how does attorney calculate damages when client surgery is covered by insurance

by Dasia D'Amore 6 min read

First, an insurance adjuster adds up the victim’s total medical expenses. Then, to account for damages that are hard to put an exact dollar figure on (like pain and suffering or missed activities), they multiply the victim’s total medical expenses by a number that’s usually between 1.5 and 5.

Full Answer

How do insurance adjusters calculate special damages?

To get a reasonable starting number for negotiating general damages, many insurance companies and attorneys multiply the amount of medical special damages by a factor of 1.5 to 5, depending on the severity of the injuries. In extreme cases, a factor of more than 5 may be used.

How are damages determined in a personal injury case?

First, an insurance adjuster adds up the victim’s total medical expenses. Then, to account for damages that are hard to put an exact dollar figure on (like pain and suffering or missed activities), they multiply the victim’s total medical expenses …

How do insurance companies negotiate medical special damages?

Mar 29, 2017 · The damages to which you are entitled are typically calculated based on the severity of your injuries, the underlying circumstances of the incident in question, and whether the case settles or proceeds to a trial. The following factors are typically considered: Medical treatment expenses.

Are medical bills recoverable in a personal injury lawsuit?

When valuing a client's pain and suffering, a lawyer will typically sue for three to five times the amount of the out-of-pocket damages (medical bills and loss of work). Therefore, if you were out of pocket $500, you might wish to ask for $1,500, the overage being for "pain and suffering."

How are damages determined?

The damages to which you are entitled are typically calculated based on the severity of your injuries, the underlying circumstances of the incident in question, and whether the case settles or proceeds to a trial.

How is settlement amount calculated?

Settlement amounts are typically calculated by considering various economic damages such as medical expenses, lost wages, and out of pocket expenses from the injury. However non-economic factors should also play a significant role. Non-economic factors might include pain and suffering and loss of quality of life.

How do you calculate compensatory damages?

Add up the total replacement cost for your items. Add the other costs and fees that you have incurred in prosecuting the lawsuit, including your attorney fees, postage and filing fees. You can also include other losses for which you are entitled to compensation, such as loss of work or loss of lifestyle.

How do you quantify pain and suffering?

You add up all actual damages (also called special damages) and multiply that number by a number between 1.5 to 5. The number by which you multiply is called the "multiplier," which indicates the degree of seriousness of your pain and suffering and any other general damages you suffered.Nov 30, 2018

Does a settlement figure include interest?

What is a settlement figure? An early settlement figure is the amount still owed, plus interest and charges if you want to pay off your car finance early. Our settlement figure calculator does not include any additional penalty charges that may be incurred.

How much should I ask for in a settlement agreement?

The rough 'rule of thumb' that we generally use to determine the value of a settlement agreement (in respect of compensation for termination of employment) is two to three months' gross salary.

What are the most frequently awarded legal damages?

Compensatory damages: This is the most common breach of contract remedy. When compensatory damages are awarded, a court orders the person that breached the contract to pay the other person enough money to get what they were promised in the contract elsewhere.Jan 22, 2018

What are the two types of compensatory damages in insurance?

There are two types of compensatory damages—general and actual. Actual damages are intended to provide funds to only replace what was lost. General compensatory damages awarded are more complex, as these compensatory damages do not represent a monetary expenditure.

How is damage determined in a lawsuit?

Damages are the sum of money that a plaintiff is awarded following a lawsuit. Basically, the damages are the amount of compensation that the plaintiff will receive from the defendant. The fact finder (judge or jury) will determine the damages in the lawsuit.Aug 30, 2017

How is insurance compensation calculated?

To determine the claimant's compensation for pain and suffering and other non-economic damages, the insurance company will multiply the sum of all medical bills by a certain number that depends on the severity of the injury: Minor injuries: their medical expenses are usually multiplied by 1.5 to 3.

How is emotional distress calculated?

The Per Diem Method With the per diem method, a daily compensation rate is applied to your emotional distress. This per diem rate is determined based on the severity of your emotional distress. The number of days (which could amount to years or decades) is determined based on your medical records and expert testimony.Oct 28, 2021

Should you accept the first offer of compensation?

