Traffic accident lawyers in Málaga

Whiplash is one of the most common injuries suffered by traffic accident victims.

On 1 January 2016, Law 35/2015, of 22^nd September, on the reform of the system for the assessment of damages caused to people in traffic accidents, came into force.

This legislation marked a turning point in claims for compensation for traffic accidents, favouring the successful outcome of accidents with major injuries and deaths, to the detriment of those injured who suffer the famous whiplash, so common in medium to minor traffic accidents, making it difficult from that moment on to close compensation claims for this injury.

To a large extent, Article 135.2 of Law 35/2015 is responsible for this situation:

 "2. The sequel deriving from a minor cervical traumatism is compensated only if a conclusive medical report accredits its existence after the period of temporary injury."

This means that, when applying for sequelae (not days of temporary incapacity) for a minor cervical injury, we find ourselves with a barrier, which did not exist before the reform. That is, the conclusive medical report.

It so happens that the definition of what is considered to be a conclusive medical report is a controversial issue to this day, on which our Courts have pronounced on different lines, without there being a unanimous Doctrine on the matter or a clear concept. 

That is why, at Trafilex, aware of the complex situation in which the new law places us with regard to whiplash or neck pains, we meticulously prioritise medical attention, and with it the evolution and discharge reports issued by our rehabilitation clinics that treat our clients. Reports which, in the opinion of our technical team, are really the Concluding Medical Report mentioned in the law, and therefore the fundamental basis for claiming the existing sequelae at the time of stabilisation of the injury, so that the injured person receives the compensation for whiplash that really corresponds to him/her.

After suffering a traffic accident, material damage may have been caused in the collision between several vehicles. In this article we are going to study how to claim for material damage in a traffic accident, and everything related to this damage, which does not involve physical or personal harm, but which can cause considerable economic damage.

Damage caused by a traffic accident considered as material damage

What are considered as material damages derived from a traffic accident? 

Damage sustained by our vehicle and its accessories when it suffers damage as a result of a traffic accident. 

Deadline for claiming material damage in a traffic accident

To claim for material damages in a traffic accident, there is a period of one year of prescription before the responsible company, whose dies a quo is the day after the date of the occurrence of the accident. 

Deadline for reporting to the insurance company

The first thing to do when you have had a traffic accident is to report it to the insurance company, in order to be able to subsequently file a claim for material damages, if applicable. 

According to the Insurance Contract Law, the insured has seven days to notify the insurance company of the occurrence of the accident.

Assessment of material damage in a traffic accident

It is a simple and quick procedure. Normally, once the insurance company has been notified of the claim, the company's expert will contact the insurer to set a date, time and workshop where the expert appraisal will be carried out, and finally the vehicle will be repaired. 

The insured person has the right to choose the garage where the vehicle will be repaired.

It is advisable that while the expert report the damage, you are present to ensure that the expert includes in his report each and every one of the damages caused by the accident, and does not leave any of them out of the report, as once it is closed, it is practically impossible to get the company to reopen it. 

What is the owner of the vehicle involved in the accident entitled to?

When a vehicle has been damaged in a traffic accident, and you wish to claim for material damages, there are two possible situations: 

The vehicle is damaged and the cost of repair does not exceed the market value of the vehicle

We are entitled to have the vehicle repaired and restored to the condition it was in before the accident.

The vehicle is damaged and the cost of repair exceeds the market value of the vehicle

In other words, the vehicle is declared a loss. In this case, we are entitled to be paid the market value of the vehicle, which is the sale value of the vehicle on the used car market. 

In addition, however, it is also possible to claim the so-called affection value, which compensates the attachment to the lost vehicle, if any, and which can be up to 50% more than the market value. 

Who pays for material damage in a traffic accident?

There is an agreement between companies for the repair of material damage resulting from traffic accidents, commonly known as CICOS (Centro Informático de Compensación de Siniestros).

