During a recent consultation with a personal injury client, I offered tons of tips as to how the client should conduct himself and things he should do with respect to his case. The prospective client said, "Gee, this is kind of like a game?" I agree but explained that we weren't trying to "trick" anyone. However, there is a strategy to presenting your case in the best possible light. You see, your opponent (the insurance company) is going to do everything it can to minimize your claim. That means you have to do everything you can to counter that - and that requires a strategy. If you know you're essentially playing a game, then you know you have to employ a strategy. Some people wait too long and never realize they were in a "game" until they lose the game.
Here are 5 common mistakes I have seen lately in my personal injury practice:
1) Clients waiting far too long before seeking medical attention.
If you are injured, make sure you get medical care. The absence of medical attention will be used against you. Calling a lawyer 6 months after an accident while you've had minimal to no medical care is not helpful. I'm only a lawyer - not a magician.
2) Clients who post stuff on social media.
The first thing the insurance company will do is look you up on social media. They will "Google" your name, look for you on Facebook, Twitter, Instagram, etc. They will look for any evidence of you acting inconsistently with your claim of injury. In fact, we now routinely look up our own clients to see what they are posting online. I encourage them to do the same. You need to know what the insurance company is looking for.
I once had a client who was claiming a shoulder tear for which he needed surgery (the MRI actually showed a tear). However, a few weeks later, there he was playing drums on Facebook with his rock band. The insurance adjuster was jumping for joy when he came across that! Of course, my client had a perfectly good explanation, but now we had something we needed to explain.
I've had clients post photos of themselves working out at the gym, mud running, hiking, on vacation, dancing at parties, and much more - all on social media while claiming to be injured. Here's some advice, if you've been injured in a car accident, don't post ANYTHING on social media until your case is concluded. If that means you are "off the grid" for a year or two, so be it. Social media is NOT your friend when it comes to injury claims. There's nothing technically "wrong" about posting stuff on social media. However, if you are claiming you're in pain, and then they find photos of you enjoying your European vacation, that's basically like sending the insurance adjuster a huge gift wrapped up in a big red bow.
3) Clients don't tell their medical providers about their accident.
I can't tell you how many clients tell me of all their medical care post accident, and then when I research those records, there is little to no mention of the car accident. If you don't mention your accident, most insurance adjusters will argue that you were getting medical care for reasons unrelated to the car accident.
4) Clients who don't realize that insurance adjusters will be reading their medical records.
I can't emphasize this enough. Don't tell your doctors you are "fine" if you are NOT fine. Remember, the adjuster is going to be reading those records and holding a magnifying glass to them. Anything in your medical records that can be used against you WILL be used against you. I always tell my clients to imagine the insurance adjuster is actually present for every medical appointment and every physical therapy session. Imagine they are standing there, recording every encounter. You want them to fully understand your injuries and the effects of the injuries. You want your medical records to be complete and well documented. If you imagine the adjuster standing next to you, I promise you will be much more vocal with your health care professionals. You are actually "speaking" to the insurance adjuster through those medical records.
5) Clients who ignore their past medical history or think it will never be an issue.
I'm convinced that many clients think their past medical history is irrelevant to their current case. If you are claiming neck and back pain from an accident, or any injury, you can bet any prior complaints of similar pain will be used against you. I often obtain my clients' past medical records to make sure I have a good handle on their medical history. I would say about 50% of the time, we find similar complaints, sometimes dating only a few days or weeks before the accident To complicate matters, my clients will actually deny any previous problems to their current providers. As such, the client looks like they are lying or hiding something when their past medical records are found to be inconsistent with their present medical records. Again, even if there was a perfectly good explanation, it just makes our hill much steeper to climb.
During every phase of a case, I try to be honest with my clients. That often means I have to give them bad news or something they don't necessarily want to hear. I don't do it to upset them. I do it because I'm trying to protect them. We have to be aware this is a "game" of sorts, and their opponent is the insurance company. My best clients understand that all I'm trying to do is be candid and offer them the best advice I'm capable of providing.
