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  1. #1

    Default How to Determine if an Injury Settlement Offer is Fair

    My question involves an injury that occurred in the state of: NC

    My husband was injured when a rotted floor joist in an old rental home gave way and he fell through the floor, about 8 feet into the dirt basement below. He landed on a cinder block that was on the ground, bruising his kidneys, fracturing 3 vertebrae, and cutting his face.

    The landlord knew my husband was going over to the house (one of my husband's family members rents the home) to check out the floor which had been sagging. It has since been discovered that the landlord often ignored reports of issues with his homes, and several homes that he rents out are in unsafe condition. The city actually now plans to condemn these homes.

    The insurance company has accepted liability and said today they will be making my husband a settlement offer by the end of next week. One of my co-workers mentioned that he shouldn't take the first offer they make. I am an insurance agent but do not work in claims, so I have no idea what is fair or not.

    My husband has a small scar on his face from the gash, but otherwise his fractures have healed. He was out of work from mid September and was just released from the dr's care today. He was in a back brace for about 4 weeks, and on pain meds for about 6 weeks. When the injury first happened in September, he could barely walk, and couldn't sleep because of the pain. He was already out of work due to a previous surgery, but was supposed to return to work the end of October, so he really only missed about 5 weeks of work.

    His medical bills are about $15k. His income is about $960 per week gross (not sure how they would count that) x 5 weeks. (although the adjuster has all his medical info, he hasn't even asked yet how much my husband makes)

    Next week the adjuster is going to make him an offer and we have no idea what should be ok- can anyone give us some guidance here? Thank you!

  2. #2
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    Default Re: How Will We Know if Their Settlement Offer is Fair

    Quote Quoting daughterofmadness
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    My husband was injured when a rotted floor joist in an old rental home gave way and he fell through the floor, about 8 feet into the dirt basement below. He landed on a cinder block that was on the ground, bruising his kidneys, fracturing 3 vertebrae, and cutting his face.

    The landlord knew my husband was going over to the house (one of my husband's family members rents the home) to check out the floor which had been sagging. It has since been discovered that the landlord often ignored reports of issues with his homes, and several homes that he rents out are in unsafe condition. The city actually now plans to condemn these homes.
    Is your husband a contractor?

    If so, then workers comp doesn't really offer much.

    If not, then what was he doing inspecting the floor?

    What was the agreement between your husband and the landlord over the floor?


    Quote Quoting daughterofmadness
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    The insurance company has accepted liability and said today they will be making my husband a settlement offer by the end of next week. One of my co-workers mentioned that he shouldn't take the first offer they make. I am an insurance agent but do not work in claims, so I have no idea what is fair or not.
    Has your husband collected from disability/workers comp for being out 5 weeks or the weeks prior to the fall? If not, why not? If so, then subtract what was paid from his gross income and you can add the balance to your bargaining/settlement.

    Quote Quoting daughterofmadness
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    My husband has a small scar on his face from the gash, but otherwise his fractures have healed. He was out of work from mid September and was just released from the dr's care today. He was in a back brace for about 4 weeks, and on pain meds for about 6 weeks. When the injury first happened in September, he could barely walk, and couldn't sleep because of the pain. He was already out of work due to a previous surgery, but was supposed to return to work the end of October, so he really only missed about 5 weeks of work.
    What was the prior surgery for? Are his new injuries totally different from his prior injuries or did the fall complicate matters worse?

    Is he suing for his prior injury?

    The scar? Was/Is your husband a model? Small scar as in under a quarter of an inch?

    Quote Quoting daughterofmadness
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    His medical bills are about $15k. His income is about $960 per week gross (not sure how they would count that) x 5 weeks. (although the adjuster has all his medical info, he hasn't even asked yet how much my husband makes)
    Has he filed a disability claim or a workers comp claim, they should pay for the missing paycheck that he has been missing? If so, subtract what was paid over the 5 weeks ($4,800) and add that amount to the bargaining/settlement. If not, why not?

    Who paid his medical bills and covered his prescriptions? The landlords insurance company? Workers Compensation? His personal medical insurance? If you sue, I'm sure workers comp/personal insurance will want to recover from the settlement what they gave towards medical bills. How much is he out-of-pocket from co payments and deductibles? You can add this to your bargaining/settlement.

    Quote Quoting daughterofmadness
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    Next week the adjuster is going to make him an offer and we have no idea what should be ok- can anyone give us some guidance here? Thank you!
    Start with what was lost from the income of $4,800 and his out-of-pocket expenses.

  3. #3

    Default Re: How Will We Know if Their Settlement Offer is Fair

    My husband is not a contractor. His aunt called saying that her floor was sagging and that her landlord wouldn't fix it. The landlord had previously used jacks to lift portions of the floor from beneath. The aunt asked the landlord if someone else could fix it would he supply the materials (he owns a building supply salvage business) and he said yes. About a month before the accident and before even seeing the floor, my husband went to pick up a truckload of what amounted to scrap lumber, ect, from the landlord. He thought he would be dealing with replacing the subfloor, which is simple. He and a few cousins were actually checking out the floor when it gave way, but my husband was the only one to fall through. Turns out this landlord is very much a slum lord. When I went to tell him that my husband was hurt, he shrugged his shoulders, laughed at me and wished me luck. That is when I went straight to the city office and found out that most of his over 100 properties don't meet city standards. But I digress. There was not a specific agreement between my husband and the landlord. The landlord was aware that the floor was sagging, and he was aware that joists were rotted. He was aware that his tenant was going to have a family member check it out and he was supplying the material to fix it. Apparently this sort of arrangement has happened in the past, but not with my husband.

    The landlord's general liability policy is what will be paying out. My husband doesn't have disability insurance and this wasn't a work comp injury. So far, our health insurance has paid all medical bills, and we didn't have to pay anything out of pocket because we had already met our yearly maximum due to his earlier surgery. The GL policy will reimburse our health insurance or we will have to reimburse the health insurance from the settlement.

    The previous surgery was heart surgery- totally unrelated. This injury didn't worsen that condition in any way. He was supposed to return to work in late October, but was injured in the fall mid September. He is in his mid 30's, so he is quick to recuperate. The scar is about an inch and a half long, 1/4 inch wide and is in front of his temple. The skin was gouged out, so there was nothing to stitch together. No, he's not a model.

    While he isn't looking to get rich from this injury, I want to make sure he is compensated fairly for his pain and suffering. He dealt with a month of severe pain and another month of moderate pain before it started to slack off. The fact that the landlord laughed at me and shrugged me off (though he did give me his insurance agents name and number while telling me good luck) pissed me off- especially when I knew my husband could barely walk up steps at the time and wasn't sleeping because he couldn't get comfortable. The landlord's insurance company will probably non-renew him over this. They inspected the houses just on this one road and were chewing him out in front of the whole neighborhood. The city will also be coming to inspect soon and has told me that they will be condemning these homes.

    We have been told that this is essentially a slip & fall case (though there was no slipping, only falling). The landlord knew there were problems. My husband could have been just visiting and fallen same as he was there looking to see where the floor was sagging. He was being careful by walking on the joists as to not fall through the subfloor. He had no way to know the joists themselves were bad. (several were found to be rotted)

  4. #4
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    Default Re: How Will We Know if Their Settlement Offer is Fair

    Was there or would there had been any compensation from the landlord?

    Was your husband employed (W-2/1099) prior to his heart surgery? Was he unemployed or working under the table (off the books)?

    If he was working then he should file for disability for wages that he lost do to his surgery. If he was unemployed or working under the table, he can't claim lost wages with the insurance company. He would need to prove his income.

    Be careful with what you turn down from the insurance company as they may want to push the issue that your husband was a independent contractor or a sub contractor for the landlord and should have held his own insurance.

  5. #5

    Default Re: How Will We Know if Their Settlement Offer is Fair

    There was not to be any compensation from the landlord. My husband was just going to help his aunt, and he had the time to do so since he wasn't back at work yet. My husband felt bad that the landlord wasn't fixing it and apparently the floor sagged bad enough to let a draft in at an outside wall, so they wanted to fix it before it got cold.

    My husband was employed full time as a truck driver. He had emergency open heart surgery in February. NC doesn't have temporary disability, and he didn't have short or long term coverage through his employer or on his own. His employer was expecting him to come back to work in late October when his cardiologist and the DOT cleared him. He was delayed returning to work due to the fall.

  6. #6
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    Default Re: How Will We Know if Their Settlement Offer is Fair

    Your husband worked over 365 days for his employer, and he was on or off the books?

  7. #7

    Default Re: How Will We Know if Their Settlement Offer is Fair

    He worked for his employer for several years. On the books. The last pay stub I have is from June. He actually tried to return to work then after February's heart surgery, but wasn't well enough. The boss and dr agreed he needed more time.

    Just to make sure there is no confusion. He has worked for this company for about 4 years. In Feb of this year he had emergency heart surgery. He tried to return to work at the end of May, lasted a few weeks, couldn't hack the schedule and his blood pressure meds were making him dizzy. Dr says he needs more time, boss says ok, they aim for end of October to return to duty. In september, he falls through the floor, and then it is the Orthopedist that keeps him out of work until December 4th. So, since he was already supposed to be out till the last week of october, I am only counting from then till now.

  8. #8
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    Default Re: How Will We Know if Their Settlement Offer is Fair

    No offense to WhosThatGuy but the discussion about work comp, disability, contractor etc is pretty much irrelevant.

    Let's go back to the basics.

    The landlord's insurance company has accepted liability for your husband's injuries and will make an offer.

    Your husbands medical bills were about $15,000 and loss of income about $4800. Duration from injury to recovery (back to work) about 5 weeks. Injuries including bruising his kidneys, fracturing 3 vertebrae, and cutting his face resulting in a small scar. Make sure you add in any out-of-pocket expenses other than medical.

    I'm sure your husband was in a lot of pain but, in the grand scheme of things and with the rapid recovery, I wouldn't expect more than about $5000 for the pain and suffering portion of the claim plus the medical bills and lost income.

    Some advice:

    1 - Don't wait for the adjuster to ask about the loss of income. Fax, write, or email the amount to the adjuster along with a letter from the employer confirming the amount from the date of the injury through the date of return to work.

    2 - Don't be in a hurry to settle. Give your husband a couple of months to make sure there are no residual issues that might come up. Once he signs a settlement agreement, he's done. There's no more money, ever, no matter what comes up as a result of this injury. Don't worry, the claim won't go anywhere.

    3 - When your husband gets the offer from the adjuster come back to this thread with the amount of the offer for further discussion.

  9. #9

    Default Re: How Will We Know if Their Settlement Offer is Fair

    Quote Quoting adjusterjack
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    No offense to WhosThatGuy but the discussion about work comp, disability, contractor etc is pretty much irrelevant.
    Thank you- I was very confused about where he was going with that, but thought maybe I had missed something.

    Quote Quoting adjusterjack
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    Duration from injury to recovery (back to work) about 5 weeks
    Duration from injury to recovery was actually about 12 weeks.

    The fall was in mid-September, but he was not released to return to work until yesterday (12/4/14). He was already out on medical leave when the fall happened, which is why there is actually only 5 weeks of lost wages. Now, when I say he was out on medical leave, its not like he was unhealthy or incapacitated. His heart surgery was in February- so he was mostly recovered. The DOT just has strict guidelines about putting you back on the road.

    The fractures have healed well and his ortho said he shouldn't have any residual effects.

    So, we have the doctor bills, the lost wages at 5 weeks, and 12 weeks of recovery. How do you think that changes the pain and suffering amount, if at all?

    I will definitely come back when they make him an offer. We appreciate your input.

  10. #10
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    Default Re: How Will We Know if Their Settlement Offer is Fair

    I thought that it was required for the employer to pay for short term disability in NC. Thinking that, I was getting at the State would owe your husband lost wages and that the insurance company would subtract that amount from the settlement offer.

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