How Insurance Companies Calculate Car Accident Settlements
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UPDATED: Jun 19, 2018
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You were just in a car wreck. You call in the accident claim and a few days later, you receive a settlement letter from the insurance company. The amount of the settlement is far less than you expected, and certainly less than you need for a replacement vehicle. Your next thought is, “How can this be?” When it comes to calculating settlements, the insurance industry does not have a precise mathematical formula because each case is different. They do, however, use a variety of factors to determine the amount of compensation they are willing to pay on a certain automobile accident claim. These factors include the nature of the property damage in a car accident, whether the claim involves a personal injury, and the policy limits of the applicable insurance policies.
Settlement Factors for Damaged Vehicles
If your claim only involves damage to your car, your settlement compensation will generally be the cost of repairs or replacement of the damaged item. For example, if only your bumper is damaged, then your settlement compensation will be the reasonable cost to have the bumper repaired or replaced. The exception to this general rule is when the replacement or repair cost exceeds the value of the car. In this situation, the insurance company may decide that your vehicle is a “total loss” and pay you for the loss of the vehicle. Unfortunately, the replacement cost is usually based on depreciation and not the cost of a new vehicle. This means the amount you receive will probably not be enough to purchase a replacement vehicle.
Settlement Factors for Injuries
If you have been injured in an auto accident, the personal injury portion of your case is negotiated separately from your property damage. For example, if you had a bone fracture, you would receive additional settlement compensation as compared to an accident where an injury did not occur. The compensation you receive from the insurance company will be determined by your total medical bills, documented wage loss and the nature and extent of your injuries as documented in the medical reports. The medical reports will strongly influence the amount of compensation you receive for pain and suffering.
Settlement for Pain and Suffering
Pain and suffering is an amount in addition to your medical bills to compensate you for your past and future discomfort associated with your injury. You need to complete your medical treatment and be released by the doctor or be declared “permanent and stationary” by the doctor prior to submitting your personal injury claim to the insurance company. Permanent and stationary means you have reached a point in treatment where no further improvement is anticipated.
Alternatively, if your doctor anticipates future treatment, your settlement should include an estimate, discounted to present value, to compensate you for future medical treatment. Other factors will influence the amount of your settlement. For example, if you have a scar from the accident, permanent disfigurement can result in additional compensation. Generally, the more serious injury will result in a higher settlement compensation. If you have residual problems, such as pain after completing your medical treatment, that factor would also warrant additional compensation. Before you accept a settlement offer, consult with an attorney who specializes in personal injury law so that you do no waive your settlement options regarding future medical care.
Keep in mind that you only receive one settlement or award from the insurance company. Submitting and settling your claim before all treatment has been completed waives your right to any future compensation. After you have agreed to a settlement, you can’t go to the insurance company later and request more money.
Insurance Policies, Policy Limits and Settlements
Even though the nature of the damage or injury will influence the amount of your settlement, a major controlling factor is policy limits. The policy limit is a cap set by a contractual agreement between the insurance company and the insured. An insurance company will not pay more than this cap. For example, you are injured in an auto accident and the other party was at fault. You file a claim and discover that even though they had insurance coverage, it had a policy limit of $20,000.00. Even if you verify and confirm that your total damages are $30,000.00, the other person’s insurance company will not pay you more than $20,000.00. If you still want compensation for your additional $10,000.00, you will have to hire a private attorney to sue the other driver individually for the remaining $10,000.00. Or, if you have under-insured motorist coverage, you can file a claim for the balance on your policy.
If the other party had no insurance coverage, your options are similar. You can hire a person to sue the other driver individually. Or, if you personal policy includes uninsured motorist coverage, you could file an uninsured motorist claim with your insurance company. Uninsured and under-insured coverage are usually addendums, or added products, to your basic insurance package where your company agrees to cover your expenses if you are hit by a motorist who does not have coverage or has insufficient coverage to make you whole.
Even if your claim is not capped by a policy limit, an insurance company may offer to pay less than policy limits because they feel that your injury doesn’t warrant a higher amount of compensation. If you are dissatisfied with a settlement offer from the insurance company, you can file a lawsuit against the other driver for negligence. Your lawsuit must be filed prior to the expiration of the statute of limitations or you will lose your rights forever in the matter. The fact that you are still in the process of trying to settle your claim will not extend a statute of limitations. If you feel like a settlement offer is not fair and you are getting close to your deadline to file a lawsuit, talk to a personal injury attorney about filing the appropriate petitions to preserve all of your legal options.