Broken bones after a car accident: how a fracture claim works

How fractures happen and how they are described#

MedlinePlus, the National Library of Medicine's health site, defines a fracture as a break in a bone and names car accidents, falls, or sports injuries as common causes. One crash can break more than one bone, and each break is documented and treated on its own.

Doctors describe a fracture in ways that later appear in your records and in the insurer's file. MedlinePlus lists several:

• Partial or complete: whether the bone is partly or fully broken.
• Open or closed: an open (or compound) fracture breaks through the skin; a closed fracture does not.
• Pattern: the direction or shape of the break, such as a line straight across the bone.
• Location: which bone is broken. Facial fractures, for example, include breaks of the nose and jaw.

To confirm a fracture, a provider does a physical exam, asks how the injury happened and will likely order an X-ray or other imaging test. For a claim, that imaging report matters: it records the break on a specific date, close to the crash. Breaks involving the spine, skull or nerves raise other issues, covered in the injuries guide.

Surgery, hardware and the medical bills#

MedlinePlus says the most common treatment for a fracture is a cast or a splint, and that some fractures need surgery to put in plates, pins, or screws. Each stage creates records and bills: the ambulance, the emergency room, imaging, the surgeon and anesthesia, a hospital stay, follow-up visits, physical therapy and equipment such as crutches or a brace.

These costs are economic damagesEconomic damages. Losses with a receipt or a paycheck behind them: medical bills, lost wages, repairs and other out-of-pocket costs. Glossary: losses with a price tag. Who pays them first depends on your coverage. Personal injury protection, medical payments coverage or health insurance often pays while the claim is open, and those payers may be repaid from a settlement. Our guides to who pays medical bills and the types of damages explain how this works.

Time off work and lost wages#

A fracture can keep you from working, especially if your job is physical or you cannot drive. Lost pay is part of most injury claims, and so is a lasting drop in what you can earn, called loss of earning capacityLoss of earning capacity. A lasting reduction in your ability to earn money because of an injury. It looks at what you could have earned, not only at the paychecks you have already missed. Glossary. Texas law, for example, says future loss of earnings includes loss of income, wages, or earning capacity.

In no-fault states, your own policy pays part of your lost income first, whoever caused the crash:

To prove lost pay, people usually gather pay stubs, a letter from the employer listing missed days and pay rate, tax returns if self-employed, and the doctor's notes on work restrictions. Our lost wages guide covers this in detail.

Future care and when a claim is valued#

Some fractures need care long after the first months, such as more therapy or another procedure. Because a settlement is final once you sign a release, many people wait to settle until they reach maximum medical improvementMaximum medical improvement. The point at which doctors expect no further recovery. Claims are often valued once you reach it. Glossary, the point at which doctors expect no further recovery. At that point the doctors can describe what care, if any, is still ahead, and its expected cost can be included in the claim.

Records that support a fracture claim#

A fracture claim rests on paper. These records are the ones insurers usually ask for:

• ambulance and emergency room records;
• imaging reports, including the radiologist's reading of each X-ray, CT or MRI;
• the operative report, if you had surgery, which names the hardware used;
• follow-up notes from the orthopedic doctor and the physical therapist;
• work notes and written restrictions, such as no lifting or no driving;
• itemized bills, receipts and a mileage log;
• photos of the injury, the cast and any scars, and a short journal of pain, sleep and missed activities.

Under HIPAA, a provider must act on your written request for records within 30 days. Our guide to medical records explains how to request them.

Permanent impairment ratings#

Some fractures leave a lasting loss of function. Once recovery has leveled off, a doctor may give an impairment ratingImpairment rating. A doctor's measure, usually a percentage, of the lasting loss of function an injury left once recovery has leveled off. It describes the body, not the value of a claim. Glossary: a measure, usually a percentage, of that lasting loss. Many doctors use the American Medical Association's Guides to the Evaluation of Permanent Impairment, and the AMA says more than 40 states rely on them as the accepted authority to rate permanent loss of function.

Ratings are built into workers' compensation laws. Texas workers' compensation law, for example, defines an impairment rating as the percentage of permanent impairment of the whole body, and it requires the AMA Guides to set it.

In a car accident claim, a rating works differently. It is evidence that an injury is lasting, not a formula that sets an amount. Even in work-injury systems, the AMA notes, a doctor's rating is often only one input into a complex disability and compensation calculation. The insurer may ask for its own independent medical examIndependent medical exam. An exam by a doctor chosen by the insurer or the defense. Despite the name, that doctor is not your doctor. Glossary, and two doctors can reach different ratings for the same injury.

Broken bones in no-fault states#

In most states, you can claim pain and suffering from the at-fault driver. A few no-fault states first require a serious injury thresholdSerious injury threshold. A rule in some no-fault states that lets you sue the at-fault driver for pain and suffering only if your injury meets a legal definition of serious, or a dollar level of medical bills. Glossary, and several name a fracture or permanent injury:

In Florida and Michigan a fracture is not named on its own; the question is whether the injury fits one of the listed categories. A licensed attorney in your state can explain how courts there apply the threshold.