What qualifies as a catastrophic injury in North Carolina?  

In our work, we meet people with many different kinds of injuries that occur in a wide variety of situations. Sometimes people want to know if their injury is “catastrophic,” often because this word was used in the fine print of their insurance policy. Depending on what the policy says, it may be a reason for denying a claim or actually paying it, or it may affect how much is paid out.

How Is A Catastrophic Injury Defined?

A catastrophic injury is one that has a permanent and serious effect on an accident victim’s life. Sometimes a person may suffer a severe injury, but after time and treatment, make a full recovery. While their injury may have caused them a great deal of pain and suffering, and they absolutely should receive compensation for their damages if another party was responsible, they did not have a catastrophic injury because it wasn’t permanent. Similarly, a permanent injury that has little effect on your life is not catastrophic, either.

Here are some examples of common catastrophic injuries:

• A back or spinal cord injury that leads to paralysis or losing the ability to walk.
• Traumatic brain injuries. The possible permanent effects are numerous since the injury is in the brain, which controls all functions in the body. Some people may lose the ability to speak or communicate clearly or develop a difficulty with short-term or long-term memory or cognitive function that prevents them from working or enjoying their life. They may also lose some physical functions or have chronic pain.
• Amputation or losing a limb.
• Severe burns, which may cause significant scarring and disfigurement.
• Loss of sight or hearing.
• Serious damage to any vital organ.

The above is not an exhaustive list. If you’ve had an injury that significantly impacts your life, and your doctors believe it is permanent, you could have a catastrophic injury. A North Carolina Automobile Insurance Policy Lawyer can go over the details of what happened as well as your medical records, and help you determine if your injury was catastrophic or not.

How Do Catastrophic Injuries Happen?

A catastrophic injury can be caused by almost any kind of accident. Unfortunately, in many cases we find that a person or entity was negligent, leading to the circumstances that allowed the accident to happen. Here are some common situations that may result in catastrophic injuries:

• Car accidents or truck accidents. Catastrophic injuries are especially likely in crashes involving large trucks, due to their size and weight. However, serious and permanent injury can also occur in a wreck with two smaller vehicles, especially at high speeds.
• Motorcycle, bicycle, or pedestrian accidents. Even a small passenger car can seem massive next to a bike, or a person on foot. Unfortunately, there is far less protection for a person riding a motorcycle or bike, or walking, than there is for someone in a car – no seat belt, no airbags, no heavy metal frame, etc.
• Boating accidents or accidental drownings.
• Workplace accidents. A catastrophic injury is most common on construction sites or in factories. With construction work, large, heavy objects are sometimes lifted up high or moved around, and if an error occurs, a person can be hit or crushed and seriously injured. Crush injuries often result in limb amputation. Hard hats provide some protection for your head and brain, but may not always be enough to prevent a traumatic brain injury. Amputations are also common in some types of factory work where an employee might lose a limb to a large cutting implement.
• Any fall from a great height. This may also be a workplace injury – for example, a window washer falling to the ground could suffer catastrophic injuries.
• Dog or other animal attacks. In some situations, a vicious enough dog may tear off a limb (including fingers or toes). We’ve also seen cases where a dog bite left significant scarring, even on the face in a few situations. Although less common, some people who work with large, typically wild animals like tigers may also lose a limb to an animal attack.
• Defective products. There is a wide range of possibilities with defective consumer goods. A defective product can be anything from a vehicle airbag that fails to deploy in a car accident to an electronic device with bad wiring that burns your house down and leaves you with severe scarring. If you’ve had a serious injury and believe it was caused by any kind of product, please seek a free consultation with a personal injury lawyer to better understand how your accident happened. It can be helpful to hang onto the bad product in these situations.
• Defective medications or medical devices. Sometimes the defective product in question is a medication that was supposed to help the patient feel better, but instead caused them permanent harm, such as organ damage. Medical devices are less regulated than medications and can also cause injury if they don’t work properly.
• Medical malpractice. A defective drug or device isn’t always the issue. Sometimes a doctor or other medical worker made an error that had serious, permanent consequences for the patient. If you believe medical malpractice has impacted your life, speak to an attorney right away.

If I Have A Catastrophic Injury, Why Won’t My Health Insurance Pay For It?

What your health insurance policy will and won’t pay for depends on the specifics of the policy. However, you should not confuse a “catastrophic insurance” policy with coverage for catastrophic injuries. A “catastrophic health plan” is health insurance that may have lower premiums, but only provides coverage after the subscriber has paid for a significant deductible, usually several thousand dollars. Sometimes people purchase these policies because they can’t afford a more robust policy with standard coverage, but are worried they’ll go bankrupt if they have a very expensive medical event.

