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Nature of the Injury Claim

In this chapter, you will discover the proper approach to medical care, the path you should follow throughout the injury claim process, and the steps that insurance carriers take to evaluate and pay these claims. Whether you hire an attorney or not, you should respond to all injuries and medical needs and secure thorough and proper medical treatment. The steps you take along the way will protect your health and your legal rights.

If you are injured because of the negligence (careless acts) of another person or entity (e.g., a business or a government official), the law allows you to collect payment from all responsible parties. In most cases, insurance companies represent the responsible parties and handle evaluation and payment of your claims.

Insurance companies are profit-motivated, and they challenge all injury claims. Injury adjusters seek to pay less by arguing that their insured was not at fault, that the injuries claimed were not caused by the accident, that the injuries are less severe than the victim alleges, that some/all medical care was not necessary, that medical care costs were inflated and unreasonable, that the injury will not be lasting or permanent, that income loss was not necessary, and that the value of the injury claim is less than the victim seeks.

Legally speaking, an accident victim truly receives nothing more than a cause of action, or a right to sue. Thus, proper determination of the value of an injury claim requires careful consideration of the evidence that a jury would see in court and the likely verdict range of your case at trial.

The individual types of losses and damages that can be collected will be addressed in careful detail throughout this chapter. If you present all claims supported by proper evidence, and if you can motivate all parties and insurance carriers to come forward with an offer of payment that approximates what you would win in court, you can settle the injury claim privately, without court involvement. Settlement of an injury claim is a contractual agreement. The right to a jury trial is forfeited in exchange for a lump-sum payment that all parties agree to.

In this chapter, we review everything that should be paid through settlement, recommended timing of settlement, and the legal affect and finality of settlement. If settlement cannot be reached, trial of your case is the only way to truly compel payment. The litigation and trial process is covered in detail in chapter 7.