Attorney for Catastrophic Injury Claims: Showing You How Insurance Companies Process Claims for Severe and Catastrophic Injuries
Learn How to Increase the Value of Your Personal Injury or Workers Comp Catastrophic Injury Claim Settlement So That You Have Enough Money for Medical Care and a Better Quality of Life
Multiple insurance industry studies report that catastrophic injuries, defined as those claims with more than $250,000.00 in total costs, account for less than 1 percent of all claims but more than 20 percent of total claims costs. Because of the nature of these injuries and how much is on the line financially – not only for the defendants but also for you and your family – catastrophic injury claims present unique challenges for trial lawyers and insurance adjusters.
The purpose of this article is to help you understand how insurance adjusters manage catastrophic injury claims and what you can do to maximize the amount of money you recover through settlement or trial. I hope this information helps you obtain a fair catastrophic injury settlement that provides financial security for you and your family.
If you have any questions, or are looking for a top-rated car accident attorney or workers compensation lawyer with experience resolving catastrophic injury claims in Richmond, Roanoke, Fairfax, Newport News, Virginia Beach, and throughout Virginia, call me: 804-251-1620 or 757-810-5614. Your consultation is free.
What is a Catastrophic Injury?
“A minor injury is one that happens to somebody else” is an old saying.
And it’s true. There is no such thing as a minor injury when you are the one hurt.
But for insurance adjusters and plaintiff attorneys, catastrophic injury claims are considered separate types of claims.
There is no established definition for the phrase “catastrophic injury” within the legal field or insurance industry. But for me a catastrophic injury is one that will:
- Result in more than $250,000.00 in economic damages (wage loss, medical treatment, permanent disability as determined by a permanent impairment rating).
- Prevent you from returning to both your pre-injury job or any other type of gainful employment that allows you to earn close to the amount you were earning before the injury. This is determined either by expert medical opinion testimony, a functional capacity evaluation (FCE), or both.
- Affect not only you, but also your entire family. For example, catastrophic injuries often require home health care and the support of family members and friends.
In short, a catastrophic injury claim is one where the defendant has significant financial exposure that exhausts available insurance policy limits and threatens bankruptcy. And that qualifies you for Social Security Disability benefits.
The insurance company in your case may have a different definition of catastrophic injury that is based on criteria from the reinsurance company. Reinsurance is insurance purchased by automobile liability insurers and workers comp insurance carriers to protect them from excessive loss.
What are the Types of Catastrophic Injuries?
Common types of catastrophic injuries include:
- Serious injuries requiring amputation of a body part.
- Burn injuries requiring skin grafting and resulting in permanent scarring and disfigurement.
- Injuries resulting in Chronic Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy and requiring life-long pain management.
- Injuries caused by defective products, such as automobiles and guns.
- Fatal injuries that result in wrongful death claims.
- Fractures and broken bones requiring extensive orthopedic treatment.
- Herniated disc injuries and other back injuries resulting in the need for a cervical spine or lumbar spine fusion surgery.
- Spinal cord injuries resulting in monoplegia, hemiplegia, paraplegia, or quadriplegia.
- Traumatic Brain Injuries (TBIs) or Head Injuries resulting in post-concussion syndrome, cognitive impairment, difficulty communicating with or interacting with others, or a permanent coma or vegetative state.
What to Expect from the Insurance Company During a Catastrophic Injury Claim
Catastrophic injury claims are unlike other negligence, tort, and workers compensation claims. They require a different type of preparation and handling.
When you suffer catastrophic injuries, either because of a work accident, someone else’s negligence, or medical malpractice, you can expect the following from the insurance company:
- Crisis Response Team or Emergency Action Plan for Catastrophic Injuries. Many large employers, especially transportation and warehouse employers, and the insurance companies that insure them, are proactive. They establish emergency action plans for serious injuries before they occur. After your injury, the Crisis Response Team may try to manage your medical care, speak with coworkers, and even issue a public announcement about the steps it is taking to try to help you and to make sure such an injury never happens again. I have found press releases more common in catastrophic injury claims based on defective products or machinery.
- An experienced claims adjuster who is skilled at investigating claims to find ways to dispute liability or coverage, and to minimize damages. Catastrophic injury claims are not assigned to inexperienced adjusters.
- That an insurance company representative will visit you at the hospital to try to establish rapport and credibility, and maybe even ask for a recorded statement before you are released to a skilled nursing facility or home. Do not give a recorded statement or sign a Medical Records Release form.
- Multiple employees assigned to your case. In addition to the claims adjuster, the insurance company may assign defense counsel, a private investigator, an accident reconstruction engineer, especially for cases involving truck drivers, a nurse case manager, a vocational rehabilitation counselor, and other medical professionals.
- A quick settlement offer to try to close your case if there is damaging evidence that it does not want to turn over in discovery or tell during depositions. Do not accept an offer made before you know the extent of your injuries.
Important Things to Consider When Negotiating a Catastrophic Injury Settlement
I have negotiated numerous auto accident insurance settlements and workers compensation settlements for persons with catastrophic injuries. And while my advice on calculating the value of your personal injury case is a good starting point, there are other items to consider before you settle your catastrophic injury claim.
For example:
- Those of you with catastrophic injuries may require years of medical treatment, even after you have reached maximum medical improvement (MMI). Given how quickly health care costs are increasing from year to year, you will want to factor in rising medical costs when settling your catastrophic injury claim. I recommend hiring an expert to develop a Life Care Plan that estimates future medical costs.
- Inflation, defined as an increase in prices and a decrease in the purchasing value of money, can make a settlement that seems fair now inadequate in the future. For example, in workers comp catastrophic injury claims it is important to consider yearly cost of living adjustments that will increase the amount workers comp pays. An economist can help you determine the appropriate settlement value using inflation estimates for the period of your life expectancy.
- When liability is accepted in a personal injury case or compensability is accepted in a workers comp claim, either through an Award Agreement form or after a workers compensation hearing, the insurer will hire expert witnesses to give opinions that minimize your damages. You will need to hire expert witnesses to prove your damages, including pain and suffering, and to counter the insurance company’s defense. This is costly and something to consider when deciding whether to settle or go to trial.
- Your catastrophic injury may not affect your life expectancy. Thanks to medical advances, people with serious and catastrophic injuries are living longer. You will need enough money to last you the rest of your life.
- You may need to take Medicare’s interest into account when settling your catastrophic injury claim. Generally Medicare will not pay for treatment for a job-related injury or occupational disease. Nor will it pay for medical care when liability insurance is involved. In these situations, you should get Medicare’s approval before settling the case. For more information, read my article on Workers Compensation Medicare Set Aside Arrangements (WCMSA).
- You may have to pay back or negotiate a workers compensation lien if you have both a third party case and workers comp claim arising out of the same accident. This may apply to you if you suffered catastrophic injuries in a work-related motor vehicle accident that was someone else’s fault.
- Depending on insurance coverage limits and the defendants’ assets, your medical bills may be more than the amount you collect through your catastrophic injury case. If so, you will need to negotiate health care and medical provider liens to maximize the amount of money you get.
These are just some of the items to consider when evaluating a catastrophic injury claim. I recommend talking with a lawyer before making a settlement demand or accepting a settlement offer from the insurance company.
How a Catastrophic Injury Lawyer Can Help You With Your Auto Accident, Product Liability, Medical Malpractice, or Workers Comp Case
As a catastrophic injury lawyer, I have one job: to get you and your family as much money as possible.
Here are some of the ways I help you get a top-dollar catastrophic injury settlement in your workers comp or personal injury case:
1. Spend time with you to see how you live and how the catastrophic injuries have changed your life. More than any other type of case, catastrophic injury claims are about telling a story to the insurance adjuster, judge, or jury. I will spend time with you so that I understand your physical and mental struggles. The closer our relationship, the more effectively I can communicate your struggles to the insurance company or jury and motivate them to award appropriate compensation for damages.
2. Interview family members and friends to determine which of them can help you tell your story. We spend a lot of time with friends, family members, and co-workers. And these are the people who are best able to explain what you were like before the injury. I will ask people close to you what you were like before the injury, what activities you enjoyed, how you spent your time, how well you performed at work, and what your plans were. Family photographs, diaries and journals, and home video can help me understand what you were like before the catastrophic injury.
Comparing life before the accident with life after the accident is a powerful tool in catastrophic injury cases. These things are not easy to talk about, but can help make sure you are awarded damages that are appropriate based on the severity of what you’ve been through.
3. Interview other witnesses to establish negligence, causation, and damages. I will interview all witnesses, including: police, fire fighters, emergency medical technicians (EMTs). I attorney will also obtain 911 call transcripts, video footage, and photographic evidence related to your case.
Witness observations are powerful tools to educate the jury on what you went through. I understand that it can be difficult to hear about the accident, but it is important that the jury understand what it was like to be in your shoes when you were injured. If the insurance company thinks you can present an effective case, it is more likely to offer a reasonable catastrophic injury settlement.
4. Hire the right expert witnesses for negligence and causation. No matter how serious your injury, you will not win at trial unless you prove that another’s negligence caused your injury. I will investigate and reconstruct the accident if you were hurt on the job or in a motorcycle, car, or truck accident to persuade the jury not only that the defendant was negligent but also that the defendant’s negligence calls for an award of damages equal to the severity of your injury.
A thorough catastrophic injury accident investigation may involve hiring investigators, liability experts, standard of care experts, and engineering experts.
By investigating and recreating the events leading up to the accident, I can show the terror and panic you experienced. It is important to walk jurors through a second by second account of the accident and injury so that they are motivated to award appropriate damages
5. Fight for your right to the highest quality medical care available. Though money is the only way to resolve your catastrophic injury claim, I know that it is a means to help make you whole physically, mentally, and emotionally. And top-notch medical care gives you the best chance of recovering maximum functionality and regaining a decent quality of life.
6. Meet with your medical providers. I will speak and meet with your health care providers, including nurses, physicians, home health aides, surgeons, and therapists, throughout the course of treatment. These providers can help me understand what type of day-to-day care you need, as well as how difficult your recovery has been. Areas of testimony include the activities of daily living you need help with, such as bathing, dressing, grooming, wound care, and transportation. The better I understand these factors the better job I can do educating the insurance company and jury and getting you more money for your catastrophic injuries.
7. Pursue your case aggressively. There is an old saying: “Justice delayed is justice denied.” I will manage your case and act with a sense of urgency so that you get either a fair settlement offer or your day in court as soon as possible.
8. Manage medical bills. The last thing you should have to worry about when trying to recover from your catastrophic injuries is who and when to pay for medical care received. I will help you manage this process throughout the course of your claim.
9. Answer all of your questions. The personal injury and workers comp claims processes are complicated and difficult to understand. But I am here to answer you and your family’s questions from start to finish.
10. Find all available defendants. My goal is to put as much money in your pocket as possible, no matter the source. My team and I will search for all possible defendants and approach them about offering fair compensation for your injuries.
An Experienced Catastrophic Injury Lawyer to Help You Get Fair Value for Your Case
From the moment you contact us, my team will work with you to develop a customized plan for gathering facts and resolving your catastrophic injury case as efficiently as possible for the most money possible.
Often this means settlement. But sometimes it means trial.
No matter what it takes, I will help you resolve your catastrophic injury claim in Virginia. Call 804-251-1620 or 757-810-5614 to get started.
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