Bodily Injury Claim Evaluation Flashcards
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Read the first 7 Bodily Injury Claim Evaluation flashcards as text
A claimant settles a bodily injury claim and signs a release. Three months later, they discover a more serious injury from the same accident. What is the typical legal outcome?
Answer: The signed release generally bars recovery for subsequently discovered injuries from the same accident
A general release typically extinguishes all claims arising from the accident, including injuries discovered after signing, which is why claimants should ensure full recovery before settling.
What does 'maximum medical improvement' (MMI) mean, and why is it important in bodily injury claim timing?
Answer: The claimant's condition has stabilized and further significant recovery is not expected, making it the ideal time to evaluate final damages
MMI marks the point where treatment has achieved its maximum benefit, allowing adjusters to accurately assess total past and future medical needs for final settlement.
An adjuster discovers through social media that a claimant claiming severe mobility limitations is playing recreational basketball. How can this information be used?
Answer: It can be used as evidence to challenge the credibility and severity of the claimed injuries during claim evaluation
Publicly available social media posts showing activities inconsistent with claimed injuries are legitimate evidence that can be used to challenge damage claims.
When a claimant has health insurance that paid their accident-related medical bills, what is the insurer's potential obligation regarding those payments?
Answer: The bodily injury settlement may need to account for the health insurer's subrogation lien against the recovery
Health insurers often assert subrogation liens, requiring repayment from the BI settlement, which the adjuster must factor into evaluating the claimant's net recovery.
A claimant is self-employed and claims $15,000 in lost income due to accident injuries. What documentation should the adjuster require?
Answer: Tax returns, business financial records, and documentation showing income loss during the disability period
Self-employed claimants must provide tax returns and business records to objectively establish actual income loss, since no employer can verify wages.
What role does a 'life care plan' play in evaluating a catastrophic bodily injury claim?
Answer: It provides a detailed projection of all future medical, rehabilitation, and personal care costs for a severely injured claimant
A life care plan, prepared by a qualified professional, projects lifelong medical and support costs, forming the foundation for future damages in catastrophic injury cases.
A bodily injury claim is approaching the statute of limitations deadline but no settlement has been reached. What action might the claimant take to preserve their rights?
Answer: File a lawsuit before the statute of limitations expires to preserve their legal right to pursue damages
Filing a lawsuit before the statute of limitations expires preserves the claimant's right to seek damages even if settlement negotiations are ongoing.