By application of the CICOS Agreement, in practice, the company of the innocent vehicle will be in charge of everything related to the material damage to the vehicle, assuming also the payment of these, always after acceptance of responsibility by the company of the vehicle causing the accident, which will pay a compensation module pre-established for this purpose through the Agreement.

We constantly face with an excessive interest on the part of insurance companies in launching the message that there is a high percentage of fraud against insurers with the aim of collecting undue compensation. 

This message is very recurrent for insurance companies, firstly, because the message gets through, and secondly, because they spread this false belief which, after so much repetition, we end up believing it, thus placing the insurance companies in a position of false prejudice. 

We can observe how, in all types of media, statistical data appear in this sense, always provided by insurance companies and never by other sources outside the sector. 

Well, the reality is quite different, and the fact is that, while the fraud of the insurance companies is minimal (barely 2%), it makes a lot of noise, compared to the real fraud that these companies carry out with each claim received by an injured person, which is devastating, but sounds very little.

The insurers are constantly extorting the success of every personal injury claim in road traffic accidents from the very moment the claim is made, using various practices.

Here are a few examples, among others:

Fraud 1

The companies control the medical treatment. In a traffic accident, the victim must be treated by a centre of the network of rehabilitation clinics whose payment must be authorised and assumed by the company itself.  Often, the companies do not authorise such treatments on arbitrary and unfounded criteria that the courts themselves do not admit, knowingly. But that does not matter, what is important for the insurer is that, if it does not pay, the injured parties cannot receive medical treatment and, from that moment on, they begin to lose their rights to compensation. The company saves on medical treatment, and saves on compensation.

Fraud 2

Out-of-court claims are rejected in their entirety by the companies, forcing the injured parties to pay the cost of legal proceedings, so that the competent court finally upholds their claim and grants the injured party the corresponding compensation. But that does not matter, because many claims fall by the wayside, again saving the companies money.

Fraud 3

Out-of-court claims involving serious injuries to which the company amicably makes fixed offers of between 3,000.00 and 6,000.00 euros. Once in the legal proceedings, there are countless cases in which we have managed to obtain compensation of up to 50,000.00 euros, light years away from the offer for which the company intended to close the case. Again, saving thousands of euros at the expense of the injured parties who, due to lack of advice, decide not to go to court. 

Fraud 4

Offers made by insurance companies without accompanying them with an expert medical report to back them up, despite the obligation imposed by law. This is in order to save the cost of commissioning the corresponding Medical Expert. This also means that the injured party does not have sufficient elements of judgement to be able to decide whether or not to accept an offer. 

 Fraud 5

Derisory legal defences. In some cases, they present a maximum limit of 200 euros, so that the injured party has to pay for the fees of a private lawyer and a private solicitor. This renders this clause, which has been considered abusive by the courts, meaning that it is devoid of content.

In short, the cost saved by the insurance companies, to the detriment of the victims of traffic accidents, with this type of practice that they carry out on a daily basis is immensely greater than the cost that the minimum percentage of fraud that exists can suppose. 

This is why we cannot allow this false dogma to continue to spread, simply because it does not correspond to reality. It is a hard task to fight the insurance lobby, but not impossible.

Contrary to what most people think, medical care for road traffic accident victims is not free of charge. According to the law, it is the person at fault who has to pay the cost of the medical treatment received by the victims of the accident. 

So if you have suffered a traffic accident and you have doubts about who is responsible for paying your medical expenses or which centre you can go to for treatment of your injuries, below we will try to answer all your questions. 

Free public or private health care? 

As a victim of a road traffic accident, you are entitled to receive the medical care you need to treat your injuries, either in a public or private hospital. 

Generally, road accident compensation covers all physical and material damage sustained in an accident, including the costs of medical care, regardless of whether the centre that provided the care is public or private. 

In the case of public health care, the injured party must provide the hospital with the details of the insurer of the vehicle responsible, and at the end of the treatment, he/she will be given an invoice that must be sent to his/her insurance company. 

If, on the other hand, the victim of the accident prefers to go to a private medical centre, then he/she will have to pay all the costs out of pocket and then claim them from the insurance company responsible.