Hello, everyone. My name is Robert Mansour. A question I get all the time is: I've been involved in a car accident. What should I be doing as soon as possible? When we're talking with a client on the phone, we are talking to them, they're generally just had an accident or they had an accident the day before. Here are some of the things that we try to focus on.
Number one: I tell the clients to see if there was a police report. The police report is very important because it might help establish fault. If you don't have a police report, the police might have given you a little card at the scene of the accident. You can call the number on the card and find out when that police report is going to be ready. Now if you don't have a police report, don't be surprised if the other side tries to change their story. This is one thing that we ask about. If you don't have one, it might not be a problem because the other side might already have confessed to the incident and taken liability, accepted fault. If they didn't accept fault and you don't have a police report, and there's no witnesses, you might have a big problem on your hands.
Number two thing you should do: You should get medical care as soon as possible. All of this is very interesting, but the most important thing is your healthcare. You've got to take care of yourself. Your injuries are more important than anything else. Plus, if you wait too long to seek medical care, the insurance company for the responsible party is going to doubt that you were injured.
So, for example, if the accident happens on this date and you wait a month before you do anything about it, and then the first time you go to the doctor is a month later, they're going to say, "Wait a minute, you waited a very long time before you did anything. You were probably not injured. You're probably faking it or you're probably embellishing it." You want to seek medical care as quickly as possible.
Also, you want to document what's going on. All of your injuries, all of your limitations, all of the ways the accident affected you, you want to communicate those to the medical professionals. You want them to write it down in their notes because, at some point in the future, if you do bring a claim, the insurance adjuster is going to be looking at these medical records and reading them very carefully. They're going to be looking for all the things that you complained about. What I tell my clients is the following: If it's not in the medical records, it's like it never happened. Documentation is very important.
Another thing I tell my clients is when you go get medical care, imagine the insurance adjuster for the other party is sitting on your shoulder, just a little insurance adjuster sitting there. They're listening to everything you say. If you say it, they will consider it, but if you don't say it, or you don't bring it up to your doctor, then they're just not going to consider it and you won't be able to bring it up later on.
The next thing that's very important is photos. You've got to have photos showing the damage to your vehicle, if possible damage the other vehicle. If you have bruises to your body, cuts, scrapes, those kinds of things, you need to take pictures of those kinds of things. Because, as they say, a picture tells a thousand words. A picture speaks a thousand words, rather. If you have photos, it's very compelling. On the one hand, you can tell people, "Oh, I got into a severe car accident," or "I had some bruises on my body." But if you show them the severe car accident and if you show them the damage to your vehicle, that's much more compelling.
Also, photos of injuries are very important as well. Bruises, cuts, and scrapes: very important. These are the most important things that we want to figure out in the very beginning. Then we want to figure out the insurance information. If you are injured and if you're going to think about bringing a claim, you have to ask yourself: Who's going to pay for all this? Well, does the other side have insurance? You'll be surprised, a lot of times they don't have insurance or they don't have enough insurance, in which case we need to look at your auto policy and take a look and see if you have something called uninsured motorist. Just because the other side has insurance doesn't mean you get to go all you can eat medical care. This is not a buffet.
You have to be very careful and judicious and you always have to ask yourself: How am I going to pay for my medical care? Perhaps you want to go through your own healthcare channels, your Blue Cross, Blue Shield, Aetna, Health Net, any variety of insurance companies. Or perhaps your own auto policy has some kind of medical benefits that we can use. Also, are you going to go through your own healthcare providers or are you going to find a doctor who perhaps specializes in personal injury cases?
