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What Is the Utah Tort Threshold?

Friday, 28th November 2008

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The Utah tort threshold applies only to car accidents.   So, if you slipped on a sidewalk that had not been timely shoveled,  then you don’t need to worry about it.

Just automobile accidents.  That’s it.

To make a claim for “general damages” (I’ll explain this term a little further on) after a car accident you have to meet one of the following criteria.  This is known as “meeting threshold”.  The criteria are:

1)  death:

2)  dismemberment:

3)  permanent disability or permanent impairment based upon objective findings;

4)  permanent disfigurement; or

5) medical expenses to a person in excess of
$3000;

Before getting into detail about the categories, I think it would be helpful to explain general damages.

General Damages

Damages means money.  Courts can’t restore your health or your lost limb but they can order the wrongdoer (known as a “tortfeasor”) to pay you money.   In an injury case the two most commonly occurring kinds of damages are:  special damages and general damages.  Special damages are easy to put a number on.  They include medical bills and lost income.  General damages are a little tougher to quantify.  They encompass what is commonly known as “pain and suffering”.   They would include not only pain but also disability and disfigurement.  The injury to your relationship with a romantic partner (known as “consortium”) is an example of general damages.

Since the Utah tort threshold applies only to claims for general damages you are not precluded from recovering lost income or medical expenses, even if you don’t meet one of the following five threshold criteria.

Death

Death of a loved one caused by the negligent act of another qualifies you to make an injury claim for general damages if you are an heir.   You are clearly an heir if you are a legally recognized child.   On the other hand, if a minor child dies, his parents are his heirs.

Dismemberment

Only the most dyed-in-the-wool conservative would reject a monetary award for someone who lost a limb in an accident.  Actually, conservatives  reject monetary awards only for other people.  When they get hurt it softens their political positions.  Trauma can be an ideologically-altering experience.

Permanent disability or impairment;

This criteria is most often met by a permanent impairment rating.   Sometimes an injured person’s medical expenses can amount to less than the $3,000 threshold requirement.  But, if permanent injury is present, an impairment rating can put him over the top.  Doctors use an important sounding book to assign these ratings.  It’s called “The American Medical Association Guide to the Evaluation of Permanent Impairment”.

Was I right?  It sounds important doesn’t it?

Anyway, that’s the book doctors are supposed to use to assign an impairment rating.  And, if they use the book, and the rating assigned is based on objective factors then the rating will qualify an injured person for monetary compensation.   Some doctors don’t feel comfortable assigning an impairment rating.  If that happens to your doctor then you need to find someone who is comfortable.  Preferably someone who has done a lot of impairment ratings.

There is also something called a “functional capacity evaluation.”  It focuses on what you can or can’t do because of your injuries.  A disability rating could be based on that.

Disfigurement

An ugly scar on the face would be a good example of this criterion.  For women this is pretty clear cut.  Women want to be pretty and scars mar looks.  For a guy it can be a little more complicated.  Sometimes scars actually make guys more attractive.  I’m not talking about a horrific shocking scar over a large surface of the body.  I am talking about a more or less simple scar that a guy might brag about afterward.  However, even if a guy is proud of his scar he can still make a claim for monetary compensation.

Leg scars will be worth more money for women that for men.  Women like to show their legs.  Men like to look at unscarred female legs.

On the other hand, unless the scarring is horrific in nature, it is my opinion that a Utah jury will not award much for a visible scar on a man’s leg.

Medical expenses in excess of $3,000;

Though not explicitly stated in the “threshold” statute it is commonly understood that the medical expenses incurred must be both reasonable and necessary.  Reasonable refers to the cost of the medical care.  If your chiropractor charged you $10,000 for a series of treatments you might run into opposition at trial.  The insurance defense lawyer may argue the charges were not reasonable.   The Utah State Relative Value Study establishes what is reasonable.  What most  doctors of that specialty are charging is the key, and, specifically, if 75% of those doctors are charging less then the charges are considered unreasonable.

Necessary refers to medical necessity.  Did you really need the treatment?  Another way of saying this is “was it medically necessary?”  Your doctor may believe it was necessary but another doctor, especially one hired by an insurance company, my have an opposite opinion.

You may have noticed that $3,000 is the required minimum amount of PIP medical coverage under Utah law.  Because the PIP medical minimum and the threshold medical minimum are both $3,000 confusion has arisen.   PIP medical is available in higher limits ( and I strongly suggest you take advantage of this as, for a few more dollars per month, you can get significantly more coverage).  Anyway,  sometimes an injured person with, say, $10,000 in PIP medical will ask “do I need to use up my PIP to be eligible to make a claim?”

The answer to that question is simple: NO.  No, you do not need to use up your higher than normal PIP limits in order to make a claim.  The threshold number is $3,000.  That number does not change even if you benefit from higher PIP limits.

Here’s a way to remember it:  you meet threshold; you use up PIP.   But you don’t have to use up your PIP to meet threshold.  You just have to meet threshold, which for the medical expense criterion is $3,000.

Exceptions to the Utah tort threshold

1)  Non-automotive related  injuries.   The threshold applies only to car crashes.  I mention this again here for those of you who entered the discussion past the beginning point.

2)  Uninsured motorist cases.  The Utah tort threshold was created in connection with Utah No-Fault law (also known as PIP or Persona Injury Protection).  The basic idea is:  you carry car insurance which pays for your medical bills up to a certain point; then, if you are injured, you don’t have to sue to get your bills paid.  However, and this is a big HOWEVER.  If you don’t have car insurance then you didn’t follow the rules of the Utah No-Fault Statute so you don’t get the protection it envisioned.  Therefore, you could be sued (even though you won’t be because you are uninsured and therefore probably broke) by someone who did not meet one of the criteria of the tort threshold.

That’s a little convoluted I know and probably TMI (too much information, for those of you without teen agers) but what it means is:  If you are injured by a negligent but uninsured motorist then you don’t have to meet the Utah tort threshold to pursue a personal injury claim for general damages.  Of course, the claim will be against your own insurance coverage not against the at-fault party (he’s broke, remember).   This is one time when it is to your advantage to be hit by an uninsured motorist.  Because, if your medical bills are, say, $2,000 and you are all healed up you can still make a claim for general damages and your insurance company will probably compensate you.

3)  You were visiting here or just moved to Utah

For the same convoluted reasons explained above, you don’t have to meet threshold if you were injured while on a visit to our great state.  And, if you recently relocated here and have lived here less than 90 days with the insurance coverage from your last state then, once again,  the threshold rules don’t apply.

If you want to read the text of the law for yourself you can find it at here.

Also, for those who want even more information about the Utah tort threshold (and, I must say, I admire your diligence) the Utah Code Annotated contains the law in print format along with small case summaries (called annotations) of Utah Supreme Court desisions that have dealt with this law.   You should be able to find a set at your local library.

If you have trouble (and with your brand of determination I doubt you will) ask the librarian to help you find Code section 31A-22-309.

 
 
 

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