If you’re ever in a bike crash, do you understand what you would need to prove in order to get compensation? The first question of course is who was at fault.

Question of Fault

There can be clear (one-sided) fault or comparative fault (both parties) involved in an accident between a vehicle driver and a bike victim. A good example is if you’re riding your bike on a trail but fail to make a full stop at a stop sign where a driver comes to a full stop. When you both proceed, there’s a collision that could’ve been avoided by both parties making a full stop. If the opposing counsel can prove the cyclist was 25 percent at fault, it would reduce the claim by that percentage. So following the rules has real life, real world consequences.

Question of Injuries

The biggest single factor in determining compensation, other than fault, is evaluating a cycling injury and its seriousness. What treatment is required and how long will recovery take? Will there be any limitation on activities in the future? In the case of a knee injury, if the victim has surgery but the doctor determines that the injury to the knee affected the joint surfaces of the knee, it may lead to post-traumatic arthritis, which opens up a whole other panorama of treatment options including knee replacement. So the value of the claim needs to account for what happened immediately, the required treatment afterward, and the future requirements of the victim.

Cost of Treatment and Amount of Compensation

With a serious injury any hospital stay is going to be expensive. Let’s say the cost ends up being $100,000. With health insurance (Medicare, private insurance, PIP), to the extent that it pays, that $100,000 amount could be reduced to as little as $30,000 depending on the policy. While the total amount of medical bills is a benchmark of the extent of treatment received, the real value driver of a claim is not the billed amount but the actual amount paid by insurance. The paid or lien amount is what will have to be satisfied from any settlement. It is the number used by any insurance company and your attorney. With an attorney’s help, that paid or lien amount owed to Medicare or health insurance company is generally reduced significantly. This reduction results in a higher net in your pocket amount.

Costs of Possible Surgery in the Future and Your Claim

In terms of future medical treatment, the injured person may be told by their doctor that they’ll likely need surgery in two-to-five years as a consequence of the accident. In this situation, I owe my client an explanation that if they settle the claim today with a recommendation for a surgery needed in the future, no insurance company is going to pay out the actual cost of a future surgery today. So the insurance company will typically add value to what the claim may be worth, but not the amount of an actual current surgery. It’s better to have the surgery first if insurance is there and then settle the claim.

What Type of Insurance Do You Have?

In a bicycle crash, we want to investigate what type of insurance policy the driver or the owner of the vehicle has. What company and how much liability insurance is available? Does the cyclist have uninsured/underinsured motorist coverage on an auto policy in their name or in the name of a family member with whom they reside? In many cases the value of the claim may exceed the amount of insurance on the defendant driver’s car. Then we look to the uninsured or underinsured portion of any policy available to the victim to help fully pay the full value of the claim. It’s the most important insurance a cyclist can have on their auto policy because it protects them in an accident with a vehicle.

The Issue of a Claims Calculator

The value of a claim depends on a number of factors which no internet search-based claims calculator can accurately predict. First of all, there’s the comparative fault factor that’s likely to surface and which cannot be predicted ahead of time. As an avid, lifelong cyclist, I’ve been able to cut through some flimsy arguments about comparative fault by claims adjusters and attorneys defending insurance companies.

In terms of determining actual medical bills, claims calculators are also deficient.
One example is the difference between medical charges with insurance and those without insurance. The numbers can vary pretty drastically so can’t be fairly or accurately evaluated by a claims calculator. Factors mentioned earlier, like future medical bills and/or future expenses of surgery and treatment, have to be figured out and factored one by one into any claim. So when we go to settle a case, we’re going to plug in actual, not estimated numbers. We use life care planners all the time to calculate what it costs to have, for example, a spinal nerve ablation done every year from age 40 to age 65. It’s a lot of money that goes into driving the full value of a claim.

The Value of an Attorney’s Advice

Most people have no idea what their claim might be worth or how an insurance company values a case. It’s an attorney’s business to know such things and to be able to get medical bills reduced by a significant number. That reduction amount will often suffice to cover much or most of the attorney’s fees as a percentage of the overall claim.