Insurance Policy Terminology
Disclaimer: The information supplied on
this web site is general in nature and should
not be relied upon to make legal decisions
-- for every rule cited, there are likely
a dozen exceptions. Interacting with e-mail
on this page or our personal injury questionnaire
does not constitute the creation of an attorney/client
relationship. This web site is an advertisement
for legal services. Any examples of client
cases and results discussed on this web
site are not a guarantee of your outcome
if we represent you in a particular case.
The material contained in this website is
not intended as legal advice. The laws of
other states and nations may be entirely
different from what is described here.
Accident Reconstruction/Accident Reconstructionist
Accident Reconstruction
is a scientific procedure by which the circumstances
of a traffic collision are proven or estimated
by working backwards from the resulting
damage and evidence. For example, the length
of skidmarks, the slipperiness of a road
surface, and the amount of crush damage
to the involved automobiles can be used
to determine, or at least approximate, the
speeds and/or directions of travel of the
vehicles before the collision occurred.
An accident reconstructionist is a person
specially trained in using these procedures
to determine the collision circumstances.
The reconstructionist is an expert witness,
usually retained by either the plaintiff
or defendant in a lawsuit, who can be of
great benefit in cases where fault for a
collision is in dispute. Some police agencies
have their own personnel trained in accident
reconstruction who will be assigned to prepare
independent reconstruction reports about
particularly severe traffic collisions.
Do not assume, however, that the police
officer who prepared your accident report
is a qualified expert. Most of the time
he will not be.
Personal injury attorneys
who are familiar with the best accident
reconstruction experts have a definite edge
in resolving cases.
Adjustor/Insurance Adjustor
Insurance adjustors are
employees or independent contractors of
insurance companies, and are given the job
of settling insurance claims for as little
money as possible. (This is how insurance
companies turn a profit.) Remember, even
the adjustor for your own insurance company
is not necessarily "on your side," but rather
is on his company's side, and has the overall
goals of settling a claim quickly and paying
out as little claim money as he can.
Each insurance company involved in a
particular dispute will have one or more
adjustors assigned to monitor the claim.
If, for example, three different vehicles
are involved in a collision, and each vehicle
owner/driver has insurance, a minimum of
three adjustors will be involved. Frequently,
other "invisible" adjustors are also present
-- the supervisors of the bottom level claim
adjustors -- who may be the people with
actual authority to settle cases. If you
have med pay or collision coverage on your
policy, there will also be separate adjustors
handling these parts of your claim. Adjustors
are individuals with their own quirks, and
attorneys who know adjustors well and have
good working relationships with them are
better able to settle their clients' cases
for optimum value.
Even after a lawsuit is filed,
and the insurance company retains the services
of an insurance defense attorney to represent
their insured client, the adjustor is still
present in the case, working with the defense
attorney and retaining the authority to
settle a case short of a jury award.
Alternative Dispute Resolution
Many courts now encourage
(or even require) people involved in lawsuits
to attempt to resolve their disputes through
formal methods other than court trials.
These methods in general are referred to
as Alternative Dispute Resolution (ADR),
that is, alternative to the formal court
process of a trial. In California, for example,
court ordered arbitration is mandatory in
nearly all civil cases before the lawsuit
can be brought to trial, so it's not usually
referred to as "alternative." Voluntary
forms of alternative dispute resolution
such as mediation or agreeing to a binding
arbitration are strongly encouraged by the
courts and may benefit the client in a particular
case.
An experienced personal injury
attorney will be thoroughly familiar
with all forms of alternative dispute resolution,
including the format and requirements of
each method and the arbitrators and mediators
likely to be involved, thus giving the attorney's
clients a significant edge in resolving
their claims quickly and for full value.
Arbitration/Arbitrator/Arbitration Award
An arbitration is a legal
hearing, less formal than a trial, in which
each side in a lawsuit or dispute offers
evidence and testimony to a neutral hearing
officer (the arbitrator). The arbitrator
is typically an experienced attorney or
a retired judge. The arbitrator will render
an award in favor of one side or the other
in a particular amount of money -- depending
upon the type of arbitration, this award
may or may not be a binding award. There
are two types of arbitration hearings which
typically apply to personal injury claims
-- court-ordered mandatory arbitration in
which the award is not binding (but still
of critical importance in resolving a case)
and binding arbitration in which the award
is final. The final resolution of uninsured
motorist claims and underinsured motorist
claims is always through a binding arbitration,
and any other type of dispute may also be
submitted to a binding arbitration at the
discretion of the parties involved.
Experienced personal injury attorneys
will have been through many, many arbitration
hearings for their personal injury cases
(and may indeed have acted as arbitrators
themselves in other people's claims), and
will therefore benefit from their familiarity
with the process when handling new cases.
Attorneys
For the purposes of personal injury
cases (as opposed to divorce attorneys,
probate attorneys, tax attorneys, etc.),
attorneys come in two types: the plaintiffs'
personal injury attorney (PI attorney/ plaintiff's
attorney), and the insurance defense attorney
(defense attorney). Personal injury attorneys
are paid by their clients out of the proceeds
collected on their behalf via jury verdicts,
arbitration awards, and/or settlements.
These fees are specified by the contingent
fee agreement that the client and attorney
signed when the case was begun. Insurance
defense attorneys are paid by insurance
companies to represent the companies' "insureds,"
the negligent persons who have insurance
policies and who are being sued as the defendants
in personal injury lawsuits. These defense
attorneys technically represent the defendants,
but are actually being paid by the defendants'
insurance company.
Other attorneys may also become temporarily
involved in personal injury cases as neutral
parties such as arbitrators or mediators.
An experienced personal injury
attorney should be able both to
add value to his/her clients' claims and
to handle efficiently the many complicated
aspects of their cases.
Attorney-Client and Attorney Work-Product
Privilege
Generally, all communications
between an attorney and his/her client are
privileged -- that is, they are entirely
confidential, being given special protection
under the law, and no one else (particularly
their opponents in a lawsuit) are entitled
to gain access to them. This is referred
to as the attorney-client privilege. Also,
most documents produced by an attorney and
his staff in regard to the client's case
are also privileged -- the attorney work-product
privilege.
Often times, however,
a defense attorney may seek to acquire access
to these documents through the discovery
process. There are only very narrow and
specific instances where they are entitled
to do so, however, and it is the job of
a personal injury attorney to know these
exceptions and to zealously guard the confidentiality
of the documents and the privacy of his
clients.
Case Evaluation/Claim Evaluation
One of the most difficult challenges
for the private individual handling his
or her own personal injury claim is to know
what their claim is worth. Some people simply
don't feel comfortable in the bargaining
process necessary to settle a claim, but
even those people who are comfortable with
it are at a great disadvantage if they have
no real idea where to start bargaining from.
Likewise, an attorney who is inexperienced
or unfamiliar with personal injury law may
not yet have developed the necessary feel
for the value of a client's case, and may
not yet be familiar with the many resources
available to help evaluate a claim.
Personal injury attorneys who are well-experienced
in resolving personal injury claims will
have developed the knowledge of how particular
factors will influence the value of a claim
-- things such as comparative negligence
issues (in which more than one person was
at fault for an accident), punitive damages
issues (in which the actions of a defendant,
such as a drunk driver, were particularly
reprehensible), and pre-existing medical
conditions of the claimant which may either
increase or decrease the value of their
claim.
Experienced attorneys
will also have access to resources, both
in book form and on-line, which give them
up-to-date details about the claim value
of particular types of injuries. At the
Law Offices of Edward A. Smith, we have
an extensive library with medical and legal
information for evaluating claims. We also
make use of thousands of on-line sites that
give us access to the very latest medical
research and legal decisions that influence
claim values. Some of these on-line sites
are available for free and listed here.
For other sites we pay considerable fees
so that we can meet our commitment to having
the best information possible for our clients.
Claim/Claimant
The claimant in a personal
injury case is the person(s) injured as
a result of the negligence of one or more
other parties. If a formal lawsuit is filed,
the claimant becomes the plaintiff in the
lawsuit and the negligent party becomes
the defendant.
An insurance claim is
made when an injured person or his/her personal
injury attorney informs an insurance company
(or a self-insured business or government
entity) that the injured person will be
seeking compensation for damages that were
sustained.
The insurance claim
is the formal beginning of a personal injury
case. It is initiated when an injured person
(or his/her attorney) contacts the negligent
party's insurance company to inform them
that a claim for damages is being made against
the person or company they have insured.
An insurance claim may also be made with
an injured person's own insurance company
for the payment of medical expenses, vehicle
damage, etc., or if the negligent party
is uninsured.
Every involved insurance company
should be promptly notified if a claim is
being made. In fact, in most instances,
a person injured in a traffic accident has
a duty to notify their own insurance company
within a certain period of time, or the
insurer may deny their subsequent claims.
It is very important
when making an insurance claim to know what
information must be given to an insurance
company, what information need not be given,
and what information should never be given.
Providing more information than required
by law may seriously damage the value of
a personal injury claim in the long run.
Code of Civil Procedure
The Code of Civil Procedure
is the section of state statutes that contains
most of the information about how civil
lawsuits proceed. It includes information
about when and how complaints are filed
to begin lawsuits, when and how they must
be served on defendants by a process server,
how a defendant or his attorney must respond
to the lawsuit, the procedures both sides
may use in the discovery process, and, in
general, most of the steps that must be
taken as a case proceeds either to a settlement,
an arbitration, or a trial.
A private individual
who plans to try handling their own personal
injury lawsuit must make themselves thoroughly
familiar with these rules or find themselves
at a very severe disadvantage. Or, if a
personal injury attorney is being retained,
the individual must make certain that the
attorney is experienced and familiar with
these rules.
Complaint
A complaint is the legal
document filed with a court that formally
begins a lawsuit. It will lay out in very
general terms the circumstances of the incident
that forms the basis of the lawsuit, and
it will also describe in broad terms the
nature of the damages suffered by the claimant.
The complaint will specify who the parties
to the case are -- the plaintiff(s) and
defendant(s). It is vital that these parties
are specified correctly in the complaint,
and any errors must be correctly quickly
or the case may be seriously damaged.
When the personal injury attorney
is ready to formally bring the defendant(s)
into a case, the attorney will have the
complaint served upon the defendant(s) by
a process server. There are very specific
rules and deadlines for having this done
which must be observed.
Contingent Fee Agreement
When an injured person
hires a personal injury attorney to represent
them in a personal injury claim or lawsuit,
they both sign a contingent fee agreement.
This document is essentially the employment
contract for the attorney and should lay
out in detail all of the terms of that employment.
"Contingent fee" refers to the fact that
personal injury attorneys are almost always
hired on the basis that they will only receive
a fee from the client contingent upon the
client receiving money from the person(s)
causing their injuries. The amount of the
attorney's fee is completely open to negotiation
with the client, although certain fee agreement
are regulated by law -- state law may limit
attorney's fees in most cases handled for
children to 25% of the total sum recovered.
Fees may also vary depending upon the stage
at which a case is resolved -- most attorneys
will charge a higher percentage fee for
a case that proceeds to arbitration, mediation,
or trial, because the amount of work required
of the attorney is much greater in such
a case.
The contingent fee agreement
should also lay out such details as who
is responsible for the costs of the case
and how any money collected for the client
is to be distributed. Most personal injury
attorneys will advance the case costs to
the client and will be reimbursed for these
costs out of the proceeds of the case. Case
costs include such things as court fees,
charges for acquiring copies of the client's
relevant medical records, witness fees and
expert witness fees, deposition fees, et
cetera.
Because of efficiencies of operation,
the Law Offices of Edward A. Smith is able
to offer discounted rates on personal injury
cases taken in via our Web site if the client
is willing to communicate with us through
the case via e-mail.
Court-Ordered Mandatory Arbitration
This is a type of arbitration
that takes place in most civil lawsuits
as a required step before a trial occurs,
because the court hopes that arbitration
will help resolve lawsuits without the time
and expense of a formal trial. The arbitrator's
award is generally not binding upon the
parties involved in the lawsuit (either
party has a period of time to reject the
award -- if they do not do so the award
becomes binding), however an award that
is favorable to one side or the other will
provide important additional leverage in
trying to settle a lawsuit.
It is vital to be properly prepared
for an arbitration of this kind
-- this is one of the primary responsibilities
of a personal injury attorney when the client's
case has moved into litigation.
Damages -- Compensatory/General/Punitive
This term refers both to the description
of actual losses that a plaintiff has experienced,
e.g., "the plaintiff has suffered the following
damages: broken left leg, sprained left
shoulder. . . .," as well as the measure
of these losses as established in monetary
terms. Damages come in three categories:
Compensatory damages
which measure actual dollar-value losses
for such things as medical expenses, lost
income, loss of future earning capacity,
etc.
General damages, better
known as "pain and suffering" damages, which
include the emotional trauma from physical
injuries, pain, humiliation, etc.
Punitive damages, or
exemplary damages, which are designed to
punish a defendant whose behavior in causing
the plaintiff's injuries was especially
egregious.
Deposition
A deposition is a form
of discovery in which a plaintiff, a defendant,
a witness, or an expert witness with relevant
information about a lawsuit is formally
questioned under oath by the attorneys representing
all parties in the lawsuit. The deposition
is similar to the giving of oral testimony
in a trial, but takes place under less formal
circumstances, usually in the office of
one or another of the attorneys. The testimony
is transcribed into a written format by
a court reporter whose costs are passed
on to the attorney (and his/her client)
who scheduled the deposition.
Discovery
After a lawsuit is begun,
all parties to the case have the right to
use certain formal procedures to discover
relevant evidence possessed by the other
parties or by independent witnesses. These
procedures include the use of depositions,
interrogatories, requests for production
of documents, and demands for independent
medical examinations, among others. This
process as a whole is referred to as "discovery"
or the "discovery process," and is regulated
in states by specific sections of the Code
of Civil Procedure.
Economist
An economist is a type
of expert witness who may sometimes be used
in cases where it is difficult to express
an injured person's future monetary losses
in simple, present day dollar terms. These
particular damages may include such things
as lost ability to earn wages in the future
(loss of future earning capacity) and/or
the costs of long-term future medical care
required by their injuries. An economist
can take these future dollar figures and,
through calculations that may involve such
things as work-life expectancy data, long-term
interest rate information, and other economic
details, provide a present day dollar value
for the losses.
Expert Witnesses
Expert witnesses are individuals
trained in some particular specialty, such
as medicine, engineering, accident reconstruction,
or economics. By virtue of this training
they are qualified to render "expert opinions"
or "expert testimony" regarding the facts
of a case. Some expert witnesses may have
had direct involvement in the personal injury
case prior to the beginning of a lawsuit,
such as a treating physician (who directly
provided medical care to an injured person)
or a police investigator at a traffic collision
who is fully trained in accident reconstruction
(although very few officers actually have
more than minimal training in this specialty).
Most expert witnesses, however, are hired
by one side or the other in a personal injury
case for the purpose of analyzing complex
information that falls within their area
of expertise.
Expert witnesses may
be vital to a personal injury case's successful
conclusion, especially in cases where the
facts are highly disputed or particularly
complicated. As personal injury attorneys
gain experience in their specialty, they
will become more and more familiar with
who the most qualified and respected expert
witnesses are. The experienced attorney
is therefore in a much better position to
determine whether hiring experts is necessary
in a given case, and if so, just which experts
should be retained.
Fast Track Court Systems
During the late 1980s and early
1990s, certain state courts changed
over to a new set of timelines for the resolution
of civil lawsuits. These new rules have
been generally referred to as "fast track,"
and require that nearly all civil lawsuits
be promptly processed through the court
system.
Very stringent deadlines
have been established for all the major
stages in a civil lawsuit after the initial
complaint is filed with the court. These
include deadlines for having a process server
deliver the complaint to the defendant(s),
deadlines for the defendant(s) to respond
in court, deadlines for the completion of
the discovery process, deadlines for completion
of arbitration and/or mediation in the case,
and finally, deadlines for the trial of
the lawsuit.
Penalties for failure
to follow all the rules for "fast track"
cases can be very severe, up to and including
complete dismissal of the lawsuit and loss
of any further rights to pursue a claim.
Anyone attempting to handle their own lawsuit
must become familiar with these rules and
deadlines, or their case may be severely
damaged. A good personal injury attorney
will be aware of all the special requirements
for "fast track" cases, and an experienced
attorney will also know how to make use
of these rules in order to benefit their
clients.
Government Tort Claims
The negligent parties in
a personal injury case may include individual
persons, may include corporate or other
business entities that employed negligent
persons, and may also include governmental
entities (cities, counties, states, etc.)
that employed negligent persons. In those
cases where governmental entities are involved,
special rules must be followed as described
in the Government Tort Claims Act. The most
important of these rules requires that a
"claim for damages," prepared in a specific
manner, must be filed with the governmental
entity within 180 days after the injury
occurred. This is a deadline that is separate
from the usual statute of limitations that
must be observed for personal injury cases,
and it can easily be overlooked if a claimant
or an attorney is unfamiliar with the requirement
of the Tort Claims Act.
The claim deadline may
also be overlooked if the case has not been
thoroughly and promptly investigated. For
example, suppose that two vehicles collide
in the middle of an intersection. It may
initially be assumed that one driver was
negligent, even though he insisted he had
a green light to proceed. If a prompt investigation
revealed, however, a number of witnesses
insisting that both drivers had green lights,
and if this were to lead to an examination
of the signal light system that provided
evidence of signal light malfunction, then
the governmental entity responsible for
maintaining the signal lights might be brought
into the case as a negligent party. This
would require the filing of a "claim for
damages" with the governmental entity which
could have been overlooked by a hasty and
incomplete investigation.
A good attorney will
thoroughly examine all the circumstances
surrounding an incident so that all negligent
parties, including government entities,
can be included in the case.
Independent Medical Examinations (IME)
The independent medical examination,
or IME, is a form of discovery allowed by
certain states' Code of Civil Procedure.
Essentially, it provides that the defendants
in a personal injury case have the right
to have an injured plaintiff examined once
by a doctor of the defendants' own choosing.
Supposedly, this doctor is "independent,"
but as a practical matter he/she is an expert
witness who has been hired by the defendants
to conduct the exam and write a report that
highlights medical facts favorable to the
defendants and unfavorable to the injured
plaintiff.
Although it is the defendants'
right to have an IME conducted,
there are many limitations to an IME that
a plaintiff may properly insist upon. For
example, it is appropriate to limit the
medical examination to those parts of the
plaintiff's body which were injured in their
accident. If the personal injury attorney
does not zealously guard the client's right
to privacy, an IME doctor may examine the
plaintiff in ways that have absolutely nothing
to do with the injuries claimed. It is also
proper for a plaintiff to refuse any forms
of examination that are painful or intrusive
and to refuse to discuss aspects of their
medical histories that are irrelevant to
the injuries they have suffered.
If plaintiffs and their attorneys
do not carefully guard the plaintiffs' right
of privacy by insisting that the rules for
IMEs be followed exactly, then the examining
doctor will happily engage in a "fishing
expedition" to turn up as many embarrassing
and irrelevant facts as possible.
Insurance Defense Attorney
When the negligent parties
in a personal injury claim become the defendants
in a lawsuit and the formal complaint is
served upon them, their insurance company
will secure the services of a defense attorney
to represent their interests. The defense
attorney is legally representing the defendant,
but is actually being paid by his/her insurance
company. This can occasionally produce conflicts
of interest which an experienced personal
injury attorney can make use of to his client's
benefit.
Also, since many insurance companies
will contract with particular law firms
to handle all of their insurance defense
cases within a given region, the
defense attorneys who work for these firms
will become very familiar to experienced
personal injury attorneys. This knowledge
of the defense attorneys and their individual
personalities and quirks will give an experienced
PI attorney an important advantage in resolving
cases in which they are involved.
Interrogatories
Interrogatories are a form
of discovery allowed under the Code of Civil
Procedure. They consist of written questions
which one party to a lawsuit presents to
another opposing party, who must answer
the questions under penalty of perjury within
a certain time period. Interrogatories will
usually consist of a number of general information
questions regarding the answering person's
name, address, employment information, educational
history, etc., as well as more specific
questions regarding how the injury occurred,
prior medical history, current medical expenses
and other monetary damages.
As with any other form of discovery,
interrogatories must be responded to within
a given time period and in a specific format
required by law. Failure to promptly or
correctly respond to interrogatories can
result in court-imposed penalties including
monetary fines and limitations upon what
evidence a party may present in the lawsuit.
It is equally important to provide no more
information that what is precisely required
by the interrogatories that have been asked
and to know what types of questions may
be impermissible to ask. In both these areas,
the skills of an experienced personal injury
attorney can greatly reduce the amount of
work required of the answering person and
carefully craft the responses so as to provide
only the specific, relevant information
required and no more.
Investigator
Often a personal injury case will
require more extensive investigation than
can be properly provided by an attorney's
in-house staff. In such instances,
the attorney will often hire a private investigator
for collection of additional evidence, such
as witness statements, photographs of an
accident site, or background research and/or
location of potential defendant. Many private
investigators will also act as process servers.
The costs for these investigative services
will normally be advanced to the client
by the personal injury attorney, to be later
reimbursed as a case cost under the contingent
fee agreement.
Lawsuit/Litigation
A lawsuit is a formal legal action
made by one party or group of people (the
plaintiff(s)) against another person or
group of people (the defendant(s))
in which recovery is sought for damages
allegedly caused to the plaintiff(s) by
the defendant(s). The lawsuit is formally
initiated with the filing of a complaint
in the proper court of law.
"Lawsuit" is a term
used to refer both to the specific documents
filed with a court that start the process,
as well as the entire process itself. "Litigation"
refers specifically to the process.
Liability
Just saying that someone caused
an injury isn't enough -- it has
to be proven, and it has to meet the legal
requirements to establish liability. This
legal conclusion that someone is formally
responsible for injuries suffered by another
is far more complicated than just reading
a traffic collision report to see who a
police officer (who may have little or no
training in either accident reconstruction
or the legal requirements of liability)
has concluded was the cause of an accident.
It may be necessary to establish
liability for many different people/corporations/government
entities involved directly or indirectly
in an incident. For example, it
might involve proof that one negligent person
was driving a vehicle and was responsible
for causing injuries, proof that a second
person owned the vehicle and gave the first
person permission to use it, proof that
a third person or corporation employed the
driver and that the driver was in the "course
and scope" of his employment, and so on.
Establishing liability for injuries
is every bit as important as establishing
the value of the damages that the injured
person suffered. An experienced
personal injury attorney will carefully
review all the facts of an incident and
apply the law to those facts in order to
prove the liability of all responsible parties.
Loss of Consortium
When a person is injured,
that person's spouse may also have a valid
claim for Loss of Consortium. Loss of consortium
represent many things, including the spouse's
loss of the injured person's assistance
in caring for the family home and children,
as well as the additional stress and strain
placed upon the marital relationship by
the physical injuries that were suffered.
Loss of consortium is an element of damages
that should never be ignored.
Mediation/Mediators
Mediation is a form of
alternative dispute resolution similar in
many ways to arbitration in that the parties
to a personal injury case come together
before a neutral referee (the mediator)
in an effort to resolve their dispute. Unlike
arbitrations, however, mediations are entirely
at the discretion of the parties, so the
event can be as formal or informal as desired.
And unlike arbitrators, mediators are not
expected to render a decision in favor of
either of the parties. Rather, the mediator's
place is to aid the opponents in negotiating
with one another and coming to a mutually
agreeable resolution for their dispute.
A mediation can take place at any time in
a personal injury case.
Many courts are now
strongly recommending the use of mediations
before a lawsuit may be brought to trial.
It is critical to be properly prepared for
a mediation because it is a prime opportunity
for settlement of a lawsuit without the
expense of a court trial. It is also extremely
important to know what information should
or should not be provided to an opponent
at the time of a mediation. An experienced
personal injury attorney will have been
through many mediations already, and will
therefore be thoroughly familiar both with
the process and with the attorneys and retired
judges who typically served as mediators.
Medical Malpractice
When a person is injured
due to the negligence of a health care professional,
the injured person may be able to pursue
a medial malpractice claim against the negligent
person and his/her employer (such as a hospital).
Medical malpractice is a sub-specialty of
personal injury attorneys because this type
of claim has many additional rules and requirements
that are not common to other types of personal
injury claims.
Medical Records, Histories and Records
Releases
In any insurance claim or lawsuit
for injuries that a person has suffered,
his/her medical records are typically the
single most important piece of documentary
evidence. These records, showing the treating
physicians' diagnoses, prognoses, and treatments
will establish what specific injuries have
been sustained, will show what the long-term
expectations are either for recovery from
the injuries or for permanent disability,
and will specify the types and costs of
medical treatment that has been and will
be received.
It is critically important
to know which of an injured person's medical
records an opposing insurance company or
party to a lawsuit is entitled to receive
and which other records are irrelevant and
protected by the patient-physician privilege.
An opposing insurance adjustor
will usually seek to have an injured person
sign a "medical records release" as soon
as possible so that the insurance company
can go on a "fishing expedition" through
the injured person's records to see what
they might turn up in the way of potentially
embarrassing (and often irrelevant) information.
For this reason especially, it is important
to consult with a personal injury attorney
as soon as possible to determine what type
of record release is or is not proper. Similarly,
once a case is in litigation, a defense
attorney will attempt to subpoena the medical
records of every one of the plaintiff's
physicians that can be determined. Again,
it is important for the personal injury
attorney to carefully guard his client's
privacy by limiting these subpoenas to only
those records that are relevant.
Medical Reports
Reports that may be requested
from doctors regarding an injured person's
medical conditions will be in one of three
different varieties: a report requested
from a treating physician, a report prepared
by a doctor who has conducted an independent
medical examination (IME) of the injured
person, or a report prepared by an expert
witness doctor hired by one side or another
in a lawsuit (other than for an IME).
Any type of medical report will
cost money, so it will usually
only be requested in an instance where the
medical evidence is particularly complicated,
unclear, or disputed. For example, a report
might be requested from a treating physician
if the doctor's own records aren't completely
clear on certain important points. A personal
injury attorney will usually advance to
his/her client the cost of any necessary
medical reports as an element of the case
costs.
Occupation Rehabilitation/Vocational
Expert/Rehab Expert
Unfortunately, a person who has
sustained an injury may be prevented
either permanently or for an extended period
of time from returning to their normal occupation
and/or specific job duties. If it is necessary
for an injured person to either substantially
change his/her job duties or to seek an
entirely new line of work, there are professionals
referred to as occupational or vocational
rehabilitation specialists who can be of
great help. These experts are familiar with
the physical requirements of all occupations
and can help find types of work for which
the injured person may be best suited. These
professionals are also acquainted with the
types and costs of job re-training programs
that are available.
Occupational rehabilitation specialists
are often hired as expert witnesses by personal
injury attorneys because the long-term employment
prospects of a permanently injured person
and the costs of re-training are often a
very large portion of the monetary damages
in a personal injury case.
Paralegal
Paralegals, often referred
to interchangeably as "legal assistants,"
handle much of the day-to-day work in a
personal injury case, including preparing
standard correspondence, reviewing records,
summarizing deposition transcripts, and
generally assisting the attorney in preparing
the case for settlement demand, arbitration,
and/or trial. Most states do not currently
require that paralegals or legal assistants
have formal training or certification, but
those paralegals who are certified have
additional proof of training for their work.
Other paralegals rely on their long-term
experience rather than certification. Either
type can provide valuable aid for the experienced
personal injury attorney who has learned
to rely upon them.
Physician-Patient Privilege
The records that a physician has
regarding his/her patients, as
well as any communications between the doctor
and patient have a special degree of confidentiality
under the law referred to as the "patient-physician
privilege." When an injured person brings
a personal injury lawsuit to recover for
their damages, they waive this confidentiality,
but only to a certain specific degree --
only as to medical records relating legally
to the injuries they have suffered. An experienced
personal injury attorney will carefully
guard his client's medical confidentiality
for all medical matters not properly relating
to the issues of the lawsuit. This is very
important, because insurance adjustors and
defense attorneys will often seek access
to all of an injured person's medical histories
-- an inattentive person handling his or
her own claim may inadvertently give access
to more of their records than is necessary.
Plaintiffs and Defendants
When a personal injury lawsuit
is filed with a court, it will specifically
name the people, corporations, business
organizations, and government entities involved
in the case. The person or persons who suffered
injury and are seeking recovery for damages
by filing the lawsuit are referred to as
the "plaintiffs." (If recovery was sought
prior to the lawsuit by way of an insurance
claim, these people would have been referred
to as the "claimants.") The person or persons
who are alleged to have caused the injury
are named in the lawsuit as "defendants."
In a personal injury case resulting from
a traffic accident, for example, the defendants
may include parties such as the negligent
operator of a motor vehicle, the owner of
the vehicle, the driver's employer (if the
driver was on-the-job), a public entity
that may have responsibility for an improperly
designed roadway or malfunctioning traffic
signal, and so on. It is very important
not to overlook any possible defendants,
because if they are not brought into a lawsuit
in a timely manner, the injured person's
right to recover from them may be lost forever.Plaintiffs'
Personal Injury Attorney (PI Attorney)
That's us!! The PI attorney
is dedicated to representing clients who
have suffered physical and emotional injuries
resulting from the negligence (or intentional
actions) of other people and/or corporations.
A PI attorney is hired by an injured person
when both the injured person and the attorney
have signed a Contingent Fee Agreement,
which states the conditions of the attorney's
employment by and representation of the
client. In most cases, the PI attorney only
receives payment from the client when the
attorney has secured a settlement, binding
arbitration award, or jury verdict for the
client. This allows even clients of very
modest means to hire the very best attorneys
for their cases. A good personal injury
attorney will be experienced in all phases
of case work, and will be able to properly
guide the client's case while it is an insurance
claim, and, if necessary, on through the
stages of lawsuit, discovery, arbitration,
mediation, and/or trial.
Process Server
Certain legal documents
are required to be delivered or "served"
by a person specially certified to do this
-- a process server. In particular, a process
server will be used to serve a complaint,
summons, and the other paperwork that formally
initiates a lawsuit on each and every defendant
in the case. A process server will also
often be used to serve subpoenas on witnesses
who are not parties to an action, such as
independent eyewitnesses. Many process servers
are also investigators, and vice versa.
Since it's so important
to have these tasks accomplished quickly
and accurately, experienced personal injury
attorneys will be familiar with and employ
process servers who are skilled at their
work.
Product Liability
When a person is injured as the
result of a defective product,
they may have a product liability claim
against such people and corporations as
the manufacturer of the product and any
or all wholesalers and retailers of the
product as it moved from the manufacturer
to the end user. This chain of responsibility
can be very complex, and in such cases it
is vitally important to identify all potential
defendants as early as possible. Also, if
a particular product has resulted in product
liability cases in the past, thorough research
can turn up a great deal of information
to speed new cases to successful conclusion.
Experienced personal injury attorneys
will have ready access to databases and
information exchange forums regarding a
wide variety of product liability data.
Property Damage
In addition to their physical injuries,
a personal injury claimant will often also
have a claim for damage that was caused
to their property. Usually, this involves
damage to their automobile in a traffic
collision, the costs of a rental vehicle,
and sometimes also involves damage to property
that was in the vehicle at the time of the
collision and damaged as a result.
There are usually two paths
that can be followed to resolve a property
damage claim. First, the client may choose
to resolve the claim through their own insurance
company. This is usually a faster and simpler
process than the second path, which is to
present the claim to the negligent driver's
insurance company, however the client may
be stuck with a deductible of hundreds of
dollars or more under his/her own policy.
In this instance, the deductible has to
be recovered from the negligent driver or
his insurance company.
There are no set rules
for evaluating damage to a vehicle -- it's
always a good idea to get repair estimates
from two or more auto repair shops, but
once one or more estimates are submitted
to the insurance adjustor (whether for your
own insurance company or the other driver's)
it all comes down to a bargaining process
with the adjustor. If you've done your research
well, or if your personal injury attorney
has done it for you, you will have a much
better idea of the value of your vehicle
and the damage that was caused to it. This
will put you in a much better position when
it comes time to settle your property damage
claim.
At the Law Offices of Edward
A. Smith, we usually handle the
settlement of property damage claims as
a courtesy to our clients -- we normally
charge no fees on any property damage money
that we recover for our clients.
Proposition 213
Request for Production of Documents
A request for production of documents
is a form of discovery permitted by the
state's Code of Civil Procedure. It allows
any party to a lawsuit to demand that another
party in the case provide to them documentary,
photographic, or other physical evidence
relevant to the case. Both the Request for
Production and the formal response to it
must follow specific formats and deadlines
specified in the law, or the party incorrectly
making or responding to the demand may become
subject to significant penalties. An experienced
personal injury attorney will be fully aware
of these requirements as well as which types
of documents should or should not be provided.
Protecting the privacy of privileged or
irrelevant documents is one of the attorney's
primary duties on behalf of the client.
Settlement
A "settlement" refers to
the resolution of a claim or lawsuit at
any stage prior to a jury verdict or a binding
arbitration award. It simply means that
the involved parties have decided to "settle"
their dispute at some agreed upon value.
This is done entirely at the discretion
of the people involved, however once a settlement
agreement is entered into it becomes binding
upon the parties.
An experienced personal injury
attorney will always have the twin
goals of settling a client's case efficiently
and at a full and fair value.
Settlement Demand
The settlement demand is
often the most important document ever prepared
in a personal injury claim. If the case
settles before a lawsuit is filed, it is
usually as the result of a settlement demand
that the attorney has prepared and delivered
to the opposing insurance adjustor. And
even if the case does not resolve after
a settlement demand is prepared, the demand
can often set the tone for continuing attempts
at settlement as case goes forward into
litigation.
When a personal injury attorney
prepares a settlement demand, he or she
must carefully analyze all factors that
relate to liability (how and why the other
parties are responsible for the injuries)
and damages, including the actual injuries
that were suffered, past and future medical
expenses, past and future wage loss, and
general damages (often referred to as pain
and suffering).
There are a great many factors
that can affect the value of a personal
injury claim, and all of these must be carefully
weighed in order to present a settlement
demand that is high enough to achieve a
full-value settlement for the client, but
not so ridiculously high that the insurance
adjustor dismisses it out of hand. Many
people who attempt to resolve their own
claims without knowing what the claim is
worth will either present a demand that
is either too low to get them what they
deserve or too high to be taken seriously.
Statute of Limitations
State law generally requires
that a person who has suffered a personal
injury must file a lawsuit within one year
after the date of injury or lose forever
their rights to sue for compensation. Therefore,
if an injury claim has not settled within
one year, a lawsuit must be filed to protect
the injured person's rights.
It is important to be aware
that this one-year statute of limitations
does not apply in all cases. Situations
involving claims against government entities
or medical malpractice claims, for example,
have much shorter time limitations which
must be observed. Uninsured and underinsured
motorist claims have other requirements
that must be followed to prevent a claimant's
loss of right to recover.
Claims involving minors as plaintiffs
sometimes have a longer statute of limitations
although a minor only has one year if he
is bringing an uninsured or underinsured
motorist claim.
Subpoena
When a lawsuit is filed by a plaintiff
and delivered to the defendant(s)
by a process server, these people can automatically
require one another to respond to certain
types of discovery and to appear at certain
types of hearings. There may be many other
people, however, who have information that
is relevant to the case but who are not
actually "parties" to the action (i.e.,
plaintiffs or defendants). These may include,
for example, independent eyewitnesses to
a traffic accident, treating physicians
who have provided medical care to the injured
person(s), and/or a police officer who may
have prepared a traffic collision report.
In order to compel these independent persons
to appear and testify at a deposition, arbitration,
or trial, or to provide copies of written
documents in their possession, they must
be served with a subpoena requiring them
to do so.
Traffic Collision Report
Every personal injury case
involving a vehicle should generate an official
report, but this will only happen if the
traffic collision is reported to the proper
authorities. In some states, most traffic
collisions are investigated by the Highway
Patrol, and the official CHP document summarizing
the collision is called a Traffic Collision
Report. If the collision occurred within
the limits of a city, the local city police
department will usually be the investigating
agency, and most police departments use
report forms very similar (or identical)
to the CHP Traffic Collision Report.
Motorists are required
by law to report any traffic accident in
which they are involved if anyone sustains
an injury or if any vehicle sustained more
than $500 in damage. If the police are actually
called to the accident scene, they will
usually prepare a collision report themselves,
of which the people involved in the accident
are entitled to receive copies. Alternately,
a motorist may go directly to a CHP or police
department office and submit a report of
their own, but this should be avoided because
these self-reports are not as effective
and don't carry as much weight as reports
prepared by police officers.
A Traffic Collision Report
will summarize the statements of the people
involved in the collision, summarize the
statements of any witnesses to the collision,
and describe many relevant facts regarding
the involved people, vehicles, streets,
weather conditions, etc. An experienced
personal injury attorney will be able to
rapidly determine the relevant facts of
the collision by closely reviewing all elements
in the Traffic Collision Report, by having
an investigator contact all listed witnesses,
by examining and comparing the location
and physical details of the accident scene
with the facts listed in the report, and,
where necessary, by seeking correction from
the investigating officer of any obvious
errors that may be contained in the report.
Very few police officers
have much formal training in either accident
reconstruction or the legal requirements
of establishing liability, so the conclusions
they place in a Traffic Collision Report
are not exactly written in stone -- rather,
their conclusions are usually only the starting
point in determining liability.
Treating Physician
A treating physician is
a doctor who has actually provided medical
care to an injured person, as opposed to
a doctor who may be hired as an expert witness
by one or another side in a lawsuit to provide
technical expert opinion testimony or conduct
an independent medical examination.
A treating physician
provides two critical services for an injured
person. First, and most importantly, the
physician provides the necessary medical
treatment, specialist referrals, etc., needed
for the injuries suffered. Second, the physician
is both an ordinary witness to relevant
facts in the personal injury case (i.e.,
the observed symptoms and injuries) as well
as being able to provide expert medical
testimony within the scope of the physician's
expertise. On both counts, having a skilled
physician is of prime importance in a personal
injury case.
Trial
Some cases just don't settle.
For whatever reason, the opposing sides
just don't see eye-to-eye on important issues
of liability and/or damages. The case has
probably already gone through the settlement
demand stage, the filing of a lawsuit, discovery,
arbitration and/or mediation, and is now
ready for the formal conclusion of the court
process -- a trial and a jury verdict.
There is no stage in the entire
process of resolving a personal
injury claim in which an individual claimant
or an inexperienced attorney will be more
vulnerable than at trial. The personal injury
attorney must be completely familiar with
the both the statewide rules and the rules
of the local court that may apply to trial
scheduling, jury selection, introduction
of evidence, questioning of witnesses, requests
for jury instructions, and so on.
Uninsured/Underinsured Motorist/Coverage/Claim
Sme sate laws require that all drivers
have a certain minimum amount of bodily
injury liability insurance coverage when
operating a motor vehicle. Unfortunately,
many people either can't afford insurance
or choose not to purchase it for their vehicles.
If you're injured by a person with no insurance,
what can you do? If someone can't afford
to buy insurance, then they're unlikely
to have enough income or assets to compensate
you for the injuries they caused, so suing
them directly may be pointless.
Moreover, whenever someone
purchases automobile insurance, the insurance
company must offer them Uninsured/Underinsured
Motorist coverage with the policy, and this
coverage can only be dropped if the person
purchasing the insurance signs a special
waiver. The Uninsured Motorist portion of
this coverage protects the policy owner,
family members residing with him/her, and
occupants of his/her vehicle if they are
injured by a person who has no insurance
at all. The Underinsured Motorist portion
provides coverage when the policy is for
an amount greater than the amount of the
negligent person's insurance policy. (This
is a very simplified description of the
law. In fact, UM/UIM coverage often presents
some very complicated situations, and it
is always a good idea to seek an attorney's
advice about UM/UIM claims.)
UM/UIM claims are very
different from other claims, because they
are presented to an injured person's own
insurance company. These claims will often
involved discovery patterned along the same
rules as for personal injury lawsuits, but
instead of heading toward a trial in the
long run, UM/UIM claims are ultimately resolved
through binding arbitration.
Witnesses
Witnesses in a personal injury case
can come in two different categories: ordinary
witnesses to events (also referred to as
percipient witnesses) and expert witnesses.
Expert witnesses are medical, engineering,
or other professionals who by virtue of
their expertise are entitled to provide
evidence in the form of "expert opinions"
regarding the facts of a case.
Ordinary witnesses to
events are often vital to the successful
conclusion of a personal injury case. In
particular, witnesses who are not associated
with either the plaintiffs or defendants
in a case are often viewed as neutral parties
with no reason to favor one side over the
other, and therefore their presumably unbiased
statements can carry great weight. An experienced
personal injury attorney will always have
a staff employee or private investigator
interview any and all neutral witnesses
in a case. This must be done very carefully
so that it does not later appear to be producing
bias on the part of the witness. It is also
vitally important to know when to have the
witness's recollections reduced to a written,
signed statement, and when it is better
not to have this done, because the written
statements may be acquired by an opposing
party through discovery.
Wrongful Death
When a person dies due to the negligence
of someone else, a wrongful death
claim results. The rules for wrongful death
insurance claims and wrongful death lawsuits
are generally the same as for claims and
lawsuits resulting from non-fatal injuries,
however there are at least two important
factors which are different: 1) If the deceased
did not die immediately, then compensation
for certain damages sustained by the deceased
may be pursued by his/her estate; and 2)
it must be determined which of the deceased
person's surviving relatives are entitled
to receive compensation by way of a wrongful
death claim or lawsuit. In some states,
the relatives entitled to do this are specified
by statute. Obviously, these situations
can be further complicated by the presence
of a will and/or by disputes among the surviving
relatives, and a personal injury attorney
will be able to help sort out these matters.
Insurance Policy Terminology
The following insurance policy terms
are defined in very broad language.
The specific definition of each term can
only be determined by a very precise reading
of the particular insurance policy in which
they are contained -- the meaning of a term
is rarely identical from one insurance policy
to another. The terms may be further limited
or expanded by the laws of the state where
the policy was issued and/or the state in
which an accident occurred.
The most frequent disputed term in any policy
is the "insured," that is who may be covered
for a loss by the policy. This generally
breaks down into two categories: the "named
insureds" and all other insureds. The "named
insureds" are the people in whose names
the policy is actually issued -- if you
have an auto insurance policy issued in
your name, then you are a "named insured
under the policy." Other people not named
on the policy may also have coverage available
under the policy. Again, only a detailed
reading of the policy mixed frequently with
a lot of arguing (and an occasional lawsuit)
can determined who is and is not an insured.
Bodily Injury
Bodily Injury Coverage
will cover claims made against the policy
by people who were injured in accidents
caused by the named insureds and/or another
person who may have been driving a covered
vehicle with the insured's permission. This
will generally cover all aspects of damages
except for property damage which has its
own separate coverage. There are frequently
restrictions on who may make a claim for
Bodily Injury. For example, if the injured
person is a member of the insured's household,
they are frequently excluded from coverage.
Also, injuries caused by intentional act,
such as an assault and battery, cannot (by
law) be covered by insurance in some states.
Collision/Property Damage
Collision/Property Damage Coverage
will cover damage to vehicles and their
contents involved in an accident -- both
your vehicle and any vehicle you may have
been responsible for damaging. If a person
has struck your automobile in an accident,
you may be able to pursue a claim for property
damage under either your insurance policy
or under the negligent party's policy. If
you have a deductible on your own collision
coverage, then this amount can only be recovered
from the negligent party or his insurance
company. If the damage is paid for under
your own policy, then your insurance company
will seek reimbursement from the negligent
party or his/her insurance company.
Comprehensive
Comprehensive Coverage
will generally cover damage to your vehicle
and its contents from causes other than
traffic collisions. The specific will often
vary from policy to policy, but this generally
covers such things as theft, vandalism,
and non-collision physical damage.
Medical Payments
Medical Payments Coverage
will cover a certain amount of reasonable
and necessary medical expenses incurred
by any person involved in an accident caused
by the named insured or other driver of
a covered vehicle, or any person injured
on a premises covered by the policy. If
you don't have other health care coverage
adequate for your injuries, then Medical
Payments Coverage can help you get the prompt
medical care needed for your injuries. It
can also be used to pay for medical expenses
for items not covered by your standard health
insurance.
If you use Medical Payment Coverage
under your own policy, then you should be
aware that many policies try to require
that some or all of the coverage provided
to you must be repaid to the insurance company
if you ever receive compensation from the
negligent person or his/her insurer. This
repayment can often be reduced or even waived,
and an experienced personal injury attorney
will know how to do this.
Uninsured/Underinsured Motorist
Uninsured/Underinsured Motorist
Coverage provides you with coverage
for injuries caused in a traffic accident
by a negligent person who either has no
automobile insurance at all (uninsured)
or has insurance that is inadequate to fully
compensate you for your damages (underinsured).