Should I accept the first compensation offer? Unless you have taken independent legal advice on the whole value of your claim, you should not accept a first offer from an insurance company.

What is medical special damages?

At the beginning of negotiations on a claim, an insurance adjuster will add up the total medical expenses related to the injury. These expenses are referred to as "the medical special damages" or simply "specials.". As a way to begin figuring out how much to compensate the injured person for pain and suffering, permanent disability, ...

Can you put a dollar figure on pain and suffering?

While it is usually fairly simple to add up money spent and money lost, there is no precise way to put a dollar figure on pain and suffering , and on missed experiences and lost opportunities. That's where the damages formula comes in.

Can an attorney text you?

Attorneys have the option, but are not required, to send text messages to you. You will receive up to 2 messages per week from Martindale-Nolo. Frequency from attorney may vary. Message and data rates may apply. Your number will be held in accordance with our Privacy Policy.

Is the internet secure?

The Internet is not necessarily secure and emails sent through this site could be intercepted or read by third parties. You may have heard that insurance adjusters use a secret mathematical formula to figure out how much compensation should be paid in a personal injury settlement.

What Types of Damages Exist in Personal Injury Law?

To make an informed decision about an insurance company’s settlement offer, you need to know the types of damages that the law establishes for injury victims. Usually, the liable party in a personal injury case (and, by extension, that party’s insurance company) is required to pay the victim for:

Damages Formulas and Other Factors That Insurers Consider

Insurance adjusters use a mathematical tool called a “damages formula” to begin the process of determining how much they should pay a victim for an injury. (It might sound harsh to evaluate someone’s injuries and pain based on a formula, but that’s the reality of the insurance business.)

How Much Will You Need for Complete Care After a Catastrophic Injury?

So, if the insurance company’s formula leads to an offer that’s too low, then what is the best way for figuring out damages in a catastrophic injury case?

Perry Charnoff: Advocates for Catastrophic Injury Victims in Virginia, Maryland, and Washington, D.C

If you or someone you love has suffered a catastrophic injury as the result of another person’s negligence, the attorneys at Perry Charnoff PLLC are here to help.

What happens when you file a personal injury claim?

When you’ve been injured and are filing a personal injury claim, the defendant’s insurance company will evaluate how much they are willing to pay to cover your damages during the settlement process. In order to do that, the insurance company has a formula they use to calculate the amount you should be owed.

Can an insurance adjuster give you a settlement?

Also, remember that the figure they arrive at may look different, depending on their evaluation of the seriousness of your injury. If you cannot reach a settlement, you may end up choosing to file a personal injury lawsuit.

How to determine damages?

The damages to which you are entitled are typically calculated based on the severity of your injuries, the underlying circumstances of the incident in question, and whether the case settles or proceeds to a trial. The following factors are typically considered: 1 Medical treatment expenses 2 Estimated costs of future medical treatment or therapy 3 Past lost wages or income 4 Future lost wages or income 5 Costs to repair or replace damaged property 6 Your out-of-pocket expenses, such as insurance deductibles or copayments 7 Rental car expenses 8 Funeral expenses, in wrongful death cases 9 Emotional distress 10 Pain and suffering 11 Punitive damages, if the underlying act was particularly egregious or intentional

What is general damages?

General damages, on the other hand, include non-monetary losses, such as “pain and suffering,” your decreased ability to perform certain functions, or the loss of a loved one. Punitive damages, sometimes called exemplary damages, are designed to punish a defendant or deter similar conduct in the future. The damages to which you are entitled are ...

What is compensatory damages?

Compensatory damages are designed to compensate the plaintiff for actual losses sustained, and are further divided into “special damages” and “general damages.”. Special damages are those fixed amounts relating to your actual losses, such as medical expenses, lost income or costs to repair your property.

What are the factors that determine damages?

The following factors are typically considered: Medical treatment expenses. Estimated costs of future medical treatment or therapy.

