentially a letter and a package

where you're gonna enclose all of your medical bills,

records, and everything of that nature,

even if we've provided the insurance company

with medical records, bills and photos earlier on,

we still include it in the demand package.

You're generally gonna want to give the insurance company

a time limit to respond so that

they put it in their calendar

and they respond within that time limit.

If you don't give them a time limit,

there's a higher chance that they're going

to sit on the settlement and wait

to make you an offer longer.

The demand package and letter is your time

to explain how this incident has affected your life.

You're gonna want to include before and after photos,

if there's been a significant change in your appearance,

or the things that you can do.

If you're a runner, for example,

and now you're unable to run or you have

difficultly running since the accident,

send the insurance adjuster some pictures

showing that you were able to run

in all the marathons or the awards that you received,

and then show 'em, perhaps a short video

or photos of you that you have difficulty walking now.

That can again, help your case stand out

in the insurance adjuster's mind

and it can show you, that your life has been effected.

In Florida, for example, if you can show

that someone else's carelessness caused your injury

and you lose enjoyment of life,

you're entitled to recover that.

In certain cases, like auto accident cases,

the standard is higher, you need to be permanently injured

in many but not all cases.

Everything matters.

Every bit that you life has been affected,

you want to make sure the insurance adjuster knows this.

You can put it in writing, you can also communicate

it with them over the phone.

In the demand letter, in certain cases,

you're gonna want to say that this demand

is contingent, it depends on there being

no other insurance available, coverage,

or in Florida, for example, if you're making

a claim against the bodily injury liability

insurer, I usually include language

in there that says this demand is subject

to the uninsured's motorists waiving

their right of subrogation.

Now comes the part that everyone wants to know about,

the negotiation process.

You want to make a high demand,

but you don't want to make too high of a demand.

I've had cases where my clients insisted

that our demand was very high

and that can delay settlement.

For example, if you make a $500,000 demand,

but your case is only worth 195,000 or so,

there's a chance that the insurance adjuster,

let's say he offers you 130,000.

And he tells you he doesn't have any more room

to increase his offer.

There's a chance, not always, but there's a chance

that the adjuster really does have more money to offer you

but because your demand is so high,

he says in his head, why am I gonna increase

my offer when they may not even decrease

their offer or even if the claimant

decreases the offer, they're still gonna be so far apart.

So, making the right demand is very important in a case.

You don't want to go too low because you should

never be willing to settle

for your first demand in most cases.

In most cases, you should typically demand

above what you're willing to settle for.

This gives you room to negotiate.

Also, when you're negotiating with an insurance adjuster,

do not believe what they tell you.

I've heard insurance adjusters for the careless party

tell me that they were giving me their final offer

and then a week later they add $5,000

or $10,000 to that offer.

Do not believe what they tell you.

Also, if you're hitting a wall

with the insurance adjuster and he won't increase

his offer, sometimes you want to speak

with the claims manager.

But understand that personal injury claims

for the most part involve negotiation.

Meaning, the first offer that the insurance adjuster

gives you will not be his last.

An exception to this, is if they're offering you

their policy limits and that's all the money

that's available, however, even in those cases,

you may be able to squeeze out a little bit

of more money from their insured.

Assume you reach that happy place

where you're able to settle the case and you're ecstatic.

The insurance company, generally speaking in Florida,

in going to send you one settlement check.

They're generally not gonna send you piecemeal

or multiple settlement checks.

They are going to require you to sign a settlement release.

Essentially, that release says,

you're never making a claim against their insured

for the rest of your life.

I, for example, use my own proposed settlement release.

There's a few things you don't want to give up.

You don't want to give up your right

to sue any other parties.

For example, let's say you had surgery

and the doctor put in hardware inside your body.

In Florida, if you just sign the insurance

company's release, you may be giving up

your right to sue if that product turns out

to be defective, or if a doctor medical malpracticed you,

or other things of that nature.

You also don't want to give up your right

to make claims against your health insurer,

or Medicare, Medicaid, things of that nature.

So, treat the release very, very seriously.

After you settle with the insurance company,

that's the time to finalize your liens

with your health insurance company and other insurers.

If you fail to pay Medicare or Medicaid,

for example, you can be thrown in jail

and face huge penalties.

Your health insurance company

could possibly reverse the payments

that they've made or cut off your future

health insurance care if you stiff them.

But like I talked about earlier on,

you should have started talking

with your health insurers about how much

they'll accept as their final lien amount

so that when the case settles,

you're in a better place to negotiate it.

You don't to settle your case,

have no idea how much the health insurer will take,

and then you lose all your leverage

because they may say, we're not gonna reduce it a dime,

whereas if you would have talked with them

earlier on, you can make the threat of,

I'm not going to continue my personal injury claim

unless you give me an off the record

that you're going to accept less than your lien.

I hope you enjoyed this video.

Please subscribe to our channel.

Please like it, let me know your comments.

Do you agree with the settlement process

and demand the way that I've discussed it?

I'm Attorney Justin Ziegler.

My office is in Miami, I serve Florida.

Have a wonderful day.

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