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Motor Vehicle Injuries
Copyright © 2004
Zegarelli
Law Group.
All rights reserved.
Many, if not most, persons are involved in an
automobile accident at some point during a lifetime of driving. Our firm
accepts representation for these types of cases on a preferred client basis.
That is, generally, the firm does not market these types of cases, but, for
certain clients and friends of the firm, we will accept representation because
certain attorneys at our firm have backgrounds in this area of law. For
the case we do not accept, we can assist with finding an attorney for
representation.
In the event you are injured in a motor vehicle
accident, you may desire to pursue legal action. In Pennsylvania, your rights
and obligations are determined by Pennsylvania's Motor Vehicle Financial
Responsibility Act. 75 Pa.C.S. §1701 et seq. A summary analysis of those rights
and obligations, as stated below, can uncover impediments to recovery as well as
pitfalls to avoid.
Full tort vs. limited tort option. A very
basic initial question is whether you selected the full tort or limited tort
option under your insurance policy. All residents of Pennsylvania acquiring
automobile insurance coverage have the option of choosing full tort or limited
tort. If you choose the full-tort option, you will pay a higher premium;
however, you have retained your right to seek damages for pain and suffering in
the event you are involved in an automobile accident. If you choose the limited
tort option, you will have lower insurance premiums; however, you have
compromised your ability to suit for pain and suffering in the event you are
involved in an automobile accident. In effect, the majority of accident victims
who have limited tort will not be able to recover pain and suffering.
Specifically, limited tort victims can only pursue damages for pain and
suffering in the event of a serious injury defined as "death, serious impairment
of body function or permanent serious disfigurement." 75 Pa.C.S. §1702. One's
status as full-tort or limited tort is easily obtained by looking at the
declaration's statement of his insurance policy called "dec sheet."
Limited tort exceptions. An insured who
has selected limited tort can still recover as if he or she had full tort in
certain situations which constitute exclusions to the limited tort option. This
includes when the at-fault driver is driving a vehicle registered in another
state. It also includes the situation where a driver is under the influence of
alcohol or some other controlled substance. In such an event, if this person is
convicted of this offense or accepts Accelerated Rehabilitative Disposition, a
more lenient disposition for first-time offenders, the injured driver is deemed
full-tort and can recover pain and suffering. The injured party is also
considered full-tort if he was an occupant of a non-private passenger vehicle at
the time of injury. Finally, in the event the other driver did not maintain
insurance coverage, the injured party would be considered full-tort. 75 Pa.C.S.
§1705.
Damages. The most significant form of
damages is pain and suffering (non-monetary damages). In a case involving death
or paraplegia, the amount can be considerable. Damages may also include seeking
recovery for medicals and all out-of-pocket expenses, such as lost wages. Under
Pennsylvania law, medical bills and lost wages are covered by one's own
insurance policy under one's first-party benefits coverage. Under first party
coverage, a policy must contain a statutory minimum of $5,000 in medical
coverage. 75 Pa.C.S.§1711. Typically, one would also find $1,000 a month in lost
wages covered. Additionally, there is rarely a need to pursue a claim for
damages to your vehicle since this portion of your damages, except for your
deductible, is essentially covered by your own collision coverage under your own
insurance policy and/or the property damage portion of the other driver's
policy. It is noteworthy that in cases involving a 'totaled' vehicle, insureds
are usually surprised to find that the value given by the insurance company for
the vehicle under collision coverage does not equal the value owed on the loan.
To avoid this dilemma, insureds can purchase ahead of time what's commonly
referred to in insurance parlance as "gap insurance."
Investigation of the Claim. A proper
investigation of the claim, whether by the injured party if unrepresented or
their counsel if represented, involves visiting the scene of the accident and
taking photographs of the vehicles and location. The view of the scene from the
perspective of each driver involved should be captured in a photograph as well
as the damages to the vehicles and any visible injuries to the parties. The
police report is a valuable source of information and can usually be obtained
for $15.00. It contains such important information as the identity and contact
information of the investigating officer, names and telephone numbers of
witnesses, statements taken from each witness or driver, summary of injuries,
and a diagram of the accident scene. Insurance adjusters always review and rely
on the police report and are usually apprehensive about paying out on a claim in
which the investigating officer has found fault in the driver requesting
compensation. Upon obtaining the police report, witnesses can be contacted for
their version of the facts. Medical records should also be obtained for the
injured driver.
Valuing your Claim. In determining a
monetary value for your claim, adjusters look to the seriousness of the injury
and the extent of medical treatment required. A typical automobile accident that
occurs with frequency is a rear-end collision involving one vehicle hitting into
a stopped vehicle in front of it. In such accidents, normal complaints include
pain in the neck region from the whiplash affect of the rear impact. Injured
parties also typically complain of significant, recurring severe headaches
during the period of recovery, which is usually a period of three to six months.
Adjusters refer to the "whiplash" type of injury as a soft-tissue injury in that
there is no visible sign of injury other than the individual's subjective
complaints of pain. Because of the subjectivity of the injury, adjusters do not
place as high a value on these types of claims. Such collisions also involve
rather minimum damage to the vehicles, a fact that insurance adjusters and/or
defense counsel is very quick to maximize in diminishing the value of the claim.
Accidents involving broken bones are considered
hard tissue claims because the injury is visible on an x-ray. Since broken bones
are objective evidence of injury, more compensation will typically be given. If
the accident involved a driver burned in the accident, the burns would also
constitute objective evidence. In the event of permanent injuries such as that
involving a paraplegic, damages can include diminished earning capacity and the
current and future need for constant and permanent medical attention. Expert
witnesses are needed to place a value on those future payments.
Adjusters will also utilize information obtained
in the medical records in placing a value on a claim. They will look to see what
complaints of injury are detailed in the ambulance trip sheet and the medical
records of each separate medical provider. Additionally, they will look to see
whether the victim went to the hospital and/or received medical treatment
immediately after the accident. Treatment that commenced months later or that is
remote to the accident is viewed with skepticism. Adjusters also want to see if
the victim is following the treatment regimen, including attending all
appointments and following any exercise routine prescribed in conjunction with
physical therapy. Finally, adjusters will want to glean from the records the
date the treating physician returned the individual to go back to work and what
conditions or limitations, if any, were placed on working.
Adjusters are very doubtful of victims'
complaints and prescribe to the theory that "seeing is believing." If a victim
claims that his day-to-day functioning during the period of recovery was
affected, documentation is the best evidence. For instance, someone claiming
that they are an avid hunter that was forced to miss hunting season as a result
of an accident is viewed with more credibility if they can submit a copy of a
hunting license. Finally, a victim can keep a diary including as much as a
detailed, day by day account of their feelings and symptoms to as little as a
couple notations of any incidents in which their pain and injuries were
particularly significant or intense.
Prior medical history. Adjusters also have
access to indexes of prior injury claims made by accident victims. If one
injured in an auto accident has a lot of prior injuries or claims, two issues
surface: one, whether the individual's claims are credible or just signs of a
litigious individual. More importantly, the prior medical history will show
whether the injuries to which the injured party is currently complaining are
genuine, or to the contrary, continuing injuries from a prior accident. For
instance, an individual with a prior automobile accident, worker's compensation
injury, and a slip and fall injury on someone's property will have great
obstacles to succeeding in their claim for compensation. If they complain of
neck pain from a current automobile accident, how is it to be established
whether the pain was from the current accident or one of these preceding
traumas.
Independent medical examination. When
there is a claim of significant or permanent injuries, adjusters will request
that the injured party submit to independent medical examinations, called IME's,
with medical providers that they routinely use to determine a claimant's
credibility or seriousness of the claim. When an injured party has prior
injuries, a physician's opinion as to causation of the injuries will be
required. In litigation, such a medical expert will need to testify to a
reasonable degree of medical certainty that the injuries were from the current
accident and not a continuation of the prior injuries. They may also testify to
the seriousness of the injuries, a prognosis for the future, and a prescribed
regimen of corrective action required, including surgery. Besides medical
experts, other experts can be used in more serious accidents. For instance,
accident reconstruction specialists are used to reconstruct accidents and
determine fault. Vocational experts will be used to determine an injury's impact
on earnings.
Workers Compensation Liens. At times, you
will have a driver that is injured in an automobile accident during the course
of their employment. They can recover worker's compensation benefits and
additionally, can pursue the negligent third-party driver for pain and
suffering. A caution to those individuals who seek to settle automobile
accidents without the assistance of attorneys is especially significant in such
a situation. The driver must remember when submitting a claim to the insurance
company for damages to include the worker's compensation subrogation lien for
expenses paid out by the workers compensation carrier.
Underinsured and Uninsured Claims. At
times, individuals will be injured by drivers that fail to maintain insurance
coverage. The at-fault driver will claim that "they are between coverage." At
other times, individuals will be injured by unidentified drivers fleeing the
scene of the accident. In these instances, a claim against the injured driver's
own insurance policy under the uninsured motorist ("UM") coverage is
appropriate. It is noteworthy that such coverage is comparatively inexpensive to
obtain as compared to liability and collision coverage. In other instances,
at-fault drivers may have maintained their insurance but due to the severity of
the injury claim, do not have enough insurance coverage to cover the claim of
the injured party for compensation. A claim against one's own underinsured
motorist ("UIM") coverage is appropriate in this instance after exhausting the
at-fault driver's coverage.
Contact us for more information:
Z e g a r e l l i
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Zegarelli Law Group
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Upper St. Clair Administrative and Postal Office:
2585 Washington Road, Suite 134
• Summerfield Commons Office Park
Pittsburgh, PA
15241-2565 USA
Pittsburgh Office:
301 Grant Street, Suite 4300 • One Oxford Centre
Pittsburgh, PA 15219-1407 USA
Voice: 412.833.0600
Fax: 412.833.0601
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