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VIDEO TRANSCRIPT: Hello, everyone. This is Robert Mansour, and I want to spend a few minutes today talking about proving lost earnings in relation to a personal injury accident. Let's say you get into a car accident and you can't work as a result of the accident. Here's how it works. If you're only going to allege $200 or $300 in lost earnings, the insurance adjuster for the responsible party is probably not going to give you a hard time, but the more money you ask for, the more information they ask for. If you start to ask for $5,000 in lost earnings, $10,000 in lost earnings, you're going to have to provide a few things.
Number 1, you're going to have to provide evidence that you were consistently earning something and then there was a big drop after the accident. How do you prove that? Number 1, you have to have consistent earnings. If you're the kind of person who has roller coaster earnings, it's very difficult to prove lost earnings. It's an extreme uphill battle when it comes to a small business or a sole business and you have to prove steady earnings for a period of time. Contrast that to somebody who gets paid the same every 2 weeks. That person might be able to show a very big drop. The other thing you need is you need to show that a doctor told you to stay off of work. In most cases, you're going to need to prove that a physician told you, "Listen, you need to stay off work," and that's with a doctor's note. If you want to stay off work, you better ask for that doctor's note. Sometimes the doctors don't think to give it to you, you have to actually ask for it. If you need to renew it, you have to renew it, because there's usually an expiration date. You can't just get the note and say, "Aha, I'm going to sit and watch TV all day." That's not going to work. The other thing is the more you ask for, the more documentation they're going to need. They might start to want to see your books. They might want to see all your bookkeeping, your tax returns. They might want to see all of that information for several years back. If you're not too excited about people looking through your tax records, people looking through your books, you may not want to bring a lost earnings claim. It might be more headache than it's worth. Also, I have seen situations where the request for lost earnings proves to be a "sideshow" that distracts from the main issue, which is the person was injured and got hurt. All of a sudden, it detracts from that portion of the case, which is more important in many cases. If you're going to bring a lost earnings claim, think long and hard about whether you really want to go through the hassle. This has been Robert Mansour on a brief video here about lost earnings. Thank you very much for visiting, and I hope I can be of assistance. Feel free to call my office if I can be of any help in your personal injury case. Thank you very much. VIDEO TRANSCRIPT:
Hello everyone. This is Robert Mansour. I'm a personal injury lawyer in the Los Angeles area. In this brief video I want to discuss the difference between a claim and a lawsuit. Many times clients come to my office and they think that we are going to bring a lawsuit against somebody. In most cases we're not bringing the lawsuit against anybody yet. What we are doing is bringing a claim against the responsible party. In most cases what we are actually doing is presenting the claim to the insurance company for the responsible party. So that responsible party may know that you brought a claim but for the most part that's all they're really going to know. Everything is going to be handled by the insurance company for the responsible party and we deal with that insurance company and hopefully we're able to resolve the claim. Now if we cannot resolve the claim then what we do is the client and the lawyer have to sit down and talk about filing a lawsuit against the responsible party. Let's say some guy named Bob causes you an injury and Bob has XYZ insurance company. We're going to bring a claim against Bob but we're going to present it to XYZ insurance company. They will pay for your injuries and your damages but only up to whatever their policy is for Bob. So if Bob has $15,000 of insurance that's all they're going to pay, the insurance company. The rest is really up to Bob and whether or not you want to pursue Bob is a whole other different story. So that's what a claim is. But if you cannot resolve the claim then you have to sit down and talk about filing a lawsuit against Bob. That involves filing paperwork with the court, it's called a complaint, serving that complaint upon Bob, and then Bob is going to call his insurance company and say, "Hey, it's Bob, I just got served with a lawsuit," and the insurance company will then assign a lawyer to defend Bob in the lawsuit that you have brought against Bob. So the claim is something that happens pre-litigation, before a lawsuit is filed. That claim 95% of the time those things resolve before a lawsuit is necessary. But every so often you reach an impasse in a case that cannot be overcome. Then the plaintiff has to file a lawsuit with the court that is served upon the defendant, the responsible party, and that person's insurance company usually provides that person with an attorney to defend them in this lawsuit. I hope that helps you understand the difference between a lawsuit and a claim. A lawsuit also can be very financially and emotionally taxing, not that a claim isn't, but a claim is generally not as stressful to go through. I hope that helps to illustrate the difference between a claim and a lawsuit. If you have any other questions please feel free to contact my office. Thank you very much. You might think your personal injury medical bills are $50,000 or more. However, you might be surprised when the insurance company offers you $23,000 for your case.
You see, when it comes to presenting your damages in a personal injury case, it's not what you are billed that matters. It's what your health care provider accepted as payment in full. Therefore, even if a doctor bills you $1500 but accepts $250 from your health insurance company, all you get to present in your case is the $250 he or she accepted as payment in full. Even if your doctor doesn't accept your insurance, you don't get to present whatever number you want and assume the insurance company is just going to accept what you send them. So if you send the $1500 bill to the adjuster, they might reject it. Remember, the insurance adjuster's job is to "adjust" your bill, so they will argue your doctor's bill is not "reasonable." In fact, if your doctor bills you $1500 but routinely accepts $250 for the same care provided, you might have a potential problem on your hands. The insurance company may argue his reasonable fee is actually $250 since he routinely accepts that amount for similar treatment. Several important California court decisions have come down the pike in recent years. Each case continues to reinforce the basic fundamental issue that all plaintiffs must now accept - your bills are not what you think they are. You have to find out what your health care providers accepted as payment in full and that is what the adjuster will consider. So if your hospital bill was $4000 but Medicare paid $900, then you're stuck asking for the $900. In many cases, you may find your "big" personal injury case isn't as "big" as you once thought. To complicate matters, your health insurance providers (including Medicare, Medi-Cal, etc) may insist on their right to reimbursement. As such, more and more plaintiffs are finding that presenting a personal injury claim is much more difficult than they thought it would be. Medical bills are known as "economic" damages. More insurance companies are slashing these economic damages since medical providers are accepting a fraction of their bills as payment in full in most cases. Therefore, it is becoming increasingly important to focus on your "general damages," often known as "pain and suffering" damages. These damages are not about bills - they are about HOW an accident affected your life. You must document how the accident affects your daily life activities, school activities, work etc. "General damages" are becoming more and more important as economic bills are being slashed and reduced. Don't lose sight of your general damages. Make sure your attorney and doctors are well aware of HOW the accident has affected your life. Make sure these issues are documented in your medical records. As I always warn my clients - If something isn't in your medical records, it's like it never happened! When I first meet with a client, it is important to gather all the important information. While many factors are important, here is a discussion of some of the most important issues.
First, I need to know when the accident happened. If it happened a long time ago, my concern is what has been going on since then. Have you just been sitting at home? Have you been seeking medical care? I need the client to fill me in from the date of the accident to the time they visit with me. Generally, I'm concerned when a client calls me weeks or months after the accident. To be honest, I like to be brought aboard soon after the accident so I can best guide and advise the client. However, every case is different and I would encourage someone to seek legal counsel anyway. Also, I need to know when the accident happened so I can be aware of any statute of limitations issues. The statute of limitations is the time within which a lawsuit must be filed or your claim will probably be barred. I also need to know where the accident happened. This will help me determine which court will probably host the trial for the case. Most cases don't go to trial, but it's good to know which courthouse might be involved. Certain jurisdictions are traditionally liberal while others are traditionally conservative. It is good to know whether or not your potential jury pool will be liberal or conservative. I also need to know how the accident occurred. I need to know who was at fault and how it happened. It's helpful to have a police report which points the blame squarely on the responsible party. If you are found at fault, or even if liability is disputed among the parties, then we have to ask ourselves whether it is worth the time, energy, and money to fight the claim. It probably doesn't make sense to spend $10,000 or $15,000 trying to prove a $5000 claim. Next, I need to know what happened to your body in the car crash. This is important to determine the "mechanism of injury." All insurance adjusters are concerned about mechanism of injury. In other words, if you claim injury to your knee, it begs the question: How was your knee injured? The answer can't just be: "Because I was in an accident." Did you twist your knee? Was it hit from the side? Did your knee hit the dashboard? If you're claiming injury, you need to explain how the injury occurred. The mechanics of the accident and how your body reacted to the accident are important. The mechanism of injury is very important to the insurance adjuster. In fact, if they don't believe your injury, they will often argue there was no "mechanism for injury." Then I need to know how much property damage there was to your car. This has become increasingly important as insurance companies fight injury claims. Think about it - if you are claiming significant injury but there's only a little scratch or dent to your car, and adjuster and the jury will probably have a hard time believing you were injured. However if the entire rear of your vehicle was crushed, that is something much more compelling and convincing. I can tell you unequivocally that this issue of property damage influences adjusters and juries perhaps more than any other issue. I hate to say it, but no matter how hard the impact felt to you, if the adjuster or a jury can't easily any appreciable damage to the rear of your vehicle, then you have an uphill battle. Next, I would like to find out what happened immediately after the accident. Were you taken away by ambulance? If so, it is generally more believable that you were injured. After all, why would anyone willingly take an ambulance ride to the hospital unless they were indeed injured? Insurance adjusters use the absence of emergency transportation as evidence that you were probably not injured in the accident. Conversely, they often consider emergency transportation as evidence that you were indeed injured. Also, I look to see if the police report documented any complaints of injury at the scene. If there were complaints at the scene, and they are consistent with your later claims, it is more convincing to an insurance adjuster. Therefore, it is in your best interest to tell the police officer what injuries you had so they are properly documented in the police report. It will serve you well later and add credibility to your claim. If you were injured in an accident, it is important for me to find out what subsequent care you received. Did you follow through with the recommendations of the emergency room doctor? Insurance adjusters are an inherently suspicious bunch. They deal with exaggerated claims all the time. If you were referred for physical therapy, make sure you follow through. If you fail to follow through or miss scheduled appointments with doctors, that will be used against you. Your medical history is also important. If you are claiming back pain from an accident but you have a history of back pain, you can bet that your previous condition will be used against you. Of course, you will likely argue that your previous condition made you predisposed to injury. However, that won't stop the insurance company from arguing that your current complaints are probably related to your previous injury and have nothing to do with the auto accident. Do not hide your medical history from your attorney. It is very important. Also, it is important to know what kind of insurance is involved in the case. The types of insurance available may help dictate how we approach your particular case. We may choose to use your car insurance or perhaps your health insurance instead. In some cases, people have medical payments coverage available under their insurance policies. It might be better to use that to pay the medical bills. Also, you need to check if you have uninsured motorist in case the other party was uninsured at the time of the accident or didn't have enough insurance at the time of the accident. Make sure you show your attorney your "declarations page" which contains a summary of all the insurance available to you on your auto insurance policy. If you don't have your declarations page, call your insurance company and they should send you a replacement declarations page. We also need to consider how we are going to pay for the treatment you might need in your case. Perhaps we should use the health insurance you have. However, keep in mind that whatever resource you use, they may have a right to reimbursement. We have to enter into these decisions carefully. If you had no health insurance at the time of the accident and incurred medical bills, there may be limited options. In some cases, your attorney might be able to get the health care providers to hold off before sending you to collections. This doesn't work in every case but it's certainly worth trying. This was a snapshot of the types of issues I think about when approaching an accident case. There are other concerns of course, but these are some of the most important. If you've been involved in a serious accident and you have questions, please call (661) 414-7100. |
Attorney Robert MansourRobert Mansour is an attorney in Santa Clarita, California who has been practicing law since 1993. After working for 13 years for the insurance companies, he now counsels victims of personal injury. Click here to learn more about Robert Mansour. Categories
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