What is the purpose of damages?

In the American legal system, damages are intended to compensate the plaintiff sufficiently to make him or her “whole,” i.e. restore the plaintiff to the same position he or she was in prior to the accident or injury.

What happens if an insurance company denies a claim?

Usually, if an insurance company denies a claim or denies coverage altogether, it has a sound reason for doing so. If the plaintiff didn't have a strong case at all and his or her settlement demands were unreasonable, an insurance company's refusal to settle is not going to equal "bad faith.".

How does liability insurance work?

How Insurance Policy Limits Work. When any kind of liability insurance policy is purchased, there is always a policy limit in place. This refers to the maximum dollar amount the insurance company is responsible for in terms of losses arising from an incident that triggers coverage.

What happens if you exceed the at fault party's insurance limits?

In many cases, if your damages exceed the at-fault party's insurance policy limits, your only recourse will be to collect directly from the defendant. This can be hard to do if the defendant does not have cash or assets to pay you.

Can a single defendant have multiple insurance policies?

In certain instances, even if there is a single defendant, there may be multiple insurance policies in play . Some defendants, especially corporate entities and large businesses, may have an umbrella policy that essentially "goes over" all of the other insurance coverage they have.

Can more than one party be held responsible for an accident?

Sometimes, more than one party can be held legally and financially responsible for an accident. In many such cases, the different defendants may be said to be "jointly and severally" liable for the whole amount of damages. This would mean that if there were two defendants and each had a policy limit of $50,000, both of those defendant's policies could likely be used to satisfy a $100,000 judgment.

What are the types of damages?

There are a few types of damages for which you could potentially recover: 1 Economic (special) damages – costs of medical treatment, estimated future medical treatment, lost earnings, future lost earnings, property damage, out-of-pocket expenses 2 Non-economic (general) damages – pain and suffering, emotional distress, inconvenience, loss of consortium (companionship of husband, wife or partner), loss of enjoyment of life 3 Punitive damages – punishment

How to get the most out of a settlement?

The best way to get the most out of a settlement is to be proactive. Take charge of your own case and know where your money is going – don't just leave it to your attorney to figure out.

Why The Need For A Damages Formula?

How The Damages Formula Works

  • At the beginning of negotiations on a claim, an insurance adjuster will add up the total medical expenses related to the injury. These expenses are referred to as “the medical special damages” or simply “specials.” As a way to begin figuring out how much to compensate the injured person for pain and suffering, permanent disability, and emotional da...
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Insurance Adjusters Don't Reveal Their Formula

  • When negotiating a personal injury settlement, the adjuster won't usually tell you what formula they used to value your claim, or even admit they are using any formula at all. They are following a basic rule of negotiations: Do not let the other side know how or what you are thinking. Since the insurance adjusters won’t let you know what formula they are using, it’s probably a good idea no…
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The Formula and The Deciding Factors

  • There are two important points to remember about a damages formula. One is that the figure arrived at by multiplying special damages is only the starting point for reaching a settlement amount. After this starting point is reached, other facts about the accident and your injuries come into play. The second point is that because the starting formula could be anywhere between on…
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What The Damages Formula Does

  • There are several types of damages the defendant’s liability insurance provider will be responsible for if they are found liable for your injury. These include medical expenses, any lost income, pain and suffering, loss of experience, and permanent disability. Of course, some of these damages are easier to assign a dollar amount to than others. Medical bills have a quantifiable amount, bu…
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How The Damages Formula Works

  • The damages formula is necessary for the insurance adjuster to come up with a number amount from which the negotiation process will start. They will start calculating by adding up all of the hard costs, like the medical expenses you’ve undertaken due to your injury – the “medical special damages,” or “specials.” They will then decide how much to co...
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Other Factors to Consider

  • As the insurance adjuster will keep the formula they use a secret, you also don’t want to give too much information away – what you are thinking or the number you have arrived at. This will help you in the negotiation process. Also, remember that the figure they arrive at may look different, depending on their evaluation of the seriousness of your injury. If you cannot reach a settlement…
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