These are some of the most important questions that we have. Finally, there's one more thing. With respect to insurance, the insurance company for the other party is going to call you. In most cases they're going to call you and they're going to ask you for a statement. They're going to want you to give what's called a recorded statement and they're going to ask your permission to record you. Usually that happens within the first few days of the accident. I am reluctant to do so. I tell my clients there's no reason to speak to the other side. Generally speaking, it doesn't serve your purposes at all. The insurance adjuster is usually trying to box you into a story. Their allegiance, if you will, is to their company and not to you. They may sound very friendly, but I assure you they are not acting in your best interest.
Finally, it might be a good idea to call a personal injury attorney and run some of the facts by them, and say, "Hey, listen. Is there anything else instead be doing? Should I hire an attorney? What are my options?" I hope you found this video helpful. If you'd like, you can call my office and arrange for an initial consultation. We'll see if we can help you with your accident case. Thank you very much.
Call us today at (661) 414-7100 if you've been involved in a serious auto accident.
After practicing this area of law for over 20 years (for plaintiff and for the defense), we have found these cases boil down to five major factors:
VIDEO TRANSCRIPT: Hello, everybody. My name is Robert Mansour and I wanted to make a brief video today about reasonable expectations and personal injury cases. If I get a perspective client walking into my office and they have "dollar signs" in their eyes and they think they've won the lottery and the heavens are going to open and all kinds of money is going to fall into their lap because they got into a car accident, that's not a very good fit for me.
You see, those clients have unreasonable expectations. I think the reason for that is back in the 1970s and the 1980s a lot of people were getting pretty amazing payments from insurance companies on auto accident cases. Then what happened is in the early 1990s the insurance companies started to fight these cases aggressively, especially the ones that were soft tissue injury which was basically sprain and strain of the muscles. No serious injuries. What happened was the insurance companies started fighting these cases aggressively. I know that because I was working for one of these insurance companies at the time, and we would take these cases all the way to trial and more often than not the plaintiff, the person making the claim got $0 or very little from a jury.
The reason that this happened is because juries were very conservative and juries were not handing out a lot of money, and the insurance companies started to realize that by fighting these cases aggressively they were discouraging the filing of these cases. In cases like that, the clients have to have very reasonable expectations. The days of money falling out of the sky, those days are over.
What you want to do is you want to focus on the injury. You want to focus on appropriate care. You want to focus on getting better. A client who comes to me and their main focus is their injury, that's a good fit for me. If they think they won the lottery, that's not a very good fit for me and that client has unreasonable expectations. That client is going to be disappointed probably every single time.
My name is Robert Mansour and I wanted to make this brief video today to talk about unreasonable expectations in relation to personal injury cases. I hope you found this video helpful. Thank you very much for watching.
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.
As a lawyer, there is only so much I can do. I'm not a magician. I can't take a horrible personal injury claim and make it into a good one. If a person calls our office months after an accident, my first concern is, "Why are they calling a lawyer so late in the game?" In most cases, the client has caused damage to their own case, and they think a lawyer is going to fix it.
Like a good coach, I'm only as good as my team. Phil Jackson is arguably a great NBA coach. However, if his players simply ran around the basketball court and did not follow his instructions or did not execute the plays they practiced over and over again, then his team is going to lose. It doesn't matter how good his coaching is.
There are many things that clients do that can ruin their personal injury case. Oftentimes, clients have no idea they are putting holes in their boat that will prove to be a problem later on. Then the boat sinks and the clients wonder why.
So here are some things people do that will almost always sink their personal injury case:
1) The client misrepresents how the accident has affected them. For example, during a consultation, the client says they can barely get out of bed, they can't work, they can't pick up their kids from school, etc. Given today's technology, insurance companies are eager to hire people to film you going about your daily life, picking up heavy groceries, going to the gym, playing ball with your friends, etc. Keep in mind this is an adversarial process. They are out to prove you wrong. In fact, that is their job. If you misrepresent matters to your lawyer, and the lawyer represents the same to the insurance company, then both you and your lawyer are going to be seen as untrustworthy. Also, be very careful of what appears on Facebook, Instagram, Twitter and other social media outlets that might be viewed as inconsistent with your claim. In some cases, you may not be the one posting harmful photos, but a friend or family member might be doing so. In short, do not act inconsistently with your claimed injuries.
2) The client fails to show up to medical appointments and/or has significant gaps in treatment. Insurance adjusters always use failures to show up for appointments and gaps in treatment as indications that your injuries aren't as bad as you say they are. Otherwise, you would show up to your doctor's appointments, and there wouldn't be such gaps in treatment. Also, when there are gaps, the adjuster may assume there must have been another injury that occurred during the gap. Remember, adjusters are generally looking for reasons NOT to pay you. Why should you make their life easier?
3) The client makes damaging statements to the doctor that show up in the medical records. For example, the client says they feel 100% better when in fact they don't. Or they don't mention an injury because "it's not a big deal." Why would a client say that? Sometimes, clients want to be "macho" or stoic in front of their doctors. I tell clients that even if they still have 10% pain, they must mention it to their doctor. Whatever you say to your doctor during your visits, assume you are speaking directly with the insurance adjuster who will, whenever given the chance, use your statements against you.
4) The client hides past medical issues or past injuries from the lawyer. So many times, clients have looked me in the face and told me they did not have any prior injuries or similar medical issues in the past. I have to believe them, so I represent the same to the insurance company. What clients may not know is that insurance adjusters have access to large nationwide databases, and clients should operate under the assumption that their past injury or past medical records will be found. How can your lawyer help you if you don't tell them the truth or deliberately hide information from your lawyer? A client came for a consultation to my office long ago, and I asked her about prior injuries. She said, "Why do you need to know that? How is that important?" Needless to say, I did not take the case. This client was going to be difficult from the start! Don't be difficult with your lawyer. They are on your side!
5) Along the same lines, some clients hide past accidents from their lawyer. Again, those will most likely be found by the insurance company. Your attorney often doesn't have easy access to the same databases, so you and your lawyer will look like fools when the insurance company finds your past accident(s).
6) The client refuses to hire a lawyer when their injuries are serious. Cases involving serious injuries require serious attention. Would you go river rafting without a guide in your boat? If you wait too long to hire a lawyer, you may already be doing things that are harming your case without even knowing it. As stated earlier, if you've done irreparable harm to your case, your attorney is only human - they can't magically make the mistakes go away!
7) The client gives too much information to the opposing insurance company. Don't talk too much at the beginning of your case. As noted elsewhere on this website, don't be eager to give a statement to the opposing insurance company. As the saying goes, "Whatever you say can and will be used against you...." Statements solicited from you by insurance companies are rarely designed to serve your interests. The insurance company is preserving its own interests. If you give them too much information, you may find yourself in a bind when some of that information turns out to be false or not entirely true. The biggest mistake I see in this regard is when clients say, "Oh, I'm not injured. I feel OK." Then a few days later, they don't feel so good as their body recovers from the impact. Then they bring an injury claim, and the insurance adjuster conveniently pulls out their recorded statement and whacks them on the head with it! In most cases, there is no exigency that requires showing your entire hand to the insurance company so early in the case. Talk to a lawyer about your options first.
8) If the client is injured at the scene, some make the mistake of not calling the police. Most insurance adjusters use the absence of a police report as evidence that no one was hurt. In other words, if someone was hurt, they would have called for the police.
9) Some clients fail to obtain information about the other party involved in the accident and fail to document other evidence of the incident. It is important to take photos of the damage, obtain names, addresses, phone numbers etc. Of course, that isn't always feasible, but when it is, failing to do so can harm your case. How can your attorney help you when you don't even know who the party at fault is? Your lawyer is not clairvoyant. The information is not going to appear to them in a dream sequence. How can your attorney help you if you don't take photos of your damage? How many photos should you take? As many as it takes to convince an insurance adjuster you were injured. Photos taken at close range or that are blurry don't help convey any message to an adjuster. In short, take photos designed to illustrate the severity of the impact.
10) The final thing that people do to sabotage their case, and this is perhaps the most important, is they wait too long before seeking medical care. Clients who wait more than a few days to seek active care for their injuries often encounter resistance from the insurance adjuster. Again, the insurance adjuster's position will likely be: "If your injuries were that bad, or as bad as you say they were, then you would have sought treatment/care for this accident."
Here is the basic overall lesson - a personal injury matter is basically an adversarial process. On one side is the injured party who may do things to sink their own case. On the other side is an insurance company that generally hates parting with money and will use your mistakes against you whenever possible. If you want help with your injury case, make sure you consult with an attorney as soon as possible so you know how to best handle your claim. A lawyer isn't a magician but a good one will tell you what mistakes to avoid and how to present your case in the best possible way. Again, no lawyer can guarantee an outcome - but at least you can increase your chances of a decent result by avoiding all the landmines that are out there.
VIDEO TRANSCRIPT: Hi, my name is Robert Mansour, and I'm broadcasting to you this brief video today from my home office in Los Angeles, California. One of my areas of practice is personal injury, and I wanted to spend today's brief video talking to you about aunt Sally. Aunt Sally got $40,000 on her case many years ago, and this is the problem that I sometimes have. Clients walk in and they compare their case to their aunt Sally or to their cousin Bill or to their friend Jose or whatever the case may be. They say, well, I don't understand. Why is my case worth this, or why are you concerned about this when my aunt Sally or my uncle Bill got $40,000, $60,000, $25,000, whatever the case maybe.
One of the biggest dangers that you can get involved in when either doing a case like this, a personal injury case, is comparing your settlement or your result to other people in your friends and family circle. The reason is that they might not live in the same region as you do. Their accident may have been more severe than yours. Their accident occurred in a different time. Frankly, as I record this video insurance companies don't like to part with their money.
They used to part with their money a few years ago a little bit more readily. Now, not so much. In these economic times everybody is watching their bottom line, including the insurance companies. So while it might have been worth x ten years ago, not so much today. Frankly, in my region of the country juries are very stingy for the most part.
Another variable is the insurance adjuster that you're dealing with. Sometimes, you deal with an insurance adjuster who's very reasonable, willing to talk about the big picture. Other times you get an insurance adjuster who's not so reasonable and very difficult. Some of them maybe had a bad childhood. I don't know. The point is that you have to deal with the variables that are involved in your case, and don't get hung up on whether so and so got this much or so and so got that much for a similar case. That's going to lead you to a road to nowhere.
You need to evaluate your case under your circumstances in the time and region that your case is being handled. Then try to fashion the best result that you can, given the scenario that you have. You can't always control it and there are many variables that you cannot control, but at the very least one thing you can control is your tendency or the propensity, rather in many cases, to compare your result with the results of others.
My name is Robert Mansour, and I thank you very much for watching this brief video. If you need help with your personal injury case and would like to discuss your options, feel free to call my office at (661) 414-7100.
VIDEO TRANSCRIPT: Hi, this is Robert Mansour, and I'm a lawyer in the Los Angeles area. One of my areas of practice is Personal Injury Law, and I'm broadcasting today from my office in Santa Clarita, California which is in northern Los Angeles County. I want to spend a couple of minutes with you talking about this letter that I got from Mercury Insurance. The reason I like this letter and I think it's a terrific letter and I want to share it with you is because it is very demonstrative of how insurance companies deny claims.
This is an accident case. It was not a big accident. My client knew that going in. Here's the letter. I think this letter just sums it all up really well. I'll show you exactly what I'm talking about. So here's the letter that I'm going to read to you. This is from Mercury Insurance.
It says, dear Mr. Mansour, we have evaluated the specials. Now, the term specials means the damages, the economic bills, et cetera. It says, this loss involves a minor impact to the driver side rear of your client's vehicle. They're using the fact that it was a minor impact to try to minimize the case. So the severity of the impact is very important. That's something that you should keep in mind. It says here, there was no police report filed. So here they're using the absence of the police report as an indication that this was not a major accident which, of course, is silly, but here's how insurance companies work.
If the police are not called to the scene, then obviously it was a minor accident, but if they are called to the scene they generally presume well, maybe there was an injury. So again, very interesting. No police report filed, it says. Your client did not receive emergency treatment on the date of the loss or subsequently. So the fact that my client never went to the emergency room or wasn't taken away by ambulance or anything like that, the lack of emergency treatment is being used against my client.
Now, maybe my client is stoic. Maybe my client wasn't hurt all that badly, but what they are doing is they are using the absence of emergency treatment against her. Also it says here, your client sustained soft tissue injury. That means pulls, muscle strain, sprain, that kind of thing. She was treated by a chiropractor which is interesting. That is the reason that they are using to minimize this claim, the fact that she was treated by a chiropractor.
Now, in some minds of some insurance adjusters, the chiropractic treatment is not as valued as an orthopedist treatment which is very interesting because many chiropractors provide terrific relief for their clients, here it is being used against my client. The fact that she went to a chiropractor. It says here, the treatment charges are excessive in relation to the injuries and the impact sustained.
Basically, they are using the size of the impact to dictate how much treatment she should have gotten. So if it was a low impact she should not have gotten this kind of treatment. Again, they don't take any individuality into consideration. They just look at the amount of the impact and determine, gee, does that make sense? Did they go treat for too long or not too long?
You'll notice in this letter it doesn't say anything about my client's medical condition, what the actual doctor had to say, what my client's reported injuries were, whether she is a frail person, whether she has any pre-existing problems, nothing like that. This denial, well actually it's not a denial. They offered her $2,000, but we suspected that in the very beginning.
Here's the thing. This letter is full of all the classic arguments. No police report, no emergency room treatment, minor impact, chiropractor. All of this being used against my client. I just wanted to share this letter with you as a demonstration of how some insurance companies, especially Mercury, just my opinion, use to deny and minimize these kinds of personal injury claims.
Thanks again. My name is Robert Mansour. You can learn more about me by visiting my website valencialawyer.com or calling my office at 661-414-7100. Thanks a lot for watching.
Hiring an attorney won't magically help your case. You must work together. We always tell our clients that we need their help while we are representing them.
Here is exactly what we tell all our personal injury clients:
By hiring a lawyer, your case won’t automatically be successful! We can’t guarantee anything, but without your help we will be at a deficit. To some extent, we have to be strategic about our approach. Unfortunately, insurance companies have created an atmosphere that demands such an approach.
Here are some things to keep in mind. Please review this checklist on occasion as things may
change as your case progresses.
1. Keep our office advised of your current address and phone number.
2. Please get back to us promptly by email or phone if we try to reach you. Sometimes we need time-sensitive information.
3. Inform this office and your doctor(s) of any prior motor vehicle accidents or medical treatments. If you have an aggravation or exacerbation of a previous injury, they should know about it.
4. Contact our office when you have any questions regarding your claim. Do not speak with a representative of the opposing insurance company. You may of course talk to your own insurance company regarding property damage issues but keep it confined to property damage.
5. Keep all medical/doctor appointments with your doctors, as well as any medical specialists to whom you are referred. Gaps in treatment will be used against you. If you miss an appointment, try to reschedule it.
6. If you are unable to work, do not leave your doctor’s office without written verification of your working status from your doctor – in other words, get a “note” from your doctor! Lost wages from work are dependent upon your doctor’s written verification of your work status. It is your responsibility to get this information from your physician. We cannot do so. Without such notes from the doctor keeping you off work, your claim for wage loss, if any, will be severely hampered.
7. If you are going to allege lost wages, we will also need verification from your employer of the dates missed and your rate of pay. If you are missing work due to the accident, your employer (the person offering verification) should know WHY you are missing work. They need to know it is accident-related. Provide us with the name/address/phone of the person who can assist us with verification of your lost earnings. If your claim is significant, providing tax returns from the past 2 or 3 years is helpful to show the decline after the accident. They won’t pay for lost wages unless they have verification from your employer AND your doctor. They don't pay lost earnings because you are a nice person. We may ask you for help if your company refuses to cooperate with our office.
8. If you see additional doctors after our initial interview you must inform us of their name, address, and telephone number. We don’t automatically find out about these things.
9. You may have sought treatment with facilities that have no relationship with my office (especially before hiring my office). We can obtain your records from these facilities, but in most cases, a direct request from you (their patient) is more effective. By law, they should comply. Please try to obtain the medical records AND billing from these facilities. Some may insist the attorney’s office obtain the records and bills.
10. Keep track of your mileage and prescriptions and submit them to us. It helps to keep a journal of doctor’s appointments and mileage (parking charges) incurred. This can be a simple sheet of paper and/or receipts from parking lots. If your mileage is very minor, this effort may not be worth it.
11. If you receive any documents by mail regarding your case (from ANYONE), please forward them to our office. This includes health care insurance, letters from insurance companies, collections agencies, etc. Keep our office completely in the loop. We are not necessarily copied on correspondence you receive from others.
12. Your “diagnosed injuries” may affect the evaluation of your case. Therefore, you MUST tell
your doctors (written and orally) about ALL your injuries. Doctors cannot read your mind. This is EXTREMELY IMPORTANT. Break your injuries down to smaller components. For example, saying “my shoulder pain radiates into my neck” will simply be considered only a “shoulder” complaint by the insurance company. Your neck pain may not be considered. If you just say “my back hurt” that will count as “one” injury when in fact, you might have “upper back pain” and “mid back pain.” That’s two injuries – not one! Keep your doctors aware of your progress or lack of progress during each visit.
The rule you should keep in mind is this: Most insurance companies are using software to analyze your case. If something is NOT mentioned in the medical records, it simply won’t be “inputted” and basically doesn’t exist as far as the insurance companies are concerned. The insurance company wants to minimize your complaints whenever they can. Also, mention ALL YOUR INJURIES to every doctor you see…even if they are not treating you for that particular injury. For example, your chiropractor and orthopedist should both be aware of ALL your complaints. Inconsistencies in their records/reports may be used against you.
13. How an accident affects your life may also affect the evaluation of your injury case. You must also report any daily activities (work, school, household, etc.) that are affected by your accident. The doctors MUST document these issues or they simply won’t be considered by most insurance companies. Just like in the previous paragraph, the insurance adjuster will not input your information into their software if the information is missing or unverified by the doctor’s chart notes and/or report.
We know this is a lot to keep in mind. However, we truly believe that our clients are better off if they are “informed” participants in their case. After years practicing personal injury for the defense and plaintiff, I share these guidelines with you so we can truly work as a team. Of course, your health is the most important thing, but we also want to maximize your chances of having a successful personal injury claim.
Call (661) 414-7100 if you want advice regarding your own personal injury case.
Some people are afraid to proceed with pursuing a personal injury claim because they are afraid to get stuck with medical bills and attorney fees they cannot pay. Here are some things worth keeping in mind regarding these important issues.
First, in most cases, personal injury lawyers work on "contingency" which means they don't get a fee unless they recover compensation for you. This compensation is usually obtained from the responsible party's insurance company. However, in some cases, the compensation comes from your own insurance company (this happens if the other party didn't have insurance or not enough insurance, provided you have "uninsured" and "underinsured" motorist provisions on your auto policy).
In any event, if you don't recover anything, then you don't owe a fee to the lawyer. I've worked on some cases for 2 years before getting a fee. In most cases, you can choose to dismiss your claim for one reason or another - if you didn't get any recovery, then you still don't owe the lawyer. A good lawyer will not force you to proceed with your claim just so he/she can get a fee.
