The answer to that question is based on several factors, among which are the extent of the injury and associated treatment comparative fault, whether loss of wages plays a role, the existence of related insurance, and the degree of pain and suffering recognized. For the sake of this article, we will assume that the circumstances leading to the injury include the existence of insurance. In other words, the person responsible for your injury has insurance related to the cause of your injury.

Is there insurance?
People purchase insurance for a variety of exposures. For instance, if you drive a car, you buy insurance protecting others for your possible negligence which could lead to your damaging their property or causing bodily injury. Owners of property purchase insurance which provides protection in the event a visitor is injured due to the owner’s negligence. The same could be said for those who fly airplanes, pilot boats, run entertainment parks, etc. If you have an exposure wherein you might damage the property of others, or cause injury to others, chances are you have some form of insurance – or perhaps, should.

Insurance is designed to pay for your injuries IF the insured person is liable for the injury.

How do insurance and liability relate?
The existence of insurance does not automatically mean you will be paid for your injury. Insurance is designed to pay for your injuries IF the insured person is liable for the injury. When would they be liable? In most cases, their liability is based upon an interpretation of their acting in a negligent manner. Negligence generally means that the person failed to do what a “reasonable person” would do in order to provide for the safety and well-being of others under the insured’s influence. A driver running a red light is negligent by failing to observe traffic laws meant to protect other drivers, bicyclists, and pedestrians – therefore that driver is liable for damage caused to others. A homeowner may be negligent for allowing their dog to roam the neighborhood should the dog bite a neighbor. The owner of a store may be negligent for an unaddressed trip hazard in the parking lot which results in a patron falling and being injured. To conclude, in order for negligence to stick, the person being accused of the damage/injury, a) had a duty owed to protect others, b) failed to fulfill that duty, c) was the cause of the damage/injury, and d) the harm caused is provable.

…future medical costs become somewhat more elusive.

Then, what are considered Damages?
In the case of injury, there are medical expenses, loss of wages, mental anguish, loss of companionship, pain and suffering, long-term disability, disfigurement, and more. As you can expect, it’s relatively simple to document actual medical expenses and loss of wages. However, future medical costs become somewhat more elusive. Then, putting a dollar amount on items such as companionship, pain and suffering, and disfigurement – these items are subjective and evaluated based on the probable juror verdicts of each case.

There is no “one size fits all” formula…

So, is coming up with a damage amount simply left up to each individual insurance adjuster?
There is no “one size fits all” formula for this question. In most cases, an adjuster will go through some variation of the following considerations:
•    Does the insurance policy provide coverage for the damages? If not, the company is technically off the hook. If yes…
•    Is their insured at fault or liable? If so, (the insurance company) should provide coverage.
•    Are there policy limits which dictate how much the company is required to pay?
•    Will there be future and/or recurring medical costs? If so, what are the best estimates?
•    Based on the severity of the injuries, how much pain and suffering shall the insurance company  attribute to the victim?
•    What would a jury do?

Let’s take a simple example. Party A, who was texting on their cell phone, rear-ends Party B at a stoplight.  Party A’s insurance company does not contest liability. Party B has obvious injuries sustained as a direct result of the accident. Party B’s medical treatments, over the course of a year, amount to $20,000 and all issues are resolved – there is no need for future medical treatment. Party B has documented wage loss of $10,000. At this point, the quantified damages amount to $30,000.

Next, there is the more subjective elements: pain and suffering. A number of factors which may be examined by a potential jury enter the realm of pain and suffering. Beyond having to deal with actual pain of an injury, considerations include scarring, activity limitations, shortened earning capacity or life span, depression, impact on family structure, and more. Convincing the insurance adjuster of the undeniable impact on the claimant’s life in such a way that encourages the insurer to settle before allowing the claim to move toward trial, is somewhat of an “art-form.”

What about partial, or comparative negligence?
Oftentimes, injuries are the result of both parties sharing responsibility for the event. For example, a driver hits a pedestrian who crosses the street halfway between one controlled intersection and the next. In this case, both parties have a degree of excuse, and both have a degree of responsibility. The circumstances of these “comparative fault” injuries are considered, negotiated, and the settlement reflects the degree of responsibility attributed to each party.

Again, subjectivity enters the equation. The adjuster for Company ABC may contend that the injured party was partially to blame. Their position is, for argument sake, that this is a 70/30 at-fault situation – arguing their insured is 70% to blame, while the other party is 30% to blame. Company ABC, therefore, reduces their settlement offer by 30%, deriving a settlement offer of $42,000.

What’s the chance of getting rich from the accident?
The idea that victims get rich from accidents is largely a myth. The real costs for a serious injury add up quickly. Loss of income can prove devastating to an individual’s or family’s financial security. An accident related injury can lead to the need for SERIOUS money. Fortunately, these costs can be quantified and are, therefore, not highly contestable. Future medical costs become much more difficult – doctors are trying to look into a “crystal ball” in anticipation of the patient’s recovery, future needs, and predicted inflation of medical costs. Then, there is the pain and suffering – which is very difficult to measure. The injury victim may experience anything ranging from inconvenience and discomfort, to never regaining nor enjoying the life they once knew. How do you put an accurate number on that cost?

The idea that victims get rich from accidents is largely a myth.

Navigating through these waters is the specialty of accident injury attorneys. A competent accident injury attorney understands the system better than a layperson ever could. The attorney takes over the role of your advocate – and interacts with the insurance companies involved during your recovery period and for the crucial negotiation phase. The records are organized and presented along with the existing medical bills, estimates of future costs, and loss of wages. Where the competent attorney truly excels is seen in their negotiating the pain and suffering aspect as well as future costs of the claim. The seasoned insurance claims adjuster considers a settlement clinically and seeks the least expensive resolution on behalf of the insurance company. Your attorney’s job involves forcing the insurance company to see your claim realistically, or face the prospects of settling in court before a jury. (Fortunately, most claims never go to court as terms are met before that option becomes necessary.)

If you hire a contingency-fee attorney, there is generally no out-of-pocket cost.

What does this cost you?
If you hire a contingency-fee attorney, there is generally no out-of-pocket cost. The attorney takes the case and his or her office works for “free” on your behalf banking on the expectation of earning a settlement which adequately compensates the client for real costs, future costs if applicable, pain and suffering, while including enough to pay for the work of the attorney and his or her staff. In other words, the contingency fee attorney contracts with the client to take a pre-determined percentage when the settlement is disbursed from the insurance company. If a case goes to litigation, generally, an injured party is asked to pay a portion of the litigation expense.

How much will you get for your injury claim?
As you can see, there are many variables involved. Chances are great that you will receive more by having the expertise and advocacy of a competent accident injury attorney representing you.

DISCLAIMER: What follows is an article written by Isaac Jackson, a Personal Injury Attorney,located in Eugene, Oregon licensed to practice law in the State of Oregon. The following article is intended for information purposes only and is NOT intended to create an attorney client relationship or give you specific advice regarding your claim.  The information below regarding personal injury claims may not apply to your case, even if it appears applicable.  You are encouraged to take your personal injury case to a qualified attorney in your area immediately.  Your injury claim may be barred by a statute of limitations, which in some cases could be as little as a month.  If you do not file a notice of claim or a lawsuit within that time period you may lose your right of recovery for your personal injury claim.