Company vehicle ran a stop sign.
There is typically no requirement for mediation to take place. This is true of what you refer to as a "commercial policy." I assume that you mean that the policy in question is an insurance policy on a commercial vehicle. Mediation can take place upon agreement of the parties. Since mediation typically costs money...the mediator is not free... the insurance company typically will not engage in mediation unless and until a lawsuit has been filed. There are pre-suit mediations that take place but they are typically in very strong cases where you are represented by an attorney. As they say, you can ask for anything but whether or not you get it is another question. You can ask for the policy maximum but the value of your case is dependent upon many things including, but not limited to your economic losses, such as medical bills in the past and those anticipated in the future, lost income in the past and anticipated in the future etc. It may also include non-economic damages that would include pain, suffering and mental anguish as well as physical incapacity and perhaps physical deformity or scarring etc. Further, it depends on the liability facts of your case, or, who is at fault and why. Lumbar surgery can be a very serious and expensive surgery and can sometimes leave a person disabled from their employment. Vocational, or job, losses in the future can be hard to determine. The bottom line is that you can ask for the policy limits but without an attorney you have no idea as to how, or whether you should ask for the policy limits. In addition, if you have UM/UIM, or uninsured/underinsured coverage then you would typically need to get permission from YOUR insurance carrier to settle with the carrier for the person at fault or you could jeopardize additional coverage that might be available to you. There are clearly some pitfalls and this could impact you long term so I recommend that you consult with an attorney who, like me, is board certified by the Texas Board of Legal Specialization. While I am Board Certified in both Personal Injury Trial Law and CIvil Trial Law you would do well to find a lawyer that is at least Board Certified in one or the other. Good luck!
In general, yes, you can ask for the policy maximum. However, no insurance company will pay the policy maximum unless you can prove up all of your damages. The insurance company's decision to pay, or not pay, will be guided by what your evidence and what you can prove. So, if you ask for he policy maximum, but you don't have enough evidence to support that amount, the insurance company may not take you seriously.
Since you have significant injuries, I would suggest that you discuss your claim with an experienced personal injury attorney. They will help you prove up your damages and maximize your recovery.
Mediation involves the parties hiring (and paying) a mediator, who is a neutral third party, usually a lawyer, to mediate the dispute with the goal of assisting the parties in settling the dispute. A mediation usually begins with a joint session in which the parties, through their respective lawyers, make presentations to the mediator and each other. The second phase is that the parties break up into caucuses, each caucus consisting of the party, his, her or its lawyer, and his, her or its insurance representative, if any. In this phase, the mediator shuttles between the caucuses to discuss the facts and issues of the case and solicit demands from the plaintiff and offers from the defendant in an effort to produce a settlement agreement.
You can ask for any amount of money you want, but unless you have a lawyer, you pose essentially no threat to the defendant or its insurer, so the offers you receive, if any, will likely be far less than the policy limit.
Mediation is a middle step to a claim. Have you submitted notice of a claim to the insurance carrier? Have you then provided the carrier with evidence of your damages including the police report and any witness statements that establish the liability and fault of the company who owned the vehicle? Have you gathered both your medical bills and medical records to show the extent of your damages? In Texas, the carrier is only responsible for the lesser of the paid or incurred medical bills that are reasonable and necessary to treat the injuries proximately caused by the accident. This means that if you had a pre-existing back injury, the insurer may need more information and evidence to show that the lumbar surgery was caused by the accident not by the pre-existing condition. If you have health insurance that has negotiated a reduced cost for the surgery, your recovery will be the reduced cost of the surgery.
If you have submitted all of the documentation required, and your reasonable and necessary economic damages (medical bills and substantiated lost wages) add up to the a large portion of the policy maximum, you may be justified in making a demand for policy limits. Keep in mind the local experience in non-economic awards (pain and suffering, mental anguish, impairment). Most jurisdictions do not award large amounts for non-economic damages unless the accident was very severe and / or there was some egregious action.
Only after having provided sufficient evidence and making a reasonable demand, then consider filing a suit within the statute of limitations and moving the case toward a mediation.
The most efficient way to determine where you are in the process is to have a competent attorney assess your claim and the evidence you have accumulated so far.
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