Negotiating an insurance settlement

J

JohnnyM

2,500+ Posts
So the gf was in an accident back in February and we're now getting down to settlement time. It was the other guy's fault, but he carried the Arizona minimum 15. Her USAA policy includes UIM coverage, so they basically told her they would figure out how much her claim is worth, subtract 15, and give her the difference. Her dad told her to reject the first offer, no matter what. He's also the same guy who wants her to get an oil change just about every Tuesday, so I don't know what to think.

Anyway I just want to know what to tell her about trying to negotiate a higher figure from USAA, or if she should even waste her breath. Just for information sake she had a dislocated elbow from the accident that racked up about 15k in medical bills and was out of work for about 3 months (she was a waitress at the time). Any information about range of settlement offers..what would be good, what would be low, etc. would be appreciated.
 
This is basic information and is not to be construed as legal advice. I highly recommend you consult an attorney of your own choosing before acting on any of this information.

First of all, unless the collission occurred in Arizona (I assume it happened in Texas), the guy's insurance will have to apply the Texas minimum of $20K, not $15K. See 21.42 of the Texas Insurance Code. Section 21.42 provides in relevant part that "any contract of insurance payable to any citizen or inhabitant of this State by any insurance company ... shall be held to be a contract made and entered into under and by virtue of the laws of this State". Texas Ins. Code Ann. Art. 21.42. Article 21.42 has been previously upheld as constitutional. Austin Bldg. Co. v. National Union Fire Ins. Co., 432 S.W.2d 697 (Tex. 1968).

Secondly, her personal auto ins. doesn't get an automatic "offset" from the limits of the policy purely by virtue of her having collected from the 3rd Party claim. If her collective damages exceed the limits of both policies, she is entitled to the full limits of her UIM in addition to the 3rd Party tortfeasor's policy limits.

Her ins. will get an offset for any benefits they may have paid her under PIP or MedPay - assuming, again that her total bodily injury damages are not in excess of the policy limits. But that is separate and apart from her 3rd Party claim.

Yes. I would reject the first offer - they would certainly reject yours, no matter what it was. Even your own carrier is not on your side in this matter as far as this goes. Push for the maximum she's entitled to. That is the very service she's been paying them premiums for the last umpteen years for.

Good luck.
hookem.gif
 
thanks for the help guys. first off the accident was in AZ, not TX. also, we've been reluctant to get an attorney up to this point...and we'll see what kind of ball USAA is willing to play. it might be a necessity at some point.
 
As a lawyer I'll probably get some grief from other lawyers here from what I'm about to say. For relatively minor accidents such as your girlfriends, I really don't think you end up net ahead by getting a lawyer by the time they take theor contingency. In most cases you end up about the same or slightly worse. The one advantage you do get by getting a lawyer involved is that you don't have to deal with the negotiations, etc. For some though that's well worth the price.
 
that was the big concern HH - coming out worse off after paying a lawyer. and since the gf has done all the work up to now, all a lawyer would do is call and scare them a bit. i guess i can just get a lawyer friend of mine who doesn't do this kind of work to call and yell if they lowball her.
 
Here's the deal USAA is a good company and they will come at you initialy with a fair but probably low offer.

You don't need an attorney yet, but you might.

What you need to determine is the value of her lost wages, her pain and suffering, and more importantly what value you might place against further medical problems at a later date the might relate to the injury.

Have anumber in YOUR mind that you think is what you would love, and what you would think is acceptable.

Her medical bills are something that if you have the rider USAA will pay, and they will be completely unrelated to any settlement. IF you have that rider on the policy.

Play nice at first saying you only want what if fair. You can wonder out loud about maybe this is something I need a lawyer for.

ALSO TAPE ALL YOUR CONVERSATATIONS! I don;t know aobut Arizona but it is certainly legal in Texas. I also beleive that they probably give some sort of disclaimer that the call may be taped (it is for settlements) so you probably have the implicit authorization to tape without specifically informing them.

Just my two cents...
 
Get with your insurance agent and have them find out the limits in AZ. In Texas, you can claim up to 4-times your actual expenses due to the accident.

Always try to work it out yourself. If it isn't close to the 4X limit, then get a lawyer.

Also, never act like you are in a hurry. They will want to settle quickly, if it looks like you will incure continual expenses. Possible future "theropy" is hell on an insurance company . . . expecially if you have a theropy/chiropractor who will charge the insurance company for you.

Remember . . . your settlement beyon actual expenses are recognized for "possible" future expenses.
 
TxSt-UIM policies do take an offset for the third party limits in the State of Texas. An offset can also be taken for any PIP/MPC benefits paid under your own policy.
The underlying liability limits come into play, that is why it is called an Underinsured Motorist claim. You DO NOT get your full UIM limits when filing this type of claim.

For Example, you have $15K in bills and the liability portion has paid their limits of $15K. If your own insurance company paid your PIP/MPC limits of say $2500, the UIM carrier would take an offset of $17500 off of what they think your claim would settle for. In other words, say they think it would settle for $25 to $30K. You first offer would be $7500.00
hookem.gif
 
I drudged this old post up because I'm dealing with it again.

After a few months of the insurance company saying they needed further medical evaluation we are finally getting to the negotiation phase. Their first offer was about 2x her medical expenses.

Since I first posted I have now taken and passed the bar and become licensed, so I am at least handling the telephone calls at this point. Any more helpful tips about what I should say or what I should push for would be appreciated. The gf is chomping at the bit to get her hands on the money so she can clear up debts but I've been telling her that time is on our side and the more patient we are the higher the settlement will become. Tell me if I'm lying to her, although I won't tell her if I am. Why piss her off more?
biggrin.gif
 
2x bills isn't too bad if they offered that.
I am an adjuster so take what I saw for what it is worth.
What county would a jury be set in? Conservative or liberal?
You may check recent jury verdicts and use them as a negotiating point.
How long was the treatment? What type? Was it BS stuff like a lot of diagnostics or legit treatment?

Just hollar and I'll be happy to provide any pointers...even though I work for the dark side.....
smokin.gif
 
As far as referring to diagnostics as "non-legitimate," I've got a real problem with that.

How the f*** is a medical provider supposed to be able to properly and accurately diagnose a medical condition without having performed the necessary diagnostic tests????

That being said, these days, getting 2X medicals on a low-impact, soft-tissue injury isn't doing that particularly bad.
 
what is considered low-impact soft-tissue?

she had a dislocated and fractured elbow that required 2.5 months of PT(and really only stopped because we moved to Austin), is not ever going to be back to normal, and has some nerve damage/problems that they are recommending surgery for. is that low-impact soft-tissue? since i'm not a doctor, i have no idea.
 
TxSt-Adjusters generally will not pay for duplicate diagnostic testing. For Example, if you went to the ER and had a Lumbar and Thoracic MRI and X-rays, then one week later went to a Chiro and got the same, which do you think is more credible?
Chiro's don't have a good rep in the metroplex because of the mills like K Clinic and Accident & Injury.
 
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