Which Medical Expenses To Use While Preparing Claim

[Stewert]

Suffered medical injuries in an auto accident few months ago - currently preparing a demand letter for the liable party's insurance company.  Reading books/guides etc. on this topic, I  understand the pain and suffering number is usually calculated as a multiple of the actual medical expenses.  My medical expenses were paid by my PPO provider, the billings from the PPO provider show

1) the gross charge by a service provider(such as a physical therapist)

2) the reduced amount they agreed to charge at the insurance carrier's contracted rate and

3) amount paid by me.  

Say for argument's sake, the first number or 1) is 100, 2) is 70 and 3) is 20.  Meaning the service provider charged reduced rate of 70, of which health insurance company paid 50 and I personally paid 20.

My question for the expert is - should the pain and suffering number be based on 1) 100 or 2) 70 or 3) 20?

Thanks much.

[kendrix]

I personally don't like computing pain and impairment damages as a multiple of the medical expenses.  Some very painful injuries have relatively low medical expenses.  Example: broken collarbone. If no surgery required, a broken collarbone takes 3 months to mend, then 3 to 6 months for the injured person to regain full muscle use and range of motion.  For weeks, they can't lift their arm or carry anything.  The medical cost?  Could be as low as $200, for one office visit and an x-ray.  Does that mean a broken collarbone should only be worth $800 in settlement?  Certainly not!

Neck or back pain?  Painful, and sometimes lingering.  Medical studies have shown that approximately 18% of such patients still have pain and symptoms after one year! But medical expenses are often quite low.

I think we ought to compensate for the injury, not pretend to compensate by using "multiples" of the medical bills.  All that does is reward the person who went to the doctor many, many times, but punishes the person who toughed it out and kept medical expenses low.

However, despite my above rant against "multiples", the insurance industry takes shortcuts like this.  My suggestion: if you are going to use "multiples" to make a settlement demand, start with the highest base number you can.

One caution---Your PPO may have a clause in its contract with you that requires you to repay the benefits it paid on your behalf, if you collect damages from the negligent party.  So, if such a clause exists and the PPO chooses to enforce it, you will need to pay the PPO some of your settlement.  Keep that in mind when you are deciding what to do about settlement.

If you find that you need assistance, contact an experienced personal injury attorney in your city.

Best wishes,

Albert Hollan

Houston, TX

www.carwrecks.com