Serious injury claims are life changing and bring their own unique concerns and challenges. A more serious injury means more medical treatment, not just initially, but potentially far into the future. The same issue applies to lost income. We go through the different losses you can pursue in an Oregon injury case to illustrate the unique issues in the serious injury claim.
It’s about the timing of the medical expense, but also how those expenses are paid.
In any injury claim, there is a claim for the medical expenses already incurred. Generally, proving medical expenses you have incurred for accident related injuries is straightforward. You must prove the medical treatment was necessary, and that the amount charged was reasonable.
When making a claim for future medical expenses, you are proving something that you will need. Usually this requires more certainty in establishing the claim. We often employ life care planners and other medical experts to document the type and cost of future care involved in the serious injury claim.
Even if you prove future medical expense, planning for future payment is another issue. In auto injury claims, Oregon motorists have “no fault” medical insurance coverage on their auto policy. If the medical expense exceeds the available medical coverage in the auto policy, private health coverage takes over.
When resolving the serious injury claim with future medical needs, it may not be clear who will cover future medical expenses. Some health plans exclude coverage for future treatment if an injury settlement or recovery is available to pay those future medical expenses. If Medicare is involved, it may exclude future accident related medical care if there are other settlement funds available to cover that care. These issues require careful planning so our client has access to future care.
In catastrophic injury cases, our client may be eligible for state-sponsored medical and disability benefits. However, if claim resolution is not carefully planned, the claim recovery may cause our client to lose disability, health and housing assistance benefits. Again, it’s about planning for the future.
A serious injury often means a long road to recovery, and a long time off work. Oregon auto policies also provide a disability benefit. However, you must be off work for fourteen consecutive days, and the benefit pays only 70% of your average weekly wage. Also, the maximum monthly wage benefit is capped, and may not be enough to meet your monthly personal overhead.
If you face a long-term absence from work, state and federal family medical leave statutes require unpaid time off from work for major medical issues. However, the leave time varies. Some employers also provide short and long-term disability benefits for non-occupational disabilities. These disability plans very, and often require that you reimburse the plan for any benefits provided if you succeed in recovering compensation for your injury claim.
Proof of future lost income is much like proving future medical expense. Expert witnesses like treating physicians and economists may have to document future disability and calculate actual future lost earnings. Sometimes, there may not be actual future lost earnings, but you may claim a future loss of earning capacity, which has its own value.
Liability or "Fault"
you must prove responsibility or fault to recover compensation for any loss. Many serious injury claims require early investigation to determine who if anyone is at fault. Sometimes, there may be more than one responsible party. Locating and interviewing witnesses or retaining an expert like an engineer may have to prove someone’s carelessness.
Causation: The Connection
you may easily prove someone’s carelessness, and you may easily prove your injury. However, you must show a connection between the careless behavior and the injury. Often, an insurer will admit that its insured caused some injury, but not the injury you claim. You must prove the full extent of the injury and harm you suffered. This often requires medical expertise. Many cases that go to trial involved only a dispute the extent of the injury sustained.
Our Role Depends on Each Case
Some of the serious injury cases we work on involve no dispute over liability, causation or the harm suffered. The bulk of our work involves negotiating liens for reimbursement of medical coverage provided and planning a future that puts our client in the best position possible to have access to health care. Other cases involve a focus on proving responsibility or locating all responsible parties.
If you have a question about a serious injury case in Oregon, contact us. We offer extensive experience and can review your case to help you know where you stand and decide whether you even need an attorney.