Personal injury claim from accident

Reading the other post about the personal injury lawyer fee has me confused.

I'm new to this insurance claim business. Recently went off a small country road and broke my leg. Still playing phone tag with the insurance to get case file started. So far they said it's a single vehicle 100% my fault. Ok.

Had surgery on leg already. I know I will need physio. Have a few other aches that I'm starting to notice since the pain from the leg is going down. Not mobile yet to go see my doctor about the other pains.

Where happens next? Just follow my doctors orders and get treatment, then submit bills to insurance? Will they try to short change me?

What is hedo2002 referring to as the settlement amount include?

Where does the personal injury lawyers fit into the equation?

From the other thread:

hedo2002 said:

.... I have never spoken to my adjuster on my second claim, I leave it to the lawyer to do it all, BUT I follow up with emails, and ask the lawyer to explain if I don't understand anything).
.....
i am also aware that I have the $36,000 deductible to deal with so we are suing for an amount which will take these "expenses" into account. Basically I told the lawyers what I NEED to get as a settlement, in MY pocket. ....
.

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A few things...

Get to your doctor as soon as you can to make sure that aches and pains are documented in a timely fashion.

Usually what happens is the insurance company will come out to see you and this should happen within a week or two of your injury. Once you have the contact info for your adjuster, you go to see a physiotherapist and they will prescribe a treatment plan to rehab your injuries. The insurance company will then approve or disapprove of that treatment plan.

The deductible you are referring to is if you were hit by someone else and you wanted to sue their insurance company for your losses (past, present and future). If you are in a single vehicle incident where you went off the road then I am under the impression that the deductible does not apply to your situation.

ditto on what Shane said above...

Get to your doctor quick and get everything documented and recommended course of treatment. Taxi it there, whatever. Else you could be in for an unnecessary fight later with the insurance company. It'll be a you said your in pain because of the accident, the insurance will be saying you didn't go to the doctor for 2 months and its not part of the accident, etc. etc.

A lawyer would the best person to ask these question

I think you are referring to the thread i made, I got my settlement a few days ago but has been a nightmare with my lawyer when he tried to trick me into accepting a lower amount towards the end. But nevertheless i am now quite confident on how this works. Of course the best way to inquire is go through a lawyer, just be reminded every lawyer is there to make money. For your case, going through the lawyer means you want to purse a settlement from your own insurance company, in particular the 'accident benefit' portion of your claim. Your lawyer will help you find physio that are not affiliated with insurance company. The longer you receive treatments and keep getting insurance approved for these will help your case significantly. The settlement amount will be based on the future medical cost, income replacement, and additional clinical treatments cost that insurance didn't approve for. It would not exceed your coverage, normally is 50k unless you bought extra coverage. It requires at least a year, or whenever your medical condition becomes more stable.

My best estimate if a lawyer decides to take your case, expect to get at least 20k from final settlement, minus the fees to lawyer between 25-35%. If he thinks the settlement will be too small he wouldn't take the case. Everything is negotiable. I would try to find smaller law firm than those advertised heavily.

If you are looking for legal advice or help with starting a claim I can put you in touch with a great lawyer. I am a paralegal that works for a downtown Toronto law firm and we dealt successfully with a few motorcycle accidents.

Yes Yanny, I was referring to your post.

So the lawyers come into play if the insurance company and I don't agree on injury and treatment compensation?

I have a broken leg plus some other aches that are showing up since I'm cutting back the pain killers.

If I go to the doctor, get treatment and insurance pays, then end of story.

If insurance doesn't want to pay, then get lawyer? ...and also have to bump claim up to cover lawyers fees

Why can't insurance play nice and save everybody time and money in the long run?

empty said:

Why can't insurance play nice and save everybody time and money in the long run?

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If an insurance company CEO doesn't care about his grandmother's leg going gangrene over lack of a five dollar treatment why should he care about you?

empty said:

Yes Yanny, I was referring to your post.

So the lawyers come into play if the insurance company and I don't agree on injury and treatment compensation?

I have a broken leg plus some other aches that are showing up since I'm cutting back the pain killers.

If I go to the doctor, get treatment and insurance pays, then end of story.

If insurance doesn't want to pay, then get lawyer? ...and also have to bump claim up to cover lawyers fees

Why can't insurance play nice and save everybody time and money in the long run?

Click to expand...

I think you may not have the idea clearly. Insurance will not pay you a compensation, unless you find a lawyer. You will only get medical and treatment bills reimbursed, this is what you originally paid for in your policy. The job of a lawyer is to prolong your rehabilitation progress, so that your insurance is fed up with keep paying out, in exchange for not approving new treatments, they provide a settlement (compensation).

For your case, because your condition is not a minor injury. Bone fractures as your doc advised takes 2-3 months to heal, and physio/chiro following takes at least 6 months. It will be a long rehab process. If you don't have sources, treatments will automatically be provided by an insurance's partner which will not be on your side. If you have sources or a lawyer(he will have treatment partner). Your insurance will pay everything out in the first few months, and then becomes reluctant as you try to get more treatments approved, they may reduce the frequency of treatments, or decline all together. Insurance has their own examiners who will conduct assessments & examinations, so they know when to stop approving. With a lawyer, he would also put you through examinations of his own, which will be used to fight against your insurance examiners.

To a point, by getting a lawyer you are at an advantage, because you would be receiving more treatments than what you qualify from insurance's point of view. This is benefial for the injury that you sustained. You would also get compensation that you didn't pay for in your policy. Insurance however will not cover legal fee.

If you had a less severe injury, the benefit is not apparent and it would be wasting time to find a lawyer, he/she may not even take your case. Whether you choose to find one or not, don't forget to apply for income replacement with the insurer, if you worked before. Or other types of income replacement for unemployed, students, etc. You will find one that you qualify to get you some money while healing, depending on the type you may or may not receive funds immediately.

Having been involved in two collisions in two years both of which resulted in treatable injuries, I can only provide TWO pieces of advice.

1. doesn't matter what you HAVE to do, get to your doctor MONDAY, even if it means taxi, paying for a wheelchair accessible van etc etc etc.

2. Find your OWN rehab people, (physio, OT, {occupational therapy}, massage/laser, chiropractor, etc). Do NOT use providers recommended by your insurer, (your insurer recommends them for a reason)

Lastly, stop playing phone tag, with your adjuster, call your insurer ask to speak to the adjuster by 3 pm Monday. IF no call is returned by 3pm call again and ask to speak to a supervisor. Advise it has been XX number of days without contact you WANT another adjuster assigned who will actually WORK on your file. You do NOT have to take the adjuster they assign, YOU are the client if your not satisfied with the level of service you can demand another adjuster. Advise them you will be contacting legal representation, as well as their own ombudsperson if they don't step up immediately.

I am using the same legal firm for both of my claims, and am happy to provide you contact info if you would like, (they are in North York, 401/Yonge area), via pm if you would like to get an initial assessment of your file. They will advise if they believe it is worth hiring a firm, (getting a larger settlement, and more treatment), or if your injuries and the circumstances, (single vehicle), won't make it advisable to hire a firm, etc.

Just be aware that with or without a lawyer, your likely to be off work for 3 - 6 months, (my last collision was in May and I just got the ok to return on a VERY limited basis), with a broken collar bone and ankle fracture. ANY settlement will be at LEAST 2 - 5 years down the road. So your in for a LONG protracted go of it.

Your right your leg was broken but you likely suffered MANY other injuries, bruised muscles, strained ligaments etc etc etc. Even if YOU think it is nothing get it noted and documented by EVERY practitioner you see.

Thanks Hedo2002 and Yanny. What you're describing now is the part I didn't know.
Made it to the doctor and hospital for follow up this week. Just found out I have a broken rib as well. Surgeon said I need a bone stimulator for the leg and started the paper work on that. He warned that its expensive and some insurance won't want to pay for bone stimulator.
Let's see how this goes.