The fact that there are massive industries devoted to health insurance, auto insurance, and property insurance is a great indicator of the complexity that insurance claims entail. Most people don’t plan to seek a personal injury lawyer, but once the frustrations of filing claims, facing denials, and endless negotiations are considered, it makes a lot of sense to hire a professional to work on your behalf. Award-winning personal injury lawyers like the team at Thompson Law can guide you through the process of maximizing your claim for an excellent settlement or case result. You deserve a fair and just recovery after a serious injury accident.
The Big 3 Factors that Affect Your Accident Claim
There are many potentially complicating factors for an accident claim. The last thing you need if you’ve recently suffered a serious auto crash is a complicated list of even more concerns. We’ve simplified the list to the Big 3 Factors that impact your claim: The Role of Fault, The Nature and Severity of Injuries, and Your Expenses from the Accident. Read on for more details on what the Big 3 may mean for you and your case.
The Role of Fault
The core of a winning insurance claim is definitively determining who was at fault for the accident that occurred. The determination of fault is closely tied to the concept of negligence. In everyday terms, we think of negligence as careless or thoughtless acts. In legal terms, however, negligence has a very specific definition:
A failure to behave with the level of care that someone of ordinary prudence would have exercised under the same circumstances. The behavior usually consists of actions, but can also consist of omissions when there is some duty to act (e.g., a duty to help victims of one’s previous conduct). (source: Cornell Law School Legal Information Instutite)
When it comes to allocating fault after an accident, most, or the entirety of the responsibility, will typically fall with the most negligent party.
So, whether or not you are at fault for an accident is one of the main factors that can affect your claim. But, can there be multiple at-fault parties? Can you share fault? The answer varies depending on where you live. Different states have different laws when it comes to shared fault – often legally referred to as “contributory negligence.” Contributory negligence is a concept where an injured party played a role in their own losses, by failing to act prudently, or even acting negligently themselves. This can result in reductions in the recovery they are eligible for, and a more difficult battle winning any deserved payout.
Texas is a contributory negligence state, more specifically, a comparative negligence state. Comparative negligence is, “A tort rule for allocating damages when both parties are at least somewhat at fault. In a situation where both the plaintiff and the defendant were negligent, the jury allocates fault, usually as a percentage.” (source: Cornell Law School Legal Information Institute). Comparative negligence also varies state to state, with the strictest locales practicing pure contributory negligence. This means if you are found to be even 1% at fault for an accident, you cannot recover funds on losses sustained in that accident. Luckily for Texas accident victims, our regulations are not that severe.
Texas is a comparative fault state, that utilizes the 51% rule. This means that you cannot receive compensation if you are determined to be 51% or more responsible for the accident, regardless of whether you were in a car wreck in San Antonio, Dallas, Fort Worth, or any other Texas city. This means that the burden on the wronged party is only to show that the other party was more than half at fault for the events that transpired. While this can be complicating, it does protect injured parties from counter-lawsuits, where the at-fault party may try to argue that since you were, say 10% at fault due to your speed, you as the victim owe the at-fault money for a percentage portion of their injuries.
To determine fault, negligence, and any comparative negligence, your personal injury attorney will examine the evidence from the events leading up to and during the accident. Factors that can impact the allocation of fault, and thus your claim, include:
- Drunk or Intoxicated Driving: operating a vehicle while impaired on illegal or pharmaceutical substances
- Distracted Driving: texting, adjusting radio, watching movies
- Driving Illegally: speeding, improper lane changes or driving patterns, failure to yield, driving without license or registration
- Unavoidable / Sudden Emergency factors: Animal enters road, exceptional weather conditions, heart attack while driving
The Nature and Severity of Injuries
While the causes and complications of fault in the accident significantly impact claims, they are not the end of the inquiry. The next crucial category that claims adjusters and accident attorneys investigate is the nature and severity of injuries sustained in the event.
