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Claim Worth: Specific Injuries

Objective vs. Subjective

Adjusters and their claim evaluation software distinguish between objective and subjective injuries.  Objective injuries are those that are observable or measurable.  This usually means a diagnostic image (x-ray, MRI, etc) or lab test will show the injury.  Objective injuries include broken bones and herniated discs.

Subjective injuries do not show up on any diagnostic image or lab result.  Instead, the injury is completely based on you telling the doctor what hurts.  Sprains and strains are the two most common.  If you only have subjective injuries, you need to focus on the affects of the injury instead of the listing the diagnosis and moving on.  For example, mention your inability to work and that you were trying to get back to work because you pride yourself on your work ethic.  Also bring up any planned activities or changes in lifestyle that would not have been missed but for an injury.

Overall, adjusters and their claims software will give more weight to objective injuries.  So you can expect to have bigger offers if you have objective injuries versus subjective ones.

Soft Tissue Claims

The majority of car accident personal injury claims involve soft tissue injuries.  These are called M.I.S.T. case, or Minor Impact Soft Tissue.  The most common MIST injuries are a sprained/strained neck or back, but can also involve your shoulders, chest, knees, and hips.  MIST injuries are usually caused by the kinetic energy that comes from the force of impact between two cars.  The majority of MIST claims will be subjective.  Objective evidence of MIST injuries includes:

  1. Stress fractures in x-rays
  2. Arthrograms
  3. MRI’s
  4. Increased space in joints
  5. EMG tests
  6. CT Scans
  7. Loss of spine curvature

These claims have the lowest value.  This is for a couple of reasons.  First, insurance companies think these injuries are not serious and will resolve on their own in 4 to 6 weeks, just like a sprained ankle.  There is medical literature out there that savvy defense attorneys use to present expert evidence that these types of injuries are inflammation that does in fact resolve by itself.  Insurance companies also know in this day and age that juries are skeptical of personal injury cases and their attorneys, especially when there are no visible injuries like broken bones or herniated discs.  The insurance companies have shared data on these types of cases and know through statistical analysis that juries on average do not award home run verdicts.  Also, they know from a business perspective that personal injury attorneys cannot afford the time and expenses on a MIST case to prove the injuries were real or substantial.  An attorney will look at what your case is worth and decide it would cost more in time and expert fees then your case is worth to prove the MIST case is worth 5 to 10 times your medical expenses.

No matter what you do, don’t label your injuries as whiplash.  Whiplash is not a medical term and carries very bad connotations.  Just think images of someone walking around with a foam collar on the neck.  Analyze your medical records and use the exact terms/diagnoses in your chart.  If you cannot find any such term, then use the phrase “severe strain of the cervical spine.”  The cervical spine is your neck; whereas, your thoracic spine is your upper and middle back while the lumbar spine is your lower back.

Do not be deflated.  The MIST case is exactly the type of case ClaimClinic was designed to help you with.  We will maximize your claim’s value without having to give an attorney 1/3rd.

Because the majority of claims that adjusters handle are soft tissue, they do not see your claim as unique but just a run-of-the-mill claim.  Adjusters will appreciate short-term pain and suffering, but not anything lasting over 4-6 weeks, even if you are still in pain after that time.  Do not overstate the time you were in pain or you risk losing credibility with the adjuster.

Back Injuries

Next to soft tissue injuries, the next most common injury in car wreck claims is back injuries.  Almost all car accident back injuries start out being diagnosed as a sprain/strain.  If your back injuries do not resolve in 4-6 weeks after physical therapy or chiropractic care, you will most likely get an MRI.  MRIs are much more helpful then x-rays both for your own treatment and your claim.  MRIs show soft tissue, which means they show the discs and nerves in your spine.  Herniated or bulging discs will not show on a X-Ray.  You will need an MRI to prove a herniated/bulging disc injury.  Once your doctor sees fit to order an MRI, you should request a copy of the MRI radiology report.  The radiologist (the doctor who reads your MRI and interprets its results) will dictate a report that he/she will then forward to your doctor.  Most doctors will review the MRI themselves and not just rely on the report, but you need that report so you can identify the findings.  The diagnosis and terms in your MRI report are critical to properly documenting your Demand.

Much of your back injury claim’s value will turn on whether and to what extent you can prove your back was not injured before the car accident.  If you refused to authorize the adjuster to obtain your medical records independently, then the adjuster will only have the records you send him or her.  But, if you injured your back in a prior or subsequent accident that was reported to an insurance company (think other car accident, work related injury, homeowner accident), the adjuster will know about it.  The adjusters run an ISO Claims Report on you when the claim is opened.  It will list all your claims and what your injury claims were.

Injuries to your spine and discs will usually result in some sort of permanent impairment, for which you need to get an AMA Permanent Impairment Rating.  The pain may subside, but that is because your body is stabilizing the injury, which will result in loss of range of motions and some pain and discomfort in the future.  If your back does not complete resolve, you either ask your treating doctor for an impairment rating or seek out a doctor who specializes in giving impairment ratings.

Multiple Disc Injuries

If you are so unfortunate that you herniated or injured multiple discs in your back, you should treat each disc as a separate injury and value it accordingly.  Then, in your Demand Letter, ask for more money than the disc’s cumulative value.  This is because multiple disc injuries when combined create a much worse situation.

Residual Pain

Doctors, physical therapists, and chiropractors will release you from treatment (stop treating you) when you reach what they call MMI – maximum medical improvement.  This is a fancy way of saying they have done everything they can for you and you have reached the maximum improvement under their care.

If you are still in pain after your provider releases you from treatment, you will need to figure out how to get your continuing problems documented.  If you are in pain and are just going to live with it, then you need to ask one of your doctor’s to assign you an impairment rating.  Of course, you can always ask your doctor for a referral to someone else who can hopefully provide you with more treatment.

There are also numerous medical studies showing cervical strain (neck) is a common cause of long term disability and that 40% of cervical strain/sprain patients have permanent symptoms and disabilities.  Adjuster’s in soft-tissue cases usually look only at the facts/data and as mentioned in the information box are hard pressed to look at this type of case as anything other than a standard MIST case.  Nevertheless, you can Google these types of phrases and quote some medical studies in your Demand Letter to support your damages claim for continued pain and suffering.

Hard Injuries

The opposite of a MIST claim is a hard injury.  We use the term “hard injury” to mean physical injuries that can be seen or measured.  This includes broken bones, torn ligaments, stitches, scarring, and herniated discs.  These are all things that appear on an MRI or X-ray or that require physical repairs to your body.  Hard injury almost always garner the highest offers from adjusters.

Head Injury Claims

Closed head injuries can range from mild concussions to severe injuries, including personality and cognitive changes.  Adjusters normally want to see head injury complaints in your ER records or that you lost consciousness in the accident before they will believe you have a head injury.  If you are experiencing head injury symptoms – headaches, hearing problems, visions problems, you owe it to yourself to finish out your treatment before trying to settle your case.  You must absolutely tell you doctor what you are feeling so your complaints appear in your medical chart.  The last thing you want to do is settle your claim thinking you only have headaches that will go away after a while only to later learn from a neurologist that you have closed head injuries.  Insurance companies will want to settle this type of case ASAP before the doctors get to the real, severe diagnosis.

Joint Injuries

These include knees, hips, ankles, shoulders, elbows and wrists.  Injuries include tearing of ligaments or cartilage, dislocations, or separations.  Joint injuries are worth more money because joints are fragile and not easily capable of being stabilized, thereby putting you in more pain.  Joint injuries are also susceptible to long term pain and suffering in the form of arthritis.  Talk to your doctor and understand all the long term consequences of the injuries to your joints.  TIP:  Understand and try to get your doctor to document the long term “risks” associated with your injuries so the adjuster can see that the doctor is behind your statements.  If long term complications/risks don’t appear in your chart, you will need to provide the adjuster with authoritative references to show the chances you will have future pain and suffering.  A little time spent on Google will get you this information.

If your joint injuries don’t heal 100%, you should request your doctor to give you a permanent impairment rating.  Your doctor will use formulas and tables in the American Medical Association Guidelines to assign you a percentage of impairment.  Impairment simply means that you are not 100%.  For example, if you broke your hip, your doctor will examine your range of motion in your hip and assign a percentage representing how off normal your hip movement is.  The doctor will then use the AMA formulas to take the hip impairment percentage and extend it to your whole person.

Scarring

Scarring will always increase the value of your claim.  Given the nature of our society, scars on women are worth more than men because everyone assumes women are more body conscious.

If you have scarring from the accident, your age, occupation, lifestyle, and future plans will all effect how much a scarring injury is worth in your claim.  It is imperative that you have good photographs of each scar.

The younger you are, the more you have to live with the scar.  If you are using ClaimClinic for your child’s personal injury claim, scarring on a small girl in a conspicuous area is worth the most compensation due to the child having to live with the scar for the rest of her life and all the possible self image/esteem issues that can occur with scarring.  The area of your body that is scarred also contributes to your claim’s value.  Scarring on the face demands the most compensation for obvious reasons.  Scarring on parts of your body that can be seen by the general public – arms, legs, shoulders, chest, etc. are second in terms of value.

If you have scarring in a conspicuous area, you should get a plastic surgeon to examine you and provide an estimate for scar revision surgery (i.e. surgery to remove or minimize the scar).  This is a future medical cost that you can include in your demand, thereby increasing the medical expenses the adjuster is using to evaluate your claim and to also provide you with the funds at the end of settlement to have the elective procedure.  You will need the plastic surgeon to write you a letter with the estimate.  The adjuster will not take your word on how much the surgery will cost.  Everything must be documented.  If it is not on paper, the adjuster will not consider it.

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