John F. Younger, Jr.
Board Certified Attorney
Texas Board of Legal Specialization

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ext.1159

 

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Frequently Asked Questions

If my insurance wrongfully denied my claim, what do I do?
If your insurance company wrongfully denied your claim, you need to seek legal assistance as soon as you can. Preserving your rights often has time limits. Other requirements that you may not understand are also critical to preserving your rights.

How do insurance companies decide how much they'll pay to compensate someone for
an injury?

In general, an injured person will be reimbursed for:

  • Medical care
  • Lost income temporary, permanent pain and other physical discomfort
  • Loss of family, social and educational experiences.

A claims adjuster begins with the medical expenses. Then the intangibles - pain and other non-economic losses - are added in. Lost income is calculated. Several factors may raise the damages. For example, painful, serious or long-lasting injuries, more invasive or long-lasting medical treatment, clearer medical evidence of extent of injuries, more obvious evidence of the other person's fault can raise the value of your damages.

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Will my health insurance coverage or paid sick leave from work limit my compensation for an accident?
Whether you paid for medical care out of your own pocket or your health insurance covered it is none of a claims adjuster's business. The same goes for whether your lost time at work was covered by sick leave or vacation pay. In fact, it is improper for an adjuster even to ask about such payments. You paid for your health insurance and earned your sick leave or vacation pay; now the insurance for the person who caused the accident has to pay. Your own health insurance, however, may require that, out of your settlement, you reimburse it for some or all of the amounts it has paid to treat your injuries.

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If I was injured in an accident, how do I legally prove how it happened?
Negotiations with an insurance company take place in letters and on the phone with an insurance adjuster, not in a courtroom with lawyers. So you don't need legally perfect "proof" of anything. You just need someone to make a reasonable argument - in plain language - that the other person (or company) was careless, even if there are also arguments on the other side. Companies usually prefer to pay a reasonable claim settlement sooner, rather than risk having to later pay not only for your injuries, but also court costs and lawyer fees.

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Can I get compensation if an accident might have been partly my fault?
Even if you might have partly caused an accident yourself, you can still receive compensation from anyone else who was careless and partly caused the accident. This is more complicated than if you were not at fault. The amount of another person's responsibility is determined by comparing his or her carelessness with your own. For example, if you were 25% at fault and the other person was 75% at fault, the other person must pay - through the insurance company - 75% of the fair compensation for your injuries. This is called "comparative negligence." A few states supposedly bar you from any compensation if your own carelessness substantially contributed to the accident ("contributory negligence"). But in practice, the question of whether your carelessness actually contributed to the accident is a point to negotiate with the adjuster. There is no formula for assigning a percentage to your and the other person's carelessness. During claim negotiations it is best to allow your attorney to come up with a valuation. The adjuster will come up with another, and explain why you bear greater responsibility for the accident. The different percentages each arrives at help to determine how much a claim is worth.

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What if my physical limitations made the accident more likely or made my injuries worse?
What if you have a bad knee, which makes one leg a bit unsteady? Or if your eyesight, even with glasses, is not very strong? If you fall on a broken stair, are you still entitled to compensation even though someone with stronger legs or better eyesight might not have fallen? Absolutely. All people, regardless of physical ability, have a legal right to make their way through the world without unnecessary danger. Owners and occupants of property must permit no unnecessary danger to any person who might reasonably be expected to be on the property. The same goes for drivers and everyone else - they must not create unnecessary danger to anyone whose path they might cross.

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I have just been in an automobile accident, what is the first thing I should do?
If you are injured in an accident, it is important to seek treatment immediately. Sometimes serious injuries do not cause immediate pain. If you experience even minor pain after an accident, seek treatment immediately. Remember to obtain the name, address, license number, and insurance information from the other drivers involved.

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Should I tell my version of what happened to anyone or should I "remain silent?"
If the accident is serious, or if you are partially or totally at fault in the accident, you should contact a lawyer prior to speaking to anyone, if practical. Your lawyer can review the facts with you to ensure that your statement is clear and factually correct. If necessary, your lawyer can help you fill out any required accident reports and insurance claim forms. You will be asked at some point to provide your version of the accident, often by police if they are called to the scene. Most, if not all states, will require you to file an accident report with the department of motor vehicles. Your insurance company and the other driver's insurance company will also want your version of the accident.

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If I have been injured, who will pay my medical bills?
Most states require drivers to carry automobile insurance. Your automobile insurance may have medical payments clauses, which require them to pay certain costs within the limits of your policy. If you have a health insurance policy, you may get additional coverage. Most health care providers will have different billing procedures depending on whether your treatment is being covered by your auto or health insurer.

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Who will pay for the damage to my car?
If you have purchased collision insurance, your insurance company will pay to have your car fixed or will pay you the value of the vehicle in a total loss. If you are not at fault in the accident, your insurance company will seek to be reimbursed by the insurer of the driver at fault. If you do not have collision, and you are not at fault, the insurer of the driver at fault will pay for your property damage.

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Can I get money for my lost wages and pain and suffering?
Most insurers will pay lost wages upon proper proof of the loss. However, many states have imposed limits on the ability of injured persons to recover for pain and suffering.

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If I decide to sue, will I have to go to court?
Most cases settle out of court. In many cases, it is clear who was at fault in a collision. Upon proper proof of damages and medical documentation, insurance companies will often settle the claim without the need for filing a lawsuit or having a trial. However, in some cases, the insurance company may deny liability on a claim and a lawsuit will be necessary. In either event, it is best to have an attorney assist you on these matters.

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What happens in a lawsuit?
A lawsuit begins by filing a complaint. The person filing the complaint is called the plaintiff and person against who the complaint is filed is called the defendant. The defendant must file an answer addressing the allegations contained in the complaint and must raise any defenses the defendant may have. The defendant's insurance company will hire an attorney to represent the defendant and will pay damages, up to the policy limits, that the plaintiff recovers in the lawsuit.

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What happens next?
The defendant may submit written questions to you to be answered under oath and may ask you to provide documents. Your attorney will assist you in the preparation of these materials. You may also be called for a deposition, where the defendant's attorney will ask you a series of questions, under oath, before a stenographer and or videographer. Your attorney will help you prepare for the deposition and will attend the deposition with you. Your attorney will also object to any improper questions asked during the deposition. Your lawyer will also likely submit questions to the defendant, request documents from the defendant, and conduct the deposition of the defendant. Witnesses to the accident may also be called in for depositions, but this is not usually done in small cases.

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What happens at trial?
If the case goes to trial, the plaintiff goes first and presents his or her witnesses, documents and any other evidence which helps prove the plaintiff's case. The defendant then puts on his or her witnesses, documents and any other evidence in defense. The case is then presented to the judge or jury, who decides who wins and, if the plaintiff wins, the judge or jury decides how much money the plaintiff gets.

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If I receive other benefits, such as health insurance as a result of the accident, will I have to repay those benefits from my settlement?
Yes. Your health insurer can file a lien (a legal claim) on your case, in which event you will be required to pay these liens from your settlement. Your attorney can help to negotiate these liens.

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