Negotiating with Computers | Part 4

by | May 17, 2023 | Negotiating with Computers

Increase Value with Duties Under Duress and Loss of Enjoyment of Life

Did you know that 50% of the value in a case comes from duties under duress and loss of enjoyment of life? Are you properly formatting your settlement demands to get value put on these two categories of damages? Or are you leaving money on the table in every case? 

What do these categories of damages include?

Duties under duress is a category of damage involving a person’s pain while conducting an activity. If a person refrains from taking part in an activity because it would be too painful or they are simply unable to do it due to the significance of their injuries, this category will not apply. It is only for those activities they choose to do and cause them pain.

Loss of enjoyment of life accounts for the effects to the quality of a person’s life following an accident. Specifically, these are activities that bring them joy but they are unable to take part in.

Loss of enjoyment of life is considered to be a permanent loss. It why the insurance company will not put value on loss of enjoyment of life without an impairment rating. In the insurer’s eyes, there is no permanency with an impairment evaluation performed by a qualified medical doctor.

Without the impairment rating, a person is not disabled in their opinion. If they are not disabled, then there are no activities they are unable to take part in. While this is wholly inaccurate, it is the framework we have to operate in.

As we discussed in Part 2 on impairment ratings, an adjuster cannot access the portion of Colossus that involves loss of enjoyment of life unless they enter an impairment rating. Colossus prevents access to this portion of the program.

Let’s Dive Deeper

These two categories of damages each have the potential to account for 25% of the total settlement offer. They are the method the insurance companies have chosen to determine to what extent pain and suffering has on the claimant’s life and how it will continue to affect them.

As with everything that is inputted into Colossus, it is not enough to simply describe this category of damage in the demand. It must also be noted and explained in the medical records. If it is not documented in the records, the insurer will not put a value on it.

Side Note: If there is one area that treating physicians need to get better in, it is describing the impact the injuries have on their patients. Doctors typically do not bother with this information because it does not affect how they treat the patient. Even doctors who regularly treat accident victims need to be coached on how best to do this. We have a developed in-house form for your clients to fill out and take to their treating provider. If you would like a copy, just ask!

Physicians need to include what activity is affected, why it affects them based on their injuries, and how long it has affected them. While it may be a controversial opinion, you should refuse to work with providers that do not properly document injuries, treatments, and effects on their patient’s lives.

If they expect you to work for them so that they get their lien paid, they need to uphold their end of responsibility and take the time to produce quality records.

It is believed that Colossus will not give value for this category of damages for those under the age of sixteen.

A Bit More on Loss of Enjoyment of Life

Loss of enjoyment of life encompasses five different categories: work activities, domestic activities (activities inside the home such as cleaning), household activities (activities outside the home such as mowing and gardening), school, and hobbies (crocheting, running, kayaking).

Sporting activities are typically encompassed in the hobby’s category, though some of the evaluation programs may evaluate them separately. This includes the weekend hacker at the golf course, someone who plays in tournaments, or the professional player. Colossus will give more value if the person plays competitively or even professionally, as opposed to the weekend hacker at the par-3 down the street.

Additional areas of a person’s life such as missing a vacation, socializing, and entertainment should also be mentioned in the demand. Even if they are not considered within Colossus, they will help you when negotiating with the adjuster to get to the top of their settlement authority.

You should also contact your client’s employer to determine if they are on any work restrictions or accommodations, as this will provide further proof of the extent of the pain. Realistically, whether your client has a desk job or one involving manual labor, they will undoubtedly experience pain while at work.

Don’t limit your client’s claim and settlement value to only material losses. Loss of job security, because they cannot perform the job fully, is just as viable a loss as missing a vacation. The same goes for loss of promotional prospects, loss of status within the company, and the emotional aspects of simply having more difficulty at work. These are separate and distinct from economic losses!

A Bit More on Duties Under Duress

There are four subcategories within duties under duress and they include work, domestic, household, and studies. As you can see, these are very similar to those within loss of enjoyment of life. Remember though, these are activities that your client does despite the pain it is causing them.

Things to consider if your client is working: are they working due to fear they may lose their job or be unable to support their family? Are they a stay at home parent and thus experience pain while cooking, cleaning, and picking up their children? Value drivers that can be entered into Colossus include difficulties bending, kneeling, and lifting, as well as vertigo, dizziness, and depression.

The same applies to domestic and household household duties such as cleaning, laundry, and cooking. Colossus will require additional information if this subcategory applies, including whether they are a single parent, the age of the children, and the duration of the difficulty.

If you have a client that is in school part time or full time, have them discuss this with their physician. Walking long distances across campus carrying heavy textbooks, sitting for long periods in class, and mental fatigue and anxiety need to be documented in the records. More value will be placed on these items if they are pursuing a higher degree. If the physician did their job, you can then properly format your demand to get value for this category of damage.

Conclusion

As we have hopefully convinced you, your settlement demands must be properly formatted to make a claim for loss of enjoyment of life and duties under duress. You must also work with physicians who understand the importance of documenting every area of injuries affecting their patient’s lives. If you fail to make a claim in your demand, or the physician does not document the issues, Colossus will not give value to these two categories of damages.

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