Who is responsible for payment according to the Conventions or Agreements? 

By law, health centres have the right to claim from the insurer of the vehicle responsible for a traffic accident the payment of the cost of the medical care provided to the victims of the accident. 

Injured people who are occupants or passengers of the vehicles involved in the accident will always be covered by the insurance companies and the Insurance Compensation Consortium. However, in the case of drivers, the responsibility for payment will depend on who caused the accident.

In this case, according to the Public and Private Agreements, the person obliged to pay the medical expenses is determined taking into account the assumptions that we will see below. 

Accidents involving a single vehicle 

When only one vehicle is involved in the traffic accident, the insurance company or, otherwise, the Insurance Compensation Consortium is responsible for paying for the medical care needed by the victims, except in the case of the driver of the vehicle. According to the Public Agreement, the expenses incurred for the medical care of the driver are included only up to a maximum amount that is established in the economic conditions of the Agreement. 

Accidents involving more than one vehicle 

In the event that more than one vehicle is involved in the traffic accident, the insurance company is obliged to bear the health care costs only for those occupants or passengers of the vehicle it insures, and also for its driver. In the event that the vehicle does not have Civil Liability Insurance, the Insurance Compensation Consortium will be responsible for the expenses of the victims who are not responsible for the accident.

Injuries to third parties who are not users of the intervening vehicles 

If the traffic accident involves several vehicles and causes injuries to third parties, such as pedestrians or cyclists, then the insurance company of the injuring party or the Insurance Compensation Consortium is responsible for paying the costs of medical assistance to the injured parties.

If the injuries are the result of the displacement of containers, street furniture, etc., then the vehicle that has displaced them is liable to pay.

What are the Public and Private Health Care Agreements? 

The first Health Care Agreements were signed decades ago to facilitate the management and claims between medical centres, insurance companies and the Insurance Compensation Consortium.

These are agreements signed between the health services of the Autonomous Communities, public hospitals, the Insurance Compensation Consortium and the UNESPA association representing private insurers. 

Over the years, these agreements have been refined to extend their functions and coverage. At present there are several types of agreements, but the most important are those that affect both the public and private health care sectors. The versions currently in force are:

• The Agreement on public healthcare derived from traffic accidents for the years 2017, 2018, 2019 and 2020.
• The Framework Agreement on road traffic accident healthcare for the years 2019/2022 (private sector).

Which health centres should you go to? 

After suffering a traffic accident, the first step is to go to the emergency services of any hospital, whether public or private.

If the injured person subsequently needs specific healing or rehabilitation treatment in order to heal or stabilise their injuries, then they can decide which type of medical centre they want to go to for this treatment. You have the following options: 

• A public health centre. You will have to fill in a form with the details of the vehicles and the insurers involved in the accident, so that the hospital can bill the medical expenses to the insurance company. 
• A hospital proposed by the insurer of the vehicle in which you were travelling or by the insurer of the other vehicle involved. In this case, the insurance company will be responsible for all treatment costs.
• A private health centre of the injured person's choice. If the injured person chooses a private centre, he/she will have to bear all the costs himself/herself and can subsequently claim them from the insurer of the vehicle that caused the accident. If the claim is not possible because he/she is at fault, it will be necessary to see in the insurance contract whether he/she can claim reimbursement.
• A centre adhered to the Private Health Care Agreement (UNESPA). The chosen centre will be the one that requests authorisation from the insurer and then invoices the insurer for the cost of the treatment. Here the injured party will not have to pay any advance payment.

Tips for coping with a traffic accident 

If you are involved in a road traffic accident, there are two things that are essential in dealing with the situation:

• If you need specific treatment to recover from your injuries, always choose the medical centre that is best suited to your case, even if you have to pay for it initially. Remember that you can claim all the costs incurred from the insurer of the vehicle responsible for the accident. 
• Seek the advice of a lawyer specialising in traffic accidents. He or she will help you to comply with all the deadlines and requirements established by law in order to claim fair compensation for the injuries, after-effects and material damage caused by the accident.

What should I do if I have suffered a traffic accident? 

If you have been involved in a traffic accident, the first thing you should do is go within 72 hours to the emergency department of the nearest hospital or the hospital of your choice, so that they can assess the seriousness of your injuries and prescribe the most appropriate rehabilitation treatment to cure or stabilise them. It is important that you follow all medical instructions given to you, both for your recovery and if you want to claim compensation for a traffic accident.

Do I have to go to the care centre assigned by the insurance company or can I choose another one? 

According to the Insurance Contract Law and Law 41/2002 on patient autonomy, when you suffer a traffic accident you have the right to choose the medical centre where you will receive rehabilitation for your injuries. You can opt for one of your preference or go to the centre recommended by the insurance company, indistinctly.

However, choosing the right rehabilitation centre is fundamental both for the recovery of the injuries, as well as for the process of claiming compensation afterwards. So, as always, seek specialist advice. 

Who should pay for health care costs? 

As we have already seen, in most cases medical assistance as a consequence of a traffic accident is universal and free of charge, although it is not the Seguridad Social that pays all these expenses, but the insurer of the vehicle responsible for the accident.

Insurance companies are obliged to pay for any medical expenses incurred by the victims of the accident. It is therefore essential to determine who is responsible for the facts, as it will be their insurer who will be responsible for payment.

In the event that the at-fault vehicle does not have a Civil Liability Insurance policy, then the Insurance Compensation Consortium will be responsible for paying the costs of medical care for those injured in the traffic accident. 

What can I do if I have already paid for health care?

If you have had to bear and pay out of pocket the health care and rehabilitation costs required to recover or stabilise the injuries sustained in a traffic accident, you can ask the insurance company of the responsible vehicle to reimburse you for all the amounts you have paid by filing a traffic accident compensation claim.

In this type of compensation, there is a specific item intended to financially compensate the victim for all the health care expenses he or she has had to bear as a result of the accident.

If you have a vehicle and you are driving it, you are exposed to the risk of suffering a traffic accident, which is why it is of vital importance how to act if you have suffered an accident and have sustained minor injuries. This type of accident accounts for the highest percentage of accidents on our roads.

Beforehand, we would like to inform you that you do not have the duty to bear the injuries you have suffered as a result of a traffic accident for which you are not responsible. You are therefore entitled to compensation to compensate for the personal injuries you have suffered.

Exchange of information between the parties involved

The first thing you should do when you have an accident with your vehicle, or are hit by a car, is to exchange personal details, vehicle registration numbers and insurance companies with the other party. This would be normal, but up to 4 cases can occur after a traffic accident.

That the parties involved agree

The parties involved agree on what has happened and share their version of events, and this is reflected in the accident report. This must be signed by both parties to be valid, and each party must keep a signed copy.

The parties involved do not agree

In this case, the most advisable thing to do is to call the police so that they can make a police report. The negative side of this situation is that the management of the claim may be delayed, as the insurers must agree on who was at fault.

If no friendly report is made and the police are not called in

If there is no friendly report or police report and there is no understanding between the parties involved, it is obligatory to exchange information so that each party involved reports the accident to their insurance company. 

If the other party involved does not provide us with the data

If the other party does not cooperate in providing us with the information, it is essential that we at least take note of the registration or plate number in order to be able to identify the owner of the vehicle and the insurance company.

In the event that the other party involved does not agree and does not want to provide their details, the correct thing to do is to take note of their number plate so that we can report the accident to the insurance company and identify the vehicle of the other party involved.

Medical assistance

Secondly, it is of vital importance that you receive first medical assistance in any medical centre, within a maximum period of 72 hours from the occurrence of the accident.

Inform the insurance company of the accident

Next, call your insurance company to report the accident, explaining the dynamics of the accident and indicating if there are any injuries. The Insurance Contract Law establishes a period of 7 days to make this notification.

