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Insurance Claims After an Accident: The Basics

If you've been injured in an accident, you'll want to file a police report and a car insurance accident claim with both your insurer and the insurer of the responsible motorist as soon as possible (after seeking medical attention, of course). The claim is the first step toward being compensated for:

This article covers the basics of insurance injury claims after an accident. After reading, you will know:

  • The difference between first-party and third-party claims
  • How to deal with the denial of claims and the appeals process
  • How to calculate the value of an insurance claim

First-Party Claims vs. Third-Party Claims

There are two types of insurance policy claims: first-party claims and third-party claims. A first-party claim is one you file with your own insurance company. A third-party claim is one you file with the insurance provider of another person or business. Most insurance holders have coverage for third parties who suffer accident injuries due to the policyholder's actions.

The type of claim you file will depend on:

If you caused an auto accident while driving in your car, you should probably file a first-party claim with your auto insurance provider.

If you were hit by a car while crossing the street or were involved in an accident while a passenger in someone else's car, you should file a third-party claim with the driver's auto insurance provider. It is also helpful to always notify your own insurance company.

If you were injured while shopping in a store or eating at a restaurant, you could file a third-party personal injury claim with the business' or property owner's insurance company. These claims apply to bodily damage as well as property damage.

The Insurance Claims Process

Whether you were injured in an automobile, a home, a building, or a business, you typically want to report the incident to the insurance company as soon as possible. If you were involved in a car accident, it is wise to report the incident to your insurance provider, even if you weren't at fault. Regardless of the location of the accident, you'll probably be required to provide information about the circumstances of the accident and the extent of your injuries.

The insurance company will then open an investigation of your claim. You may be asked to provide:

  • Photos of the accident scene
  • The names of any witnesses
  • A more detailed account of the incident

Before sharing some of this information, consult an attorney to ensure your rights are protected.

After calculating the value of your claim, the insurance company will issue a settlement check. If your claim is denied, or if you believe the settlement amount is inadequate, you may be able to negotiate with the insurance company.

If negotiation isn't a viable option, you can appeal the company's decision. An appeal may require you to submit to additional examinations or to provide further information and evidence about the accident.

Collecting Necessary Information for a Car Accident Claim

If you've been involved in a car accident, it is crucial to gather all relevant contact and insurance information for a successful car accident claim. This includes the names, addresses, and phone numbers of everyone involved in the accident, as well as those of any witnesses. Be sure to collect the license plate numbers of all vehicles involved and take notes on the specific details of the vehicle damage.

When it comes to insurance information, you should gather the car insurance company names and policy numbers of all drivers involved. Keep in mind that it's crucial to never admit fault at the scene of the accident or to the other driver's insurance company, as this can complicate your claim.

PIP and the Role of Insurance Adjusters

Personal Injury Protection (PIP) is a type of auto insurance coverage that is mandatory in some states and optional in others. Known also as no-fault insurance, PIP covers your medical bills and sometimes even lost wages, regardless of who was at fault for the accident.

The specifics of what PIP covers can vary from one state to another. It generally includes a range of expenses like:

  • Medical treatment
  • Rehabilitation costs
  • In some cases, funeral costs and services, like childcare, that you may be unable to perform due to injuries

When you make a PIP claim, the role of the insurance adjuster becomes critical. The insurance adjuster is an employee or representative of the insurance company. They investigate insurance claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company's liability.

In the context of a PIP claim, an insurance adjuster's role is to review your medical bills, verify the treatments you've received, and ensure that the costs align with what's typically charged for such treatments. They also review the medical necessity of treatments and their connection to the auto accident.

The adjuster's findings play a significant role in determining how much the insurance company will pay on your claim. If there's any disagreement about the costs or necessity of treatments, or if you believe the adjuster's conclusions are incorrect, you may need legal advice to challenge these findings and ensure you're getting the fair compensation you deserve.

Filing a Personal Injury Lawsuit and Dealing with Underinsured Parties

In some cases, your car accident claim may evolve into a personal injury lawsuit, especially if you sustained significant injuries or if you and the insurance company cannot agree on the extent of your compensation. When filing a lawsuit, having all the collected information about the accident, including the contact and insurance information, will be essential.

In certain situations, you may find that the at-fault driver is underinsured or has no liability insurance. If the at-fault driver's insurance coverage is insufficient to cover your damages and medical expenses, you may need to file an underinsured motorist claim with your own car insurance company, assuming you have such coverage in your policy.

In the absence of such coverage, or if the at-fault driver is uninsured, a personal injury lawsuit may be necessary to