A frequent question we're often asked is: "How does an insurance company evaluate my injury claim?"
One basic element is what I call "calculator” damages, for hard numbers that can be added like medical bills, lost wages, etc. These are tallied and then are included with what I refer to loosely as "general” damages, such as physical pain and disability, inability to enjoy activities of life and hobbies, and more important things like that (in my opinion, those are way more important than “calculator” damages…). From those basic factors, an insurance company will make an offer, recognizing that there is no magic formula for evaluating a personal injury case. And that’s because each case is unique (the subject of another post, so stay tuned…)
Until recently, insurance companies were not allowed to factor into the "calculator damages" the amount of medical bills actually paid by the injured person's insurance company. Example: a drunk driver broadsides you and you incur $10,000 in bills. Your health or auto insurance company pays $7,500 of those bills as "payment in full."
Until a few years ago, insurance companies had to accept the higher or gross amount of your bills instead of the discounted amount. However, The Ohio Supreme Court ruled that insurance companies and juries were permitted to take into consideration the discounted amounts paid.
So here’s what insurance companies are doing with this judicial gift. They are DEMANDING that you, the injured person, produce all the information on what any insurance company paid for your medical bills. Keep in mind that all the Ohio Supreme Court said was that they are allowed to consider these discounted amounts.
Well, the discounted amounts are now gospel and they have totally ignored the gross amount of the bills as an evaluation tool. Almost all of them will now claim that they “can’t evaluate the claim” even if you’ve provided a tally of all of your bills…unless they include the discounted amounts paid for those bills.
Baloney. It’s a ruse to ramrod a lesser offer down the throats of injured accident victims, and it also conveniently allows insurance companies to sit on your claim and delay an offer.
For the twenty five years I’ve been a personal injury attorney in Ohio, insurance companies and I managed to evaluate and settle hundreds of personal injury claims without all this attention to discounted medical bills.
Now, these multibillion dollar companies are just helpless and can’t begin to evaluate the claim unless you or we produce the discounts.
Discounts and delays. It’s good to be an insurance company.