The Shoulder
The Shoulder
61
calm-fox-735

UMBI offer came in — is this fair or should I push back?

Long story short: we got hit by an uninsured driver a few months back. He ran a red light at a pretty high speed and T-boned us on the passenger side. My husband was driving, I was in the front passenger seat, and our two kids were in the back — thankfully they walked away fine.

My husband had it worse than me — broken collarbone, needed surgery, spent several days inpatient. He's doing better now but still in PT. Our insurer is handling his claim separately and that one feels more straightforward since the damages are obvious.

My situation is murkier. I didn't go to the ER that night because I was so focused on the kids and honestly felt okay on adrenaline. Two days later I could barely turn my neck. Ended up with a cervical strain, some soft-tissue stuff in my upper back, and what my doctor is calling "possible early-stage TMJ" from the impact. About eight weeks of PT, two MRIs, a bunch of co-pays — my out-of-pocket came to somewhere around $4,000 after insurance picked up the rest.

I missed almost three weeks of work. I'm a self-employed graphic designer so I had to scramble to cover client deadlines AND manage everything at home since my husband was basically out of commission. No paid leave for me obviously.

Our insurer just made a UMBI offer on my portion. It covers my medical bills and a little on top, but I feel like lost income and the whole chaos of those weeks isn't really accounted for. We haven't hired anyone yet.

Is this the kind of thing worth pushing back on, or is a soft-tissue / delayed-onset claim just hard to negotiate? Has anyone dealt with a similar situation?

13replies

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13 replies

  • 17
    keen-beaver-755

    Delayed symptoms are SO common and insurers absolutely know that and use it against you. I had almost the exact same thing — felt fine at the scene, woke up two days later unable to move my shoulder. My first offer was laughably low. Once I documented literally everything — texts to my doctor, a journal I kept about pain levels, emails where I told clients I was behind because of the accident — the number got better. Don't accept the first offer without at least countering.

    • 8
      tired-dreamer344

      Appreciate the detailed write-up. Saving this for later.

  • 8
    careful-owl-728

    They love soft-tissue claims because they're easier to undervalue. No visible broken bone, delayed treatment, you didn't go to the ER — they'll build a whole narrative around that. The offer covering your bills "plus a little" is almost certainly their opening number, not their final one. They fully expect you to push back. That's the game.

    • 18
      kind-bison-267

      Worked claims for years. Here's the honest truth: when an adjuster writes an initial offer, they're pulling from a formula. Your delay in seeking treatment automatically lowers their "reserve" on your file — it's a multiplier thing. What that doesn't capture is loss of earning capacity for self-employed people, which is genuinely harder to calculate but absolutely real. If you can produce invoices, client emails showing delayed work, or bank statements showing a revenue dip during those weeks, that changes the conversation significantly. Submit a counter with documentation and a short written statement about what those weeks actually looked like.

    • 21
      calm-grouse-985

      Not legal advice, but soft-tissue cases with delayed onset and self-employment income loss are genuinely tricky to value without help. A lot of PI attorneys will do a free consult and give you a realistic sense of whether the offer is in the right ballpark for your specific situation. Given that your husband's claim is also open, it might be worth having someone look at both together to make sure nothing is being left on the table. Just shop around — the consult costs you nothing.

  • 17
    quiet-mole-354

    A couple of things worth knowing: UMBI claims are typically subject to your policy's per-person limit, so first thing is to confirm exactly what that cap is and how much headroom you actually have. Second, most insurers will accept a written counter-demand — you don't need a lawyer to submit one, though having one helps. If you do write a counter, itemize everything: medical bills, co-pays, lost income with documentation, and a section on pain and disruption to daily life (sometimes called "general damages"). Keep it factual and attach every receipt and record you have.

    • 1
      steady-dreamer627

      Seconding this. The same approach worked for me last year.

  • 7
    calm-crow-880

    The possible TMJ from impact is something people really underestimate long-term. Make sure your dentist or an oral specialist has it on record officially, not just as a "possible" finding. If it progresses you could be looking at appliances, physical therapy specific to the jaw, even procedures down the road — and if it's not well-documented now as accident-related, connecting it later gets much harder. Get that nailed down medically regardless of what happens with the claim.

    • 2
      patient-parent313

      Same boat here. Did anyone mention a deadline to watch out for?

  • 16
    kind-marmot-143

    Counter it. You have nothing to lose. Write up what you're owed, attach your proof of lost income, and send it back. Worst they say is no and you're back to the original number. Best case you get more. Don't leave money on the table because the first offer felt sort of reasonable.

  • 18
    swift-crane-831

    I just want to say — managing everything alone while your husband was recovering AND running your own business AND dealing with your own injuries sounds absolutely exhausting. I hope you're actually doing okay beyond the claim stuff. Don't rush this decision just to get it over with. You deserve to take the time to get it right.

  • 13
    keen-tern-911

    Few questions before you decide anything: Do you actually have documentation of your lost income — like invoices you couldn't send, client communications showing delays, or bank records? Self-employment loss of income claims fall apart fast without paper. Also, what does your policy's per-person UMBI limit actually say? Because if the offer is already near the cap, there may not be much room to negotiate no matter how solid your case is.

    • 9
      weary-walker428

      Solid advice. Getting it in writing is the part most people skip.