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: Fri Mar 29, 2013 06:39 pm Post Subject:

Each case is based on its own merits. Some folks suggest 2x or 3x the medical expenses, but this is not always a reasonable amount. You pretty much have to decide what you think your damages are worth.

Your wife's anxiety in traffic is understandable and not uncommon, but it should dissipate with time. How much time? Could be a few months to a few years. But it will fade, unless she's succumbed to PTSD. To be compensated for that will require a fairly extensive psych evaluation by your side and the at-fault party's as well.

Posted: Fri May 23, 2014 12:58 am Post Subject: lumbar sprain/strain

I work with. Disabled. Adults. While. Assisting. A client. In a wheelchair. Up on to a van. That was did not have. Wheelchair. Access. The client. Fell on me and i had to lift. The client. Up off me. After. That i had to lift. Her wheelchair. Up on to the van.. .and. normally. The company. I work. For. Suppose. To supply. A wheel chair. Access. Van. But they. Rented. One. Cause. The bus.They. Have. Was in the shop. . Can i sue them for. That. When. It was there Fault? ?? :twisted:

Posted: Fri May 23, 2014 04:56 am Post Subject:

April . . .

Your injuries are covered under Workers' Compensation laws which normally prevent you from suing your employer. Where folks end up in litigation over WC injuries is the determination of the degree of disability.

You are free to contact any WC attorney of your choosing and obtain a free consultation about your situation.

Posted: Fri Jun 20, 2014 01:15 pm Post Subject: BI settlements for soft tissue injuries

I think everyone needs to look at the whole aspect of the claims. Each person is diffrent and each claim is handled diffrently.

Vehicle now days are designed to absorbe the impact so it doesn't get transferred to the occupants of the vehicle so when you have vey little damage based upon a bio-mechanical standpoint you should have no injury or a very minor injury that will resolve on it's own.

With that being said there is nothing wrong with going to the emergency room or your primary doctor to be evaluated and if they feel a referral for additional treatment is needed they will give you one.

Also the provider you choose has a great deal to do with how the insurance companies evaluate your claim. Insurance companies now days track the relationships between attorneys and providers. They alos look at the reputation of the providers as well. If you go to an attorney who sends you to a chiropractor without the recommendation of a medical doctor it will be viewed diffrently. On the same note if you go to a doctor who has a history of over treating or being excessive in their treatment then that is looked at as well.


So to summarize if you are involved in and accident by all means go to be evaluation in the emergency room or your primary doctor. If they feel that additional care is needed they will send you. Most insurance companies don't change their evaluation based upon attorney involvement. The only diffrence is some people accept the first offer the insurance compaies puts out when all they really need to do is say they are looking for more and negotiate with the insurance company. Attorneys like to say they will get you a third more in your settlement but they take 33% of your settlement and then deduct any fees involved which in most cases will cause you to receive less than you would have received on your own. There is some additional work you have to do the present the claim on your own such as submittting your medical records and bills for review.

Posted: Thu Jul 17, 2014 08:18 pm Post Subject: car accident

My daughter was in a wreck, not her fault totaled her car, gave her $12000.00 do get another car. They want to pay med bills which total $4400.00, $660.00 lost wages and
$3500 general damages. Do you think the $3500 in general damages is fair?

Posted: Fri Jul 18, 2014 06:05 am Post Subject:

Do you think the $3500 in general damages is fair?

It's not what I think, it's what your daughter thinks. If she believes that amount is fair "compensation" for her injuries, fine. If not, then she needs to ask for more -- ideally with a specific number in mind. If she asks for more and they refuse, then she can do one of two things: (1) accept the offer or (2) hire legal counsel to sue the person who caused her injuries, knowing that the attorney will take 30%-40% of any settlement or jury award.

Posted: Wed Aug 06, 2014 03:42 pm Post Subject: 3 year old toe.

My son who is 3 opened a door to a establishment. In doing so the weather stripping at the bottom of the door was not attached properly, and the metal sliced the tip of his toe. I know from a previous incident with myself, they really don't stitch that area. We bought bandages, ointments, etc. And took care of it on our own. We sent pictures of when it happened and pictures throughout the healing process. That company wants to know what kind of monetary compensation I would like. I have no idea what to say. Any suggestions would be great.

Posted: Wed Aug 06, 2014 05:40 pm Post Subject:

Is your child going to be permanently disabled? If not, in my opinion, you should only ask for your out-of-pocket expenses to be reimbursed. But most people will want thousands or millions of dollars. So what's it worth to you? Will the money go into your pocket or into a savings account for your child?

Instead, I would ask, "Why would you negligently allow your 3-year-old child to do this? Don't you feel a little responsibility for his injury?"

Posted: Sat Sep 27, 2014 09:43 pm Post Subject: Soft tissue injury

I have $15,000.00 in medical thus far n another $15,000.00 yet to recieve,what would my case be worth after legal fees?

Posted: Sun Sep 28, 2014 12:02 am Post Subject:

No one here knows anything about your matter and no one can answer that question for you. Attorneys take 30%-40% off the top of the settlement/judgment you get. You can do the math.

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