Clients worry about getting stuck owing a lawyer for services. In most cases, it isn't much of an issue. You might be on the hook for some "costs" such as filing fees etc., but before filing a lawsuit, there are rarely many significant costs. In many cases, the lawyers will waive minor costs as business expenses (i.e., obtaining the police report, getting medical records, photo printing fees, etc.).
Next, clients worry about owing the doctor money for treatment. While it is true that most doctors won't work for free, there are strategies you can employ to minimize the risks. Here are some common routes to entertain:
First, you can ask the doctor to treat you on a "lien." That means the doctor will provide treatment to you without up front costs. In most cases, they will do so only if you are represented by a lawyer. They will submit a bill to your lawyer after you conclude treatment. The bill is usually paid out of proceeds obtained when settling with the responsible party. However, if you don't recover any money from the responsible party (or from your insurance), you are still technically on the hook for the doctor's bill. The "lien" approach is good when you don't have any other insurance resources and/or if liability is clearly established in your favor.
Therefore, if that is a concern (i.e., liability is an issue and there is a danger the other party won't pay, or there is another concern you won't be able to pay the doctor), then you should consider having your medical bills paid by your health insurance company. If you choose to do that, the responsible party won't entertain the full amount of your bills, but they will instead consider the amount accepted as payment in full. That can be a fraction of your actual bills. Also, it depends if the health care provider has an agreement with your health insurance company (i.e., they are a preferred provider, etc.).
That means if your actual bills are $3000 but your health insurance paid $1000, the insurance company for the responsible party will only consider $1000 as your bills (if your provider accepted it as payment in full). That may be a detriment, because your case will seem "smaller" and less significant as a result. However, on the positive side, you will have peace of mind knowing your bills have been paid. Make sure your provider will accept the payment as payment in full if this is important to you.
Now, one more caveat to consider - your health insurance will expect to be repaid in most cases. You have to reimburse them from any settlement you may get. This expectation of reimbursement is usually contractual. The silver lining is that, in most cases, you only have to pay them back IF you recover any money. If you don't recover any money, then you generally don't have to reimburse them. That way, your medical bills are paid and you don't have to worry about any outstanding medical bills.
Finally, you can have your bills paid by your Medical Payments Coverage, if you have that kind of coverage under your auto policy. This is known as MPC. You need to find out if you have that kind of coverage, and you also need to learn how much you have. Typical amounts are $2000, $5000, and sometimes more. In some cases, your auto insurance will only pay secondary to any health insurance you may have. In other cases, they will go ahead and pay regardless.
Therefore, your health care provider can bill your auto insurance instead of billing your health insurance (very helpful especially if you don't have health insurance). Again, that doesn't mean your MPC will pay every dollar billed, but you need to ask the health care provider if they are going to accept payment from the MPC policy as payment in full or if they are going to hold you responsible for the balance. You see, your health care provider may have a contract with your health insurance company to accept payments as payment in full, but they probably don't have the same agreement with your auto insurance company. Similarly, your auto insurance company will expect to be repaid the MPC benefits IF you recover from the other party. If you don't recover anything from the other party, you generally don't have to repay your auto insurance company for payments made under the MPC provisions. Therefore, your medical bills are paid and you don't have to worry.
Just keep in mind that how your bills are paid is important. Strategically, you may consider one avenue over another. Just talk to your lawyer about the pros and cons of each approach. At the end of the day, you want to proceed cautiously, and your lawyer should offer you some direction about which path to take.
If you have been involved in a serious car accident and you want some legal advice, call Robert Mansour at (661) 414-7100 for a free consultation. Robert serves Santa Clarita, Valencia, Saugus, Canyon Country, Newhall, Stevenson Ranch, Castaic and surrounding communities.
by Robert Mansour
Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia,