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Insurance Tactics

How do I know if the insurance offer is fair?

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You usually can't tell on your own — and that's by design. A fair value depends on your total medical bills, future care, lost income, and non-economic harm like pain and limitations on your daily life, weighed against the available insurance coverage. Adjusters count on you not knowing those numbers. Before accepting any offer, have a lawyer value the claim; if it's already fair, a good lawyer will tell you so.

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Before the number: are you finished treating?

If your doctor has not released you and has not told you what the remaining care looks like, the honest answer is that nobody can tell you whether the offer is fair — not the adjuster, and not a lawyer who says otherwise. Future care is often the largest line in a serious claim, and until it has a shape, the claim does not have a value. An offer that arrives while you are still treating is an offer priced on incomplete information, which is precisely why it arrived then.

What goes into the number

Texas divides damages into economic and non-economic, and both are recoverable for the past and for the future.

Past medical expenses, limited by statute to what was actually paid or incurred — not the sticker price on the hospital bill. This surprises people: a $40,000 billed charge that a health plan settled for $9,000 supports the smaller figure.

Future medical care: injections, therapy, a recommended surgery, the replacement of a hardware implant twenty years out.

Lost wages, which is documented income you did not earn, and lost earning capacity, which is a different and often larger thing — the diminished ability to earn going forward. A roofer with a permanent lifting restriction has a capacity claim even if he is back at work.

Non-economic damages. The Texas statute names them: physical pain and suffering, mental or emotional pain or anguish, disfigurement, physical impairment, loss of consortium, loss of companionship and society, inconvenience, loss of enjoyment of life, injury to reputation, and other non-pecuniary losses. Texas places no cap on these in an ordinary injury case. The $250,000 cap people have heard about applies to medical malpractice claims, not to a car wreck.

In cases of gross negligence, fraud or malice, exemplary damages may be available — but the standard is clear and convincing evidence, the jury must be unanimous, and the amount is capped by formula. They are rare and should never be assumed into a valuation.

What limits it

Two ceilings operate independently of how badly you were hurt.

Available coverage. A catastrophic injury caused by a driver carrying Texas minimum limits of $30,000 per person runs into a wall at $30,000 on that policy, no matter what a jury would award. This is why identifying every policy — UM/UIM, an employer's commercial coverage, an umbrella, a second at-fault driver — often matters more than arguing about pain and suffering.

Comparative fault. Your percentage of responsibility comes straight off the award, and above 50 percent you recover nothing. An adjuster asserting you were 30 percent at fault is asserting a 30 percent discount, and that assertion deserves the same scrutiny as the medical numbers.

Gross versus net — the comparison people get wrong

The question is never "is this number big." It is "what do I keep, and what would I keep the other way."

Out of any settlement come the hospital's lien, your health plan's reimbursement claim, any medical provider treating on a letter of protection, and the fee. Some of those are negotiable and most people do not know it: a Texas hospital lien is limited to a reasonable and regular rate and to the first 100 days, and most health plans' reimbursement is capped by statute at a share of the recovery, with the made-whole doctrine no longer available as a defense. Getting those numbers reduced is ordinary work, and it changes the net far more than the last $2,000 of negotiation does.

That is the real test of an offer. If ours does not beat what you would net on your own, we will say so.

Authority: Tex. Civ. Prac. & Rem. Code ch. 41 · Tex. Civ. Prac. & Rem. Code ch. 33 (proportionate responsibility)

What to do

Your next steps

First

Ask your doctor where treatment ends

No valuation is possible until the future care has a shape.

Collect

Bills with amounts PAID, not billed

The paid or incurred rule means the sticker price is not the claim.

Find

Every policy, not just the at-fault driver's

UM/UIM, commercial, umbrella, a second driver. Coverage is often the real ceiling.

Then

Compare net to net

After liens and fee, both ways. That is the only comparison that means anything.

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