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: Mon Mar 22, 2010 12:00 pm Post Subject:

Penny, I don't understand what you question is...Are you asking if you can go back now and collect additional monies on an 08 injury? You say they 'cut you off' after six months...do you mean the PIP ran out? We need more infor before we can hope to assist you...

1 year before grad i was in this accident stop my life


I hope you aren't saying that due to this accident in 08, you relapsed and went back to your old way of life...

Posted: Wed Apr 28, 2010 08:02 pm Post Subject: how much should I seek in my accident settlement.

Myself my friend and three children were on our way to the circus, I stopped for a pedestrian walking in the crosswalk when I was rear ended by a drunk driver. He was arrested for DUII and wreklass driving. I was the only one who got hurt, I have had to go to physical theropy 2 times a week and my neck, back, head, legs all still hurt. I wasnt able to hold my 9 month daughter for about a month or my 3 and 5 year olds I still cant hold them. it is interfearing with my work. please help if you can

Posted: Thu Apr 29, 2010 05:32 pm Post Subject: soft tissue

my wife was hit from behind at a yeild sign. it was the other persons fault to fast for conditions. car was totaled out with 2500 in damages and the said it was only worth 600. and alloted time with out car was total of 975 so i bought it back for 125 they suppose to send a salvage title. so now she sent her medical in and one day of loss waiges it values at around 2200. so there first offer allstate gave was only 3000 should i get a attorney on this

Posted: Thu Apr 29, 2010 06:46 pm Post Subject:

so there first offer allstate gave was only 3000 should i get a attorney on this

Only you can answer that question. What amount are you looking for? I'd say with the injury that you described, that amount seems like a good starting point. It sounds like it's an initial offer and those are usually increased. Consider this, an attorney will take 33% of the _offer_. If you were to use an attorney and the offer stayed the same, the attorney would collect $1000 and you'd be left with $2000. In order for you to break even with an attorney the offer would need to be increased to $4000. I can tell you that this is possible but on a soft tissue injury and what appears to be about $1500 in diagnostic treatment, this probably won't happen. It may... but I'd say it would be a fight to get $4000 paid on this claim.

People think that attorneys are "free". Their commercials certainly make it sound like they are. They are not... they collect 33% of the person's settlement. Just something to consider.

As mentioned above, $2200 sounds like their initial offer. With a bit of negotiating I'm betting this amount could be increased.

Posted: Fri Apr 30, 2010 03:27 pm Post Subject:

the 2200 was for medical and loss waiges. so all they want to settle on pain and suffering is 800. i know if i was in the car and didnt get hurt i would of got 500. i feel her pain and suffering seems to low

Posted: Sun May 09, 2010 12:07 pm Post Subject:

Negotiate with the ins co. Your wife should get at least a min of 2k for pain/suffering.

Posted: Sun May 09, 2010 12:31 pm Post Subject:

Steel I don't know what your experience is, or how you feel qualified to put this 2k value on the pain and suffering, tell you what I've got about oh, 23years experience, and I can't so that...so unless you have the ability to be inside his wifes body and feel what she feels you're off the beam.....and I seriously doubt with 2200 in specials she will get 2k in pain and suffering..

It's all relative, and subjective, Mark. Is she done treating? is she back to her old self? if she is not you shouldn't even be considering settling yet anyway.

Tcope gave you great advise take it.

Posted: Sun May 09, 2010 02:20 pm Post Subject:

"Pain and suffering" is what the attorneys try to throw at the juries to see what sticks. This is such a dubious phrase. Very similar to the "soft tissue" injuries that no X-ray or MRI can locate, but which the chiropractor finds within minutes using only his educated fingertips.

That's not to say your wife has not endured any pain, but from the description of $2500 in collision damage, I would not believe that your wife's injuries were substantial or serious. Certainly not life-threatening.

Why not? Because those "bumper crash tests" that the IIHS and others conduct every year have demonstrated for the past ten years that most cars, SUVs, and light trucks suffer a minimum of $3000-$5000 in a 5 mph rear-end impact. Your described damage was $2500.

If the insurance company is willing to offer $3000, you might be able to squeeze another $500-$1000 out of them, but beyond that, your efforts or those of an attorney will likely only cause you mental anguish and not yield any special result.

Posted: Tue May 25, 2010 08:22 pm Post Subject: auto accident injury settlement

I was involved in an MVA and the other person was at fault. I have severe whiplash and during an MRI it was found that I already had an existing problem with my cervical vertebrae (bone spurs, and degenerative discs) I never had any symptoms until the accident. I have exhausted my PIP of 10,000 and my health insurance company is now paying medical bills --I have been in PT for 2 months and just underwent an epidural procedure with cortisone. I expect another month or two of treatment. I do not want to use an attorney if I do not have to for settlement with the other insurer. How much is my claim worth? What should I start asking for? I did not miss work --only because I could not --did not have any available time off --so I HAD to work and endure all the pain and my employer had to purchase a special headset so I could still answer phones.

Posted: Wed May 26, 2010 04:37 pm Post Subject:

This is far too complicated to not explore the potential with an attorney.

You are not a medical professional. Who's to say that the whiplash injury was severe enough to cause the pain you are experiencing as a result of your preexisting condition? The two could be entirely unrelated.

At least that's what the insurance company might tell you when it denies your claim. Then what will you do, hire an attorney?

Attorneys normally offer a free consultation to decide the merits of your case. If they feel your case is worth pursuing, they'll tell you what it's worth. You can decide to use their services or go it on your own.

Just remember, the insurance companies have more money than you do, and can easily outlast you when you're on your own. They often just write checks to make attorneys go away.

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