Compensation if there are injuries

Finally, you should know that you have the right to receive free medical treatment to heal your injuries, as well as medical assistance from the corresponding doctor until you are definitively discharged. 

This can be carried out in various clinics of your choice, depending on the proximity to your home. 

Once your injuries are stabilised and you have been discharged, your injuries can be assessed and it is time to claim your compensation.

After 20 years of applying an obsolete system for the valuation of damages caused to people in traffic accidents, on 1^st January 2016, a new system came into force (Law 35/2015, of 22^nd September, reforming the system for the valuation of damages caused to people in traffic accidents) which came into force, correcting a large part of the previous one, providing us with a complex system composed of tables and concepts, based on the circumstantial casuistry that could occur in the victims.

The system advocates, this time more correctly, as fundamental principles:

1. Principle of full reparation: it assumes full indemnity for the damages caused.

2.     Principle of articulation: it requires that patrimonial and non-patrimonial loss be assessed separately and, within each other, the different concepts.

What elements make up the compensation

First of all, it is important to recognise all the items included in the Schedule to compensate those damages which, consequently, are liable for compensation.

The structure of the Schedule is clear, concrete and simple, leaving little room for discretion, offering a method of compensation that starts with whether, after the traffic accident, the object of assessment is death, permanent incapacity or sequelae or temporary incapacity. In each of them, there are 3 concepts that are the object of compensation; the basic personal injury, the particular personal injury and the patrimonial loss.  Below we show the structure of the Schedule.

CALCULATION OF COMPENSATION FOR PERSONAL INJURY IN CASES OF TEMPORARY DISABILITY AND SEQUELAE

This section will focus on the calculation of compensation in situations 2 and 3, after-effects and temporary disability. The case of death, due to its complexity, will be dealt with in a separate post later on.

- TEMPORARY INCAPACITY. WE TURN TO TABLES 3.A, 3.B and 3.

Table 3 (A, B and C) values the damage caused within the period from the time of the accident until the date of injury stabilisation or medical discharge, whether personal, assigning an amount per day depending on whether it is classified as basic, moderate, serious or very serious. And patrimonial, depending on the amounts that are accredited as having been borne.

-AFTEREFFECTS or SEQUELAE. Tables A, 2. B and 2.

Sequelae are the physical, intellectual, organic and sensory impairments and aesthetic damage that derive from an injury and remain after the healing process is complete. And for this, we turn to Table 2:

TABLE 2.A.1 corresponds to the medical scale, and the BASIC PERSONAL INJURY.  

Locate the sequela in question within the Medical Scale, and observe that a range appears for each one of them. This is the score that corresponds to that sequela, and within which the corresponding number of points will be assigned.

Once the score has been assigned, we turn to the following table.

TABLE 2.A.2. ECONOMIC SCALE

This table, which is easy to apply, shows the economic valuation of our injuries, according to the number of points assigned to the specific injury and according to the age of the injured person.

TABLE 2.B. PARTICULAR PERSONAL INJURY

Table 2.B, will be used only in those cases in which the sequela suffered exceeds a certain number of points. It is a table that compensates in an extra way those cases in which the damages are of greater severity.

TABLE 2.C. PECUNIARY DAMAGE or PATRIMONIAL LOSS

Table 2.C guarantees compensation for present and future pecuniary damage, if any, caused to the injured party.

And finally, a simple example:

A 31-year-old male cook with 2 sequelae and 95 days of temporary incapacity, 30 of which he was on sick leave, during which time he received his full salary.

We turn to Table 3 to quantify the period of temporary incapacity, i.e. the number of days.  In this sense, 30*54.30 and 65*31.32 = 3,664.00 euros.

On the other hand, we turn to Table 2, first to the medical scale to identify our sequela, then to the economic scale to quantify it. In this way, we extract that a person of 31 years of age with two points of sequela corresponds to 1,678.64 euros.

Since in our example there are no other damages, the total amount to be compensated is 5,342.64 euros.