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Back and shoulder injuries are common in car accidents. The value of your claim is determined by several factors, including the type of injury and needed medical treatment. Rotator cuff injuries, particularly injuries that require surgery to repair, can be expensive and you will want to be sure you are compensated for your medical bills.

A rotator cuff repair is usually done with either an arthroscope or as a surgery with an open, large incision or a very small incision. If your surgeon repairs your rotator cuff with an arthroscope, they'll put the small camera in one hole, and then make one to three additional small incisions for other instruments. the surgeon will use these instruments to reattach your tendon to your bone. 

How does the insurance company value a claim with rotator cuff injuries?

During settlement negotiations, it is extremely important to be open and honest with your attorney regarding medical records. You will want to prove with medical records that the injury was not pre-existing. Insurance companies love to assert that the injury was pre-existing in order to drive down the settlement amount.

Make sure to get a statement from your doctor proving that the injury was caused directly from the accident. This will help you answer the common questions that insurance companies will ask. You will also want to have all medical records and bills to prove to the insurance company that your desired settlement estimate is accurate. They will likely ask:

  • Was there a pre-existing condition?
  • What is the total of the victim’s medical bills?
  • Does the victim have health insurance?

What is the “Formula” for Settling a Claim with Rotator Cuff Injuries?

There is no specific formula for settling an auto accident case with rotator cuff injuries, but the insurance company is still responsible for your past medical bills; past lost wages; pain, suffering and inconvenience; and any future medical costs that you are likely to incur as a result of the crash. All relevant medical records and bills will be helpful in outlining exactly what the insurance company owes you.

There are four main factors to account for when settling a rotator cuff surgery case. The first factor is liability. Can you prove that the other driver was the direct cause of the accident and your shoulder injury? The second factor is accounting for all financial consequences from the injury. This includes all lost wages, past and future, as well as its impact on your quality of life. The third factor is your medical history. Have you had any prior shoulder injuries or pre-existing shoulder complications leading up to the accident? The fourth and final factor is the monetary compensation the guilty party can contribute, i.e. insurance plan, assets, etc.

Other factors can include:

  • Past and Future Pain and Suffering
  • Physical Impairment
  • Disfigurement
  • Mental anguish

Consult with your attorney and figure out exactly which documents you will need when negotiating with the insurance company.

Should I Get an Attorney for My Accident Claim?

Yes, in our opinion, an attorney will bring value to a surgery personal injury case. Insurance companies will often attempt to settle quickly assuming you will be looking for quick cash. While you focus on recovery, an experienced attorney can handle the negotiations and make sure you receive the best possible settlement. Surgeries are often expensive so making a mistake in estimating the value of your case can ruin your chances of receiving a larger settlement. Remember, insurance companies are looking to give you the lowest possible settlement

Brian Glass
Virginia personal injury lawyer selected to SuperLawyers Rising Stars List and the NTLA's Top 40 Under 40.