insurance settlements

General Damages — 16 Building Blocks to Higher Settlement Offers

insurance settlementsDon’t let the adjuster simply double your client’s specials to determine pain and suffering. In How Insurance Companies Settle Cases, insurance expert Dave Frangiamore reveals these 16 building blocks, many overlooked by plaintiff’s attorneys, that carry weight with adjusters.

When discussing general damages with the adjuster, you don’t want the adjuster to think that you just plucked a figure from the clear blue sky. The adjuster needs to see the thought process you used to arrive at fair and real reasonable general damages.

Provide the adjuster with: (1) photos showing the severity of impact to your client’s vehicle, (2) the dollar amount of the medical bills, (3) the number of days, weeks or months that your client was off the job because of the accident, (4) the number of treatments from physical therapists or similar types of medical attention, (5) the number of pain pills consumed over the duration of the injury, and (6) any residual physical or mental impact that the accident had on the personal or professional life of your client.

Do not forget to factor into a settlement offer, in addition to future medicals and lost wages, (7) the future pain and suffering. (This is probably the number one item left out of most plaintiffs’ attorneys’ analysis).

Additionally, (8) your client’s age should be taken into consideration if your client will take two or three times as long as a younger individual to recover or may never recover. (9) When dealing with scarring, either facial or on the arms or legs, where the scarring will be highly visible, increase your factoring of general damages to allow for this lifetime disfigurement. Although plastic surgery is available, no plastic surgeon can completely erase a scar.

Do not overlook (10) psychological injuries that your client may have incurred. Loss of self-esteem is common with scarring or loss of limbs. Loss of self-esteem can be more valuable than the actual physical injuries. Additionally, (11) double-check with your client to see if your client has developed phobias as a result of the accident. For example, some people are afraid to ride in an automobile after being involved in a serious collision. Some individuals will have a constant fear of being “hit” again. This fear of riding in an automobile may increase the (12) stress level of an individual for the rest of his life.

Also (13) consider any nightmares that your client may experience for an extended duration or for the rest of his life, “reliving” the accident. If your client is unable, in the future, (14) to participate in activities he or she was able to enjoy before the accident, this loss should be factored into the general damages. (15) Keep in mind the loss of sexual function as a result of an accident or injury, which may be psychological or physical, and temporary or permanent.

Lastly, (16) look at your client’s loss of the ability to “maintain” his or her home and person. Simple examples are inability to mow lawn, clean house, do laundry or maintain an automobile. If your client is 30 with 43 more years life expectancy, and has to hire someone to perform these tasks at a cost of $50 a month, that computes to a “loss of maintenance” claim of $25,800! Think of all possibilities and all damages.

Don’t overreach for damages. More cases are delayed or denied because the plaintiff’s demands were beyond what the adjuster could comprehend within the realm of reasonable damages.

 

David Frangiamore is a principal of 2nd Insight, a consulting firm in Alameda, California, that provides expert witness services and testimony in a wide variety of insurance-related cases. He is a former unit claims manager for nationwide/Wausau Insurance, where he was responsible for the supervision, litigation, and settlement of most of the major West Coast environmental claims and litigation. He also served as manager of the California construct defect unit.