Unfortunately, medical costs are very high, and you do not need to have a catastrophic injury to rack up thousands of dollars in medical care very quickly. So if you have a “catastrophic” policy, it will eventually start to pay for your expenses, but you will still be responsible for the amount of bills up to the high deductible.

On the other hand, just because you have a lower-deductible policy doesn’t mean that all or most of your treatment will be covered if you have a catastrophic injury. Many policies have limits to how much they will pay in total per year or per medical event. A catastrophic injury often involves a lot of extremely expensive care, so you may reach a limit after which your health insurance policy will not pay anymore. Additionally, most policies pay anywhere from 50 – 80 percent of covered services. If your care is expensive enough, even paying 20 percent could wipe out your finances. In any event, if another party was at fault for your injuries, an attorney can help you seek compensation from the other party or their insurance carrier.

Do I Really Need A Lawyer For My Catastrophic Injury Claim?

Sometimes it seems like your claim should be very simple. You were hurt, severely and permanently. Someone else was to blame. You should just be able to file a claim with their insurance carrier and get all the compensation you need for your medical bills, as well as lost income, pain, suffering, and loss, right?

Unfortunately, it doesn’t always work out that way. Catastrophic injury claims can be quite complicated, and the insurance adjuster is going to do their best to save the company money. What that means for you is that they will try to pay as little as possible on your claim. One common mistake many people make with any kind of injury claim is accepting the insurance company’s first offer without consulting an attorney.

This can be an even bigger problem if you’re dealing with a catastrophic injury. Why? First, it’s very difficult to accurately calculate how much of an award you should get from the insurer. There are many costs an experienced attorney will calculate – your current medical bills, any expected future medical expenses, additional costs for mobility aids (wheelchairs, crutches, prosthetic limbs, hearing aids, home modifications like wheelchair ramps, etc.), the income you’ve already lost, the loss of future earning potential, your pain and suffering (both physical and emotional), loss of enjoyment of life or the ability to do your usual activities, and any other losses you may have experienced. It’s a long list, and putting a price tag on many of these items can be difficult. Most people who don’t work in the insurance or legal field have no idea how to value their claim – but a personal injury attorney does. They’ll figure out a fair amount and fight to get it for you.

Often, this amount is nowhere near the insurance company’s first offer, which is why it’s so important that you speak with a lawyer before making a decision. If the insurance carrier is pressuring you to accept, tell them that you will look over the offer and call them back soon. Then call a lawyer for a free consultation. If it turns out the offer was a fair one, you can go ahead and accept it. If not, your attorney can negotiate with the insurer on your behalf.

Negotiation can also be a tricky part of handling a catastrophic injury claim. Insurance adjusters are well-versed in current state laws and know all the loopholes. They may also threaten you with not paying anything if you don’t take their offer. Or they may claim the accident was your fault and therefore, they don’t have to pay a thing. This tactic takes advantage of North Carolina’s contributory negligence statutes, which state that if a plaintiff is even one percent at fault for an accident, they can’t collect any damages. However, just because the insurance adjuster says an accident was your fault, doesn’t mean they can actually prove it in court. In many situations, your attorney may be able to demonstrate that you weren’t at fault, and the insurer actually is responsible for paying your claim.

These are just a few of the possible complications that can come up with a catastrophic injury claim. Again, these cases are complex, may take time to resolve, and can sometimes require a court case to reach a satisfactory resolution. (The majority of personal injury cases settle out of court, but this still involves a negotiation process that may take weeks or months.) Most people simply don’t have the legal knowledge and experience to go head-to-head with the insurance company and walk away with a fair settlement. Retaining the services of a personal injury lawyer is the best thing you can do for your case.

Whether you’ve already received an offer from the insurer, or have not yet filed your claim, speaking with a lawyer is the best next step to take. Look for an attorney who offers a free, no-obligation consultation so you can learn about your options at no risk and with complete confidentiality.

What If My Injury Is Not Catastrophic?

Even if your injuries were relatively minor, the at-fault party’s insurance should still reimburse you for any medical costs and property damage. If you had a more serious but non-catastrophic injury, you’re still entitled to reimbursement of medical bills, lost wages from time missed at work, other expenses, and pain and suffering. The insurance company will still be inclined to make a lowball offer, but an experienced personal injury lawyer can help improve your chances of receiving the compensation you deserve.

If you or a loved one have been seriously hurt in any kind of accident in North or South Carolina that was caused by another party’s negligence, you should contact Auger & Auger immediately. We know how frustrating and exhausting a catastrophic or otherwise severe injury can be. Our experienced team has helped hundreds of Carolinians recover compensation for accidents caused by another’s negligence.

Learn more about how Auger & Auger Accident and Injury Lawyers can help you by requesting a FREE case review here.

Or call 800-559-5741 to schedule your complimentary meeting with our experienced personal injury attorneys.