First, the severity of the injuries plays an important role in the claim. Life-altering injuries like paralysis (including paraplegia or quadriplegia), or traumatic brain injury (TBI) are going to be awarded significantly more money than less severe injuries like broken bones or soft tissue injuries. This is not to diminish the pain and suffering that can come with any injury. Your personal injury attorney especially sympathizes with all that you are going through, but accuracy in degree and severity of the injury is important to recover all you are owed.
In addition to the severity of your injury, the duration of time that it will impact you is also a factor in your claim. This is why it is especially important to seek medical treatment early, and carefully continue with your prescribed treatment regimen. This will support and strengthen your case for what you are owed. Variation in treatment and healing time can range widely. Whiplash injuries, sprains, and strains may completely resolve in a matter of weeks with a few physical therapy appointments. On the other hand, paralysis will drastically change an individual’s life forever – from their physical mobility to their work and family life, to their need for caretaker support. Accordingly, the outcome of such different types of injury claims will vary widely.
When it comes to injuries, sympathy also plays a role in claim payouts, especially if the case makes it to court and is heard by jurors. Sympathetic personality types on either side of the accident, at-fault or injured, or visible casts, scars, injuries, can sway the jury and play on emotions in the decision making. This is always an added complication and one that your personal injury attorney can advise you on as it pertains to your situation.
Your Expenses from the Accident
We’ve seen how fault and bodily injury can impact your claim, but there is a final important component to negotiating fair and just claim outcomes: expenses. The losses that resulted and the costs associated with repair and recovery can be extremely significant. These lost funds need to be factored into a complete claim demand.
There are a few nuances to consider when it comes to calculating these costs. Perhaps most obviously is the extent of medical treatment. Surgeries, doctor’s visits, prescriptions and more can add up quickly. It’s very important to document these costs and keep your receipts if you pay out of pocket for any medical expenses after your accident. In addition, it’s important to consider the duration of treatment. If your injuries will require two surgeries and 18 months of post-op physical therapy, you will want your claim to capture the entire scope of related bills and costs. This can take time and tedious attention to detail in documenting the finances.
In addition, it may be important to consider which healthcare providers you visit to receive necessary treatment. Workers’ compensation claims, for example, require visits to authorized providers in order to approve claims. Health insurance companies will have requirements to use in-network providers. Even auto insurance companies often have designated retailers that you must use for any car or truck repairs after an auto accident. These administrative details in selecting providers can be tedious, but the research is worth it when it comes to maximizing your claim value.
Finally, and perhaps the most complicated expense consideration in an insurance claim, is determining your daily life disruption. Have the accident and resulting injuries impacted your earning potential? Did this mean that you were out of work for two weeks for recovery? Or do you have a catastrophic injury that won’t allow you to work ever again? Will you need help running your home or caring for your kids due to your injury? Will you need to retrofit your house or car for your change in mobility? These are serious questions that may have expensive answers. If you and your family are impacted by a change in life circumstances since your accident, you deserve compensation from your insurance payout accordingly.
Hitting a Wall with the Insurance Company?
Fault in an auto accident can be straightforward. You can be stopped at a red light and have someone rear-end you out of the blue. On the other hand, collisions can be really complicated, with multiple vehicles, many driver mistakes, and other dangerous road hazards playing a role in the crash. From the most straightforward to the most unbelievable wreck, you can be sure that the insurance companies will complicate, deny, and delay to the greatest extent they can.
If you are finding this out in your claim process with the insurance company, know that this is not your fault, and you do not have to go through an arduous claim process alone. Seek out great attorney representation for the help you need. The at-fault’s insurance provider has legal resources, why shouldn’t you? Thompson Law offers a wealth of personal injury legal services. Start your path to repair, recovery, reimbursement, and relief by calling today.
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The State of Texas has a statute of limitations of two (2) years for personal injury cases, so if you have been denied by your medical insurance provider, consult with an experienced personal injury attorney. The sooner you know your options, the sooner you are on a smooth path to recovery and your deserved compensation. If you’ve been hesitating to reach out, don’t delay any further. Call Thompson Law right away for assistance with your injury and claim.