Why insurance claims for soft tissue injury are so critical?

by Modelkrb » Mon Apr 13, 2009 10:01 pm

Filing for an insurance claim is a tedious process. You eventually get paid for the losses, but only after the insurance company verifies that your claim is authentic. You would rather not expect them to pay more than what your loss had been. On the contrary, the insurers may try in every way to pay as less as possible. In that case, you may have to fight hard to receive a satisfactory compensation. Demanding insurance compensation for soft tissue injuries might be all the more difficult.

What is a soft tissue injury?

Soft tissues in a human body include everything except the bones and the organs. Thus, any injury to the muscles, ligaments, tendons, and other connective tissues can be termed as a 'soft tissue injury'. Bruises, sprains, strains, abrasions are the common soft tissue injuries that might affect an individual. Whiplash is one of the most prominent forms of soft tissue injury that affects the neck and upper back of the individual, if his/her car is rear-ended during an accident. Top

When to claim compensation for a soft tissue injury?

Claims for the soft tissue injuries are incorporated as a part of personal injury compensations that you can seek from your insurer after an accident. It is only justifiable to file a soft tissue injury claim when the injuries have been caused by:
  1. Auto accident
  2. Reckless or violent activity
  3. Defective equipment
  4. Defects in playing surfaces
  5. Lack of proper supervision
  6. School sporting activitiesTop

How are the injuries treated?

The soft tissue injuries cannot be easily diagnosed and there are no specific treatments for such injuries. However, health care specialists often use prescription drugs to relieve the pain from the injuries. The most recommended forms of treatments include:
  1. Rest
  2. Physical therapy
  3. Chiropractics
  4. Oral pain relievers and muscle relaxants
  5. Soft cervical collars (to immobilize neck after a whiplash injury)
  6. Massage
  7. Heat
  8. Ice
  9. Injection
  10. Ultrasound.
    11. Top

Why soft tissue injury claims are different from other injury claims?

Soft tissue injuries cause pain and soreness to the affected individual. Not only that, it also affects the earning capability of the individual. However, unlike other injuries, it's difficult to document them. Most of the time, the injuries don't show up on the skin. Even X-rays may fail to point out that injury in the area. The treatments may not follow the conventional path, as for other form of injuries. It's also hard to determine the claim amount for pain and suffering and loss of pay. The insurers often take a long time to settle a claim for a soft tissue injury. Often, the injured has to go to a trial to get a reasonable amount as compensation. Top

How much to claim for settlement of soft tissue injury?

The claim amount for soft tissue injuries differs from person to person. Your soft tissue injury settlement claim would depend mainly upon the factors mentioned below:
  1. The treatment - Your diagnosis and the mode of treatment will affect the claim amount, since you'll be asking your insurer to reimburse the corresponding expenses.
  2. Your income - Your income will affect your claim amount, since you'll be asking compensation for the loss of pay. Losses of past and future income along with the cost for future care are included when an insurance claim is filed. Besides, it would also depend upon the duration for which you were unable to work.
  3. Attorney fees (if any) - In case you're hiring an attorney, your claim amount should be more than the actual expenses for the treatment and loss of pay. It is so, since the attorneys deduct a share of the settlement amount that the insurer pays you.Top

Points to remember when filing claims for soft tissue injuries

Certain factors should be kept in mind, if you want to file an insurance claim for a soft tissue injury, as mentioned below:
  1. Take pictures of any visible symptoms - It is difficult to prove the extent of injuries. Therefore, any physical symptoms like swelling or bruising should be documented with the help of photographs.
  2. Save the documents - All details of medical advices and treatments should be stored in a proper order. You might need them to substantiate the treatments for your injury.
  3. Negotiate on your own - Try to settle the amount yourself initially. Negotiate with your insurer to arrive at a reasonable claim amount.
  4. Consult an attorney - Hire an attorney to represent you, only when your insurer refuses to pay anything. You should keep in mind that you'll need to pay the attorney, out of the claim amount that you receive.
  5. Don't make haste - You must have patience when dealing with your insurer. A settlement will take time, if you want to receive a decent amount at least. You can claim for any soft tissue injury, if the other party is responsible for it in any way. Every insurance claim needs to be proved. As for a soft tissue injury claim, substantiation is all the more vital.

You can claim for any soft tissue injury, if the other party is responsible for it in any way. Every insurance claim needs to be proved. As for a soft tissue injury claim, substantiation is all the more vital.Top

Related discussions

i have a similar post but i am going to go into detail with this.i need you alls advice.i am wondering what is the highest amount i can get from soft tissue injury settlement after my attorney takes her 33 percent out.Here Is My Situation,On December 26,2008 I Was At A Stop Light Waiting For It To Turn Green.The Light Finally Turned Green.As I Was Pulling Off The Lady Behind Me Ran Right Into The Back Of Me.We Pulled Over She Came To Check On Me To See If I Was Ok.At The Time I Was Fine.She Immediately Got On Her Phone And Called Her Insurance Company In The Process Of Doing That She Was Telling Me I Dont Have To Call The Police She Will Take Care Of My Car.I Called The Police Anyway To Make A Long Story Short She Ended Up Getting A Citation For Following To Close.This Was 11am On A Friday.I Didnt Feel Sore Until I Want To Say 12 To 1.A Member Of My Church Reffered Me To An Attorney,She Gave Me The Name Of A Chiropracter To Go To.I Went In And Basically I Went For 3 Months At 3times A Week.To Make A Long Story Short My Car Damage Was 559.78 .My Lawyer Said That Usaa Doesnt Believe That The Damage To My Car Was Bad Enough For Me To Be Hurt.If I Wasnt Hurt I Would Have Never Went Threw The Process Of All Of This.My Lawyer Asked Me To Contact My Insurance Company To See How Much Is My Med Pay.Ok To Make Another Long Story Short My Entire Bill With The Dr Was 3,692 And Some Change,My Med Pay Paid My Entire Bill So I Am Ok With That Portion,My Lawyer Put A Demand To Usaa For 16,000.I Understand I Am Not Going To Get That Much Back.Usaa Is Offering 4,225 That Is Too Low And My Lawyer Already Said She Is Going To Put In Another Demand.My Question To You All Is What Is The Most I Can Get From A Soft Tissue Injury Settlement Claim.If You All Have More Advice For Me Feel Free To Reach Me On Yahoo Messenger My Id There Is Kai30034 I Need All The Advice I Can Get.

Total Comments: 97

Posted: Tue Apr 14, 2009 05:57 am Post Subject:

I know what I sent to you in your mailbox conflicts with what I am about to type, but now that you have provided more details the picture is a little more clear. With less then $600.00 in property damage, the insurance company is going to question your injury or at least the severity of your injury and that you needed 3 months of chiropractic treatment at about $3,700.

What happens many times (not saying this completely happened to you) is someone gets in an accident and gets an attorney. The attorney sends to them to a chiropractor “friend” and the most treatment possible is given in the shortest time possible. The treatment is usually excessive and insurance companies don’t put as much weight on the medical bills. So no, I don’t see them looking at your claim in the 10K range or the 8K range. They may go about 6K just to get rid of a soft tissue injury settlement worth more. Now a days, $600. is not that much damage to a car.

On a personal note, it makes me sick when attorney’s marketing material have chiropractic cards attached.

Posted: Tue Apr 14, 2009 09:32 am Post Subject: Deciding such settlement can be critical

I know it sounds bad but often the chiropractors are know to inflate their bills and keep the patients coming to them even when its not required. This, however, leaves a scope to the insurance companies to negotiate the chiro's bills.

The proper soft tissue injury settlement is hard to determine. IMO Das's prediction is likely to be correct. The attorney can ask for $16k as BI but nothing guarantees that you'll see that money. Most likely you would receive something around $6k as Das has said.

Posted: Tue Apr 14, 2009 10:53 am Post Subject: hey das and simon

she sent me an email with the subject title top offer.this is the second demand she said they are trying to give 5,000 but after she takes her fees out i will only get back 3,333.00 is this fair and how many times can i try to get more out of a soft tissue injury settlement !!! PLEASE HELP I NEED YOUR ADVICE BAD.

Posted: Wed Apr 15, 2009 07:02 am Post Subject: settlement negotiation

It sounds like your attorney is saying that this is their top soft tissue injury settlement offer. If that is the case you can always refuse the offer, your attorney will most likely walk away since there is no chance they will want to pursue this in court. One thing that you or your attorney can do is contact the chiropractor and see if they will reduce their bills (most will). This could get you to a break even point or put a couple bucks in your pocket.

USAA pretty much has you. They know there is no attorney that is going to take this to court since the cost would be too high compared to what they would get out of it. That leaves you two choices.... take the offer and work with the chiro to lower the bills or attempt to get the attorney out of the picture and take a shot yourself. You may also be able to work with the attorney to try and get them to drop their %. (I've seen them do this to get things settled, similar to real estate agents droping theirs to get a house sold or purchased.)

Posted: Wed Apr 15, 2009 05:27 pm Post Subject:

Your lawyer should be able to look at other similar cases and what that case got the claimant and give you an estimated range of what you could get from a case. However, as mentioned before your attorney may have already done this and that is where they got their requested offer, probably plus a little bit just to see what they could get the insurance co to bite at. The insurace co came back with a soft tissue injury settlement offer, thus your attorney could make a counter. However you are probably not going to get much more than what the insurer offered unless you go to a law suit. Which from from the sounds of it your attorney has already decided is not feasable based on the facts of everything. Of course you would have to discuss all of what is happening with your attorney.

Posted: Thu Apr 16, 2009 06:33 am Post Subject: settlement is affected by low PD claim

I think the low value of the PD has made the whole BI thing complicated for you. It’d be very hard to convince the insurer that you had sustained severe soft tissue damages in an accident where the damage to the car is only over $500.

I’d agree with Das, it may not worth pursuing the claim in the court. Therefore, you seriously need to work this soft tissue injury settlement the other way, i.e. by asking the chiropractor to lower his bill amount.

There is no harm in pressing the matter little harder and IMO you also have hurried in hiring an atty. Taking care of your businesses yourself at times are easier than retaining professional help.

Posted: Thu Apr 16, 2009 10:48 am Post Subject:

Hi,

You'd certainly need to discuss everything with your attorney at this juncture.

However you are probably not going to get much more than what the insurer offered unless you go to a law suit.



Once you'd go in for a lawsuit that might lead to an ultimate settlement. It might add a few more bucks to the intial offer. On the other hand, you should also consider the fact that a lawsuit could even lower the offer that had been made to you initially.

ArindamSenIndies

Posted: Wed Sep 23, 2009 02:10 am Post Subject: soft tissue damage

Hi I was injured on my job back in 2007. It's September of 2009 and October 26 will be 2 years since I had my injury, which was no fault of my own. I've been basically going through the same sisutation for quite some time now. I've seen several doctors, in which the majority were chosen by the attorney's that i've had. Every doctor that I have seen has had something different to say. I substained a nasty blow to the right back side of my head and neck. My entire body has been affected. Neck , shoulders, arms, entire back, hips, legs fingers, and toes all have been affected. Not all at once, but over a period of time. With all of these things going NO ONE KNOWS WHAT THE PROBLEM IS. This is what i've been told by the NO GOOD ATTORNEY THAT I HAD.I know that this is very frustrating and your not getting the answers that you feel you need,but I can assure you that if you don't settle for anything and keep believing and have faith,HE WILL TAKE CARE OF YOU AND ASSURE YOU THAT IT WILL ALL BE WORKED OUT IN DUE TIME...

Posted: Wed Sep 23, 2009 03:14 am Post Subject:

I didn't quite understand the reason why you had to visit doctors chosen by your attorney. A doctor has to be chosen out of your health requirement and not to satisfy legal agreements. You've mentioned that a majority of them were chosen by your attorney - what about the rest of them? What do they have to say regarding your health conditions? Did they figure out any particular reason?

Posted: Fri Oct 02, 2009 10:19 pm Post Subject: What should my sister expect

I need your help as well my sister was diagnosed with a soft tissue injury from an accident in Nov 2007 and the Dr says she will still have some problems and need to periodically she gives her cortisome shots and an anti inflamatory. She was hit in the back by a tow truck and the damage to her car was $8000.00 The lawyer said they want to her offer her a soft tissue injury settlement in the 20,000 but my sister is still hurting some and getting shots what do you think she should accept anything less than 50,000

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