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.

Topics covered

What is a soft tissue injury?
When to claim compensation for a soft tissue injury?
How are the injuries treated?
Why soft tissue injury claims are different from other injury claims?
How much to claim for settlement of soft tissue injury?
Points to remember when filing claims for soft tissue injuries

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:

Auto accident
Reckless or violent activity
Defective equipment
Defects in playing surfaces
Lack of proper supervision
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:

Rest
Physical therapy
Chiropractics
Oral pain relievers and muscle relaxants
Soft cervical collars (to immobilize neck after a whiplash injury)
Massage
Heat
Ice
Injection
Ultrasound.

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:

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.
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.
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:

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.
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.
Negotiate on your own - Try to settle the amount yourself initially. Negotiate with your insurer to arrive at a reasonable claim amount.
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.
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: Sun Jan 08, 2012 09:08 am Post Subject: anxiety, diagnosed with ptsd

I have an ongoing anxiety problem, this has really tweeked it. I just want to be able to see my therapist 2 times to work on a plan but I don't think I should have to pay for it. As far as the car (I live in AZ) I'm worried that it is toast and old and many miles may mean I'm out a working vehicle with very little to help me get another. I'm not sure how this works. I just want to stay in bed until the head achs stop and go to work in a week or so. Not sure how to work thatt either. I'm in a lot of pain from the bruising and just thing 2 weeks off to heal is reasonable. I am not sure what kind of a demand someone rear ending a car, totalling it, hurting me with bruises nad a slight concussion should ask for. I think there is at least 5,000 in car damages, ER and a doc visit, and two weeks off work... not sure what to ask, of course my thinking is fuzzy today.

Posted: Sun Jan 08, 2012 09:08 am Post Subject: anxiety, diagnosed with ptsd

Posted: Mon Apr 09, 2012 04:00 am Post Subject: car accident

19 months ago, we were in a car accident, we were stopped at a light and got rear ended. It was late at night on a friday. I opted not to take the ambulance ride, but knew that I was sore. Monday I started treatment with a chiropractor. The damage to our vehicle was 2400.00. I have had 88 chiropractic visits, 20 physical therapy visits 11 massage therapy visits, 2 visits to a MD, x rays, and an MRI and a TempurPedic bed. There is soft tissue damage. They also thought that I had a cracked vertebra. This is not for certain however, and would require yet another MRI. The accident was no fault of ours. There were 2 other people in the vehicle, in the front seat. They were not injured. My insurance company has paid the medical and reimbursed the massage. The bed hasn't been paid for, but was prescribed. I was a house cleaner making $25 an hour 3-4 days a week 6 hours a day. With these injuries, I am still unable to complete the duties that are required of the profession I had pre-accident. I have lost the ability to hunt for my family (which was 80% of the meat for our family for a year) I cannot vacuum, ski, take care rides, or plane trips without pain. I have to travel with a Tens Unit to have shock therapy. I cannot play with my kids or lift more than 20 lbs. I cannot stand for longer than 2 hours without my back spasming and my legs going numb. I cannot sit for extended periods without spasms in my back and numbness/pins needles in my arms. Because of these limitations, I am unable to work in the profession that I was in, and have a hard time completing the requirements of a new job. With all of these factors, I am curious what kind of settlement I should be looking for.

Posted: Mon Apr 09, 2012 12:45 pm Post Subject:

I am curious what kind of settlement I should be looking for.

First, see my sig.

You have a soft tissue injury and with the limited information you mention, somethings don't add up. Setting that aside, there is no way for anyone to say what this is worth as all the facts are not known. For starters, we don't know the amount of the meds or if your state allows for an offset on what your carrier paid. We also have not reviewed your medical notes to know what is going on. We don't know your age, etc.

($25/hour for house cleaning?)

Posted: Sat Apr 21, 2012 04:01 am Post Subject: Darn Good House Cleaner

Yes $25/hour for house cleaning. I am in an oil boom area and cleaners are in high demand. We are in North Dakota. Medical is over 12,000. My carrier has paid for everything because North Dakota is a no fault state. I am 32 now, so was 30 then. Fairly active, skiing, softball, playing with kids and yes cleaning house. What else do you need to know?

Posted: Sat Apr 21, 2012 04:03 am Post Subject: Darn Good House Cleaner

Posted: Wed Jun 20, 2012 12:25 am Post Subject: soft tissure injury

I was involved in an accident whereas someone backed into the rear quarter panel of my car while I was sitting still and my body was turned sideways. I had 1200.00 damage to my car and 2000.00 in chiropracter bills and one trip to urgent care in which I was prescribed pain meds and muscle relaxers. What is the appropriate amount I should settle for. I missed one day of work but was in agonizing pain for a few weeks whereas I couldn't sit still or stand in teh same position for more than minutes. Lower back, neck and mid back pain as well as headaches.

What should be the lowest amount to settle for and highest?

Posted: Wed Jun 20, 2012 05:42 pm Post Subject:

1200.00 damage to my car and 2000.00 in chiropracter bills and one trip to urgent care in which I was prescribed pain meds and muscle relaxers.

Your "chiropracter bills" are far too excessive in relation to the amount of damage done to your vehicle.

What should be the lowest amount to settle for and highest?

No one here can answer that question for you. But I'm sure you will find an attorney who will lead you to believe that your new home and future retirement are now secure as the result of your injuries if you allow him to sue the at fault party.

I wouldn't believe it.

Posted: Wed Jun 20, 2012 07:04 pm Post Subject:

That could be the ER bill _and_ chriro bills together.

Posted: Wed Jun 20, 2012 08:37 pm Post Subject:

A trip to urgent care -- not the ER -- is about a $150 event (and considerably less, if a person in only counting their HMO copay of $15-$30). I know, I was just there last week for a pulled muscle.

The bulk of the charges are the DC. And we know that they will keep "adjusting" until the insurance companies refuse to pay.

You, better than anyone, should know the kind of energy it takes to do $1200 damage to a rear quarter panel, and how little it really is -- a kid on a bicycle could do that much. I don't think there is as much reported "soft tissue" injury possible by comparison. But I wasn't there either.