How exactly do insurance companies figure "pain and suffering" on car accidents?

January 16, 2004 4:44 PM

How exactly do insurance companies figure "pain and suffering" on car accidents? I've been told by several people to take whatever they offer and double it, but how do they decide what they offer? And how do I know if that's enough (because I assume once I take their offer the claim is closed)? (more inside)

I've been told to think about it over the weekend by the other car's insurance claim person. I can either just give them a number for expected future doctor's visits or go for a few visits and then decide how much, whatever is the most comfortable with me.

posted by nramsey to Work & Money (10 answers total)

When was the accident? What kind of injuries did you sustain? And are you in the U.S.?

Typically, 'pain and suffering' is an amount above and beyond the cost of your medical expenses, but related to it by some multiplier (1.5 is a figure I recall, but can't back up).

It sounds like the company paying is trying to get you to settle now (rather than later). This is in their favor, but not necessarily yours.

Without more information, I'd recommend you say "I'd like to settle this claim after my medical issues are resolved." and leave it at that. On the otherhand, the pain and suffering of having to track your receipts and harass the Ins co is fairly large too...
posted by daver at 5:12 PM on January 16, 2004

I'm very very interested to hear from anyone who has had experience with ICBC (British Columbia). My wife was run over six months ago, and has been in surgery and rehab since. So far ICBC has been perfectly supportive and pleasant. We're hoping this bodes well for a reasonable final settlement...
posted by five fresh fish at 5:56 PM on January 16, 2004

nramsey, you'd be insane to be settling before all the doctoring is complete.
posted by five fresh fish at 5:57 PM on January 16, 2004

I second what FFF said. Do not let them railroad you into settling until you are ready and all the costs are fully known.

Unfortunately this means sometimes you have to get a lawyer, but hopefully you won't need to this time.
posted by litlnemo at 6:20 PM on January 16, 2004

See this article on Findlaw. Generally, lawyers will conduct "Quantum Studies" to determine the amount of damages that might be recoverable. These studies simply involve researching case law and locating cases where the victims had similar injuries and documenting the range of awards for such injuries. There is nothing lost by speaking to a personal injury attorney before you settle.
posted by ajr at 8:41 PM on January 16, 2004

I had a friend involved in a rollover that was not her fault. Her foot was injured, and a letter to the insurance company netted her $35k. She explained that this was to cover any future medical costs that were invoked. I asked her if she was going to return the money if her injuries weren't permanent. [uncomfortable silence].

That was 10 years ago, and I'm less of a dork now. Were I in her shoes today I would do the exact same thing. Being involved in an accident not your fault and seeing your friends die--35k is nothing.
posted by mecran01 at 8:43 PM on January 16, 2004

I third what FFF said - wait until everything has healed before settling.

The laws where you are may differ but in Japan they calculate pain and suffering based on how many times you went to the doctor. If you feel any pain or discomfort, you should continue to visit the doctor on a regular basis. If you don't go to the doctor for a while, the insurance company may try to use that as proof that you no longer experience pain or suffering from the injuries sustained in the accident. Again, this is how it works in Japan so it would be best to check with a lawyer in your area.

Good luck and remember: the insurance company is not your friend. They will say and do anything to settle quickly and make the payment to you as small as possible. That is their business and they are very good at it. Again, don't settle until everything has healed.
posted by cup at 9:05 PM on January 16, 2004

I have negotiated bodily injury claims for over 25 years and have seen many changes in the way insurance companies handle claims. Actually insurance companies do everything to avoid the possibility of acting in bad faith these days. The penalties can be quite severe in a consumer oriented society where state insurance commissioners are elected officials. But once you make a claim it is the adjuster's job to get it resolved. An experienced adjuster will advise you NOT to settle your injury claim before you have completed your medical care but based just on the few facts you have written here most adjusters would assume you do not have a serious injury and just want some cash which is why you are getting an offer before you have even started much less completed your medical care. It is a dead giveaway to an adjuster anytime people are willing to discuss settlement before finishing their medical care. Don't get in a hurry and remember that state laws protect you by statute by giving you at least two years before you must either settle your claim or file a lawsuit to protect your interests. There really is no so called formula for settling injury claims. Take five people with a similar injury and all will have different levels of pain and suffering. It is difficult to assign monetary value to a person's pain and suffering. Quite frankly the number of times you go to a doctor or the amount of medical bills is not a measure at all. A person can suffer a soft tissue injury and accumulate a lot of medical bills going to physical therapy but his claim will not have the same value as someone with similar medical costs who suffers an "obvious" injury such as a broken bone. In the long run it simply boils down to what money you are willing to accept to make your pain go away. The best advice I can give is treat it like any other business transaction by leaving emotion out of it. Think about what you would pay someone for their pain and suffering if the situation were reversed and go from there. Stay away from turning your claim over to an attorney who will charge you at least a third of your final settlement dollars until you have exhausted all your best efforts to resolve the claim yourself. Keep in mind you can always turn it over to an attorney before the statute of limitation expires if necessary.
posted by oh posey at 7:54 AM on January 17, 2004

Anyone have an informed guess as to how much my wife might receive for a broken, dislocated shoulder that required surgery and three pins, plus a broken, dislocated, shattered elbow that now has pins, screws, and some fancy titanium plate? The hospital stay was six days (could easily have been ten if she were less driven to heal). Doctor visits average once every two or three weeks. Elbow pins came out six months after the accident. Physiotherapy, massage therapy, and "healing touch" continue, and there's no end in sight. She'll be returning to work, graduated re-introduction, in a month.

Kinda curious what sort of offer will be first made, and how to prepare to get more. These injuries are going to haunt her for life, and they're going to be especially painful when she's in her senior years. Grrr.
posted by five fresh fish at 9:53 AM on January 17, 2004

I was in a car vs bike some years ago. The insurer for the company (it was a company vehicle) offered me $20K upfront the day I was discharged from the hospital. I said "talk to my lawyer." They continued coming up with unacceptable offers that involved partial payment upfront and further payments over time, some of which would have actually left me out of pocket.

Eventually my lawyer (who happens to be a relative--convenient, yes) said "look, pay him $100K or we're going to court."

They paid.

I didn't want to go to court--I'm in Texas, where sideswiping a cyclist is considered meritorious conduct, and I might not have had a sympathetic jury. My lawyer took 30%. My insurance company subrogated my claim (that is, they wound up being $0 out of pocket). I still wound up with a good chunk of change. To put this in context, I had a broken hip that put me at risk for avascular necrosis, which would be Bad--so I wanted to make sure my settlement took care of that risk, since I'd be in for a world of hurt (and bills, and reduced mobility) if I needed a hip replacement 5 years down the road.
posted by adamrice at 10:29 AM on January 17, 2004