Hello, everyone. This is Robert Mansour. I wanted to make a brief video today about general damages. You see, if you've been involved in a serious automobile accident, a serious car accident, and you are injured and you want to bring a claim, there are two components to your case. The first component is what's called special damages or the economic damages. Those are damages that can be easily measured such as medial bills, lost wages from your work, the damage to your car, things that are quantifiable generally, that there's some kind of estimate or a receipt or some kind of a bill.
Then, there's something called your general damages. Your general damages are generally your pain and suffering. It's a much more subjective analysis. You might think your pain and suffering is way up here, but the insurance company thinks your pain and suffering is way down here.
How do you convey general damages? Well, the best way to do it is to keep a journal of how the accident is affecting you. Anytime you have a particularly rough day, write it down. Write down what happened, what challenges you've had, who might be able to corroborate that. For example, let's say you had a really bad day at work. There was so much pain, and you have to keep getting up and taking breaks, walking around the office so that your back doesn't hurt you so much. Maybe you had a colleague take you home early several times because you were in so much pain.
Those are the kinds of things that you need to write down and journal. It doesn't have to be everyday. It could be every few days, or if you have a particularly rough day. Say for example you had to cancel a family vacation, or you had stay off of work for a long period of time. Let's say for example you couldn't go out with friends because you were in so much pain, or you canceled a big family birthday. A whole bunch of things you can write down and keep track of, because here's the thing: The insurance adjuster who is evaluating the case is not going to know about those things unless you tell him or her, unless you convey it to them. The other thing I like to do is near the end of the case when I'm about to present your case to the insurance company is I like to prepare declarations for you to sign, for your family to sign, for friends to sign, people who observed how the accident affected your life.
If you've been involved in a serious Santa Clarita car accident and need an attorney's advice, give our office a call to see if we can assist you.
If you incur hospital bills after a car accident, you might be wondering, "Who is responsible for paying for my hospital bills?" The short answer is - You! Just because someone causes you harm doesn't mean they are going to pay for your hospital bills. The hospital, emergency room, doctors, xrays facilities, etc. expect to be paid. You can't simply ignore those bills. I've known some clients who get hospital bills and toss them in the trash thinking, "These aren't my responsibility. I don't need to worry about these bills." The truth is you DO have to worry about these bills. When I tell clients they are responsible for their hospital bills, many protest, "Why should I have to pay these? I'm not the one who caused the accident!"
So then I tell the clients a little story that oftens help explain the situation: Let's say someone vandalizes your home one day by painting graffiti all over it. You catch them in the act and call the police. The police show up and arrest the perpetrators. So far so good. Then you hire Johnny's Painting Company to come and remove the graffiti and repaint your home. Johnny and his crew do a great job. Then Johnny knocks on your door and asks you to pay him for the work. You can't tell him, "Listen, I'm not going to pay your bill. You need to go after the people who vandalized my home." Johnny isn't going to do that. It's not his problem. He provided a service and expects to be paid. Paying him is your responsibility. Then you can theoretically pursue reimbursement from the vandals. So basically, it's the same story with medical care - the health care providers will provide a service to you, but you need to pay them. You can't expect them to go after the responsible party for payment.
There are some medical providers who will provide you service on a "lien" basis. Those providers are not the subject of this posting. When a provider is on a "lien," that simply means you are promising to pay them for their service at the conclusion of your case. You are basically deferring payment to them. This FAQ deals with providers who are NOT on a lien (most hospitals, ER doctors, urgent care centers, PPO doctors, etc.).
Since you have to pay the hospital and related bills, you need to determine what resources you will use to pay. First, if you don't have health insurance, you can ask the providers to treat you as a "cash" patient. Generally, most providers have a "cash" price that is often a fraction of what they would charge to an insurance company. Some also have special programs available to people who need financial assistance. Most will accept payment plans as well.
Second, if you have health insurance, you can simply use that to pay. However, if you have a high deductible, that might be burdensome. Most health care providers who are "in network" will charge you the negotiated rate they have with your health insurance company. That is often far less than "sticker price" on most services. Keep in mind if you recover money from the responsible party, most health insurers have "reimbursement" provisions built into their contracts. That means you need to reimburse your health care insurance company if you recover money from the responsible party. In general, you only need to reimburse them if you recover. You are not obligated to recover money for them.
Third, you might have coverage for health care expenses under your own automobile insurance policy. Many folks have "medical payments" coverage under their own policy and they don't even know it. Many insurance companies aren't eager to tell you about this, but you need to find out if you have it. In many cases, you can have your bills (copays, etc.) paid by your own car insurance company. You've been paying for this benefit so you might as well use it. As with the health insurance companies, your auto insurance company also has a right to reimbursement if you recover compensation from the responsible party. Make sure you don't ignore these reimbursement provisions. In most cases, your auto insurance company will send you a letter reminding you of this obligation if they pay any funds pursuant to any medical payments coverage.
The main thing you need to keep in mind is that you are responsible for paying your health care bills. You can ultimately recover them from the responsible party, but that doesn't absolve you from the responsibility of paying your bills. Therefore, you can't just ignore or throw those bills in the trash when you get them. Talk to an experienced lawyer about how you might handle your accident related medical bills. There are several approaches you might consider, each with its own pros and cons.
If you are involved in a serious car accident and need advice, feel free to contact our office at (661) 414-7100 to see if we can help.
VIDEO TRANSCRIPT: Hello everybody, my name is Robert Mansour, and I wanted to make a brief video today about causation. Causation is an important element of personal injury cases. Just because you have an injury doesn't necessarily mean it was from the car accident. Sometimes I have clients who have a lot of pain and we go and we take an MRI or some kind of scan of their back or their neck, and we find a problem. Let's say we find a herniation of the disc or a bulging disc or a tear in the shoulder or something like that.
The question from the opposing side is always going to be well fine, but is that from the accident or perhaps it's from something else. When you have a preexisting problem for example before the accident, it's a 2-edge sword. The defense is going to argue that that's a preexisting problem and the accident has nothing to do with it. The plaintiff is going to argue that the accident aggravated that condition and made it worst. Now its tough to tell of course when it's aggravated, when does it go back to pre-accident level or does it ever go back to pre-accident level.
This is where doctor's testimony is very important. This is where you want to be able to ask the doctor, "Doctor can you say with any certainty that this is from the accident versus something that predates the accident?" Now another thing that you can do sometimes is you can say, "Fine. Maybe I have this problem before the accident, but it was dormant. It was asymptomatic. I didn't have any symptoms." The argument that I would use is I would say, "Ladies and gentleman, my client is standing at the edge of the cliff."
The other party came and push them over the cliff. By doing so, they can't just say, "Oh well, I pushed you over the cliff. That's your problem." If you have a preexisting problem that was asymptomatic but is now symptomatic, that is an argument that you should make in your personal injury case. My name is Robert Mansour and I just wanted to address this issue causation today in this brief video. I hope you found it helpful, and thank you very much for watching.
Call (661) 414-7100 if you've been involved in a serious car accident and need advice. Robert serves Santa Clarita, CA and its communities of Valencia, Saugus, Canyon Country, Newhall, Castaic and Stevenson Ranch. Robert also serves the larger Los Angeles county area.
When you submit a bill to an insurance company for payment, don't expect the insurance adjuster to simply accept whatever you send them. Whether it's a property damage claim or an injury claim, most adjusters will not accept the bills you send them. They will look for every conceivable reason to reduce the bill you sent them.
Many insurance adjusters will do everything they can to minimize payment on your claim. Some look for reasons not to pay your claim. Insurance companies do not make money by giving you money, they make money by holding onto their money. That means they will look for reasons not to pay or to pay you less than what you expect. Sometimes, you just get unlucky and get assigned an insurance adjuster who thinks everyone who makes a claim is trying to "game the system." Others are working for insurance companies that have company wide policies/culture and software programs designed to reduce claims and payouts. Here are some common arguments:
1) The property damage estimate is too high.
2) The property damage estimate includes items not involved in the accident. (Most adjusters don't actually go to the body shop - they send "estimators" who are arguably beholden to the insurance companies)
3) You treated with the doctor too long (most insurance adjusters don't have medical degrees last time I checked).
4) The charges from the doctor are too high. (This is usually based on software programs arguably designed to favor the insurance companies).
5) The frequency of your treatment was too frequent.
6) The frequency of your treatment was not frequent enough.
7) You waited too long to seek treatment.
8) You sought treatment too soon. You should have waited.
9) You did not have any diagnostic testing like an MRI or CT scan.
10) You should NOT have had diagnostic testing because it was "unnecessary." (and too expensive).
11) Some of the medical records don't specifically mention the accident, so the treatment was obviously unrelated (these are adjusters who can't see the forest from the trees).
12) Your injuries are pre-existing.
If you think about it, the insurance adjuster's job is to "adjust" your claim. That means they have to legitimize their existence by "adjusting" the claim you present to them. If they don't adjust your claim, then it is reasonable to question why they are even employed by the insurance company. Therefore, in an effort to legitimize their position, they MUST adjust the numbers you send them. This is true whether it is a property damage claim or a medical claim. So if the adjuster's job is to "adjust" the numbers, which direction do you think they will adjust? To "increase" the claim or to "decrease" the claim?
While there are rare exceptions, they will typically adjust the numbers downward. It is rare that I see an insurance adjuster simply accept the numbers as given to them. They also rarely "adjust" the number upward. For example, I've never had an adjuster say, "I know you sent me the bill for $5000, but I think the bill should be $10,000!" Can you imagine if an insurance adjuster did that? Therefore, by design, an insurance adjuster will "adjust" your figures downward. I have never seen it the other way around. Be prepared to be disappointed. It's just the way the game is played.
A client recently visited me after a severe car accident. He was having difficulty raising his arm which he could do without a problem before the accident. He explained his shoulder felt like it was just "hanging there" - something was wrong. He had his shoulder in a sling. His doctor explained he may have suffered a tear to the shoulder from the accident. A subsequent MRI confirmed a tear to his labrum.
Much like the hip joint, the shoulder joint is comprised of a ball and socket joint. However, the socket is generally pretty shallow and therefore is a bit unstable. This means that the bones sometimes need "extra support" to keep the shoulder joint working properly.
Due to the shallow socket, the shoulder joint has a cartilage called a labrum. This cartilage forms a cup at the end of the arm bone. The Labrum essentially makes the shoulder joint more stable, and facilitates a wider range of movements.
The labrum is basically made of thick tissue that can be injured with trauma to the shoulder. Therefore, when involved in a car accident that involves some trauma to the shoulder, it is possible to suffer a labral tear. The labrum also gets weaker with age, making a person more prone to injury.
Symptoms of a labral tear may include an aching sensation in the shoulder, a "catching" sensation of the shoulder with certain movements or pain with specific activities.
If you suspect something is wrong with your shoulder after a serious car accident, bring it to your doctor's attention sooner than later - even if you're not sure. Make sure you document your injury and raise your concerns early, or the insurance company for the responsible party might try to minimize your injury.
If you need help with your personal injury case, give Santa Clarita injury attorney Robert Mansour a call at (661) 414-7100.
I got a call from a potential client who said, "The insurance adjuster says I have a duty to mitigate my damages. What does that mean?" Simply put, that means you just can't sit around after an accident and let your damages get out of control. Your damages include your rental bills, your lost earnings, your doctor bills, etc. You have to "mitigate" your damages which means you have to make sure you do what you can to keep your damages reasonable.
For example, if the insurance company pays you for the total loss of your car, you can't just keep renting a car forever and expecting the other party to pay for it. At some point, you have to go buy another car or make other arrangements. If you don't have a car, you just can't stay home from work and say, "Oh well, I don't have a car so I won't go to work for 3 months. I guess they'll pay me for my lost earnings." You need to get to work by making other arrangements when available. If you truly cannot get to work any other way, then I suppose you will make your argument when the time comes. However, you need to make an effort to keep your damages in check.
If a doctor tells you to rest and not do anything strenuous, you should not go to the gym and reinjure yourself! You can't hold the other party responsible for things they cannot control or for mistakes in judgment on your part. Therefore, generally speaking, you have to do what you can to keep your bills reasonable. Of course, certain things are out of your control, but don't be surprised if the other party asserts you need to mitigate your damages.
My Aunt Sally Got $40,000 for her personal injury case. Isn't my case worth at least that?
One of the issues I struggle with is the occasional client who expects a certain monetary outcome from his/her case based on what a friend or family got from another unrelated personal injury case 5 or 10 years ago. They'll say, "Well, I was talking to my friend Bob and he got $35,000 for his personal injury case. He barely had a scratch on his car. How come I'm not getting $35,000?" Or they will say, "My friend Suzie told me she got $60,000 for her personal injury and she never even went to the doctor!" You are going to get a lot of input and "advice" from friends and family members, and that may affect your expectations. However, trust me when I tell you that every case is unique in many ways. Also, many other factors affect the "value" of your case. You can't expect to get what Aunt Martha (who lives in New York) got on her injury claim. Factors such as age, jurisdiction, the adjuster assigned to your case, residual injury, amount of property damage, the current economic climate, and much more can affect your case. Comparing your result to the results of others is a futile exercise.
If you did not have insurance on the date of the accident, then your recovery (assuming you recover anything at all) will be limited to your economic damages. Examples of economic damages are hospital bills, ER bills, physical therapy bills, property damages, lost earnings, future medical bills, and other economic damages that can be measured. However, that's pretty much where it stops. If you did not have insurance on the date of the accident, then you cannot recover "general" damages.
General damages are often known as damages for "pain and suffering." If you have a smaller injury, then involving a lawyer will be tough. Most lawyers won't get involved in a case like this because your recovery will be severely limited. Also, just because you have certain economic damages doesn't mean the insurance company for the responsible party won't try to nickel and dime every expense. After all, they don't have to pay your bills just because you accumulated them. However, if you have a significant injury, especially one that will require future care, a lawyer may be willing to help you because there is more chance for recovery. Getting a lawyer on board in that case might be helpful to your case.
I recently had to turn away a handful of cases because the clients had no insurance. Proposition 213 (a California law passed in 1996) limits their recovery to only economic damages. These are known as the Financial Responsibility laws because they essentially say that if you don't play by the rules, you cannot benefit from doing so. Because their cases were relatively small, I told them they might be better off without a lawyer because my fees would eat into their recovery which is limited in the first place. Therefore, you can always get legal advice but if you did not have insurance, there is only so much a lawyer can do.
by Robert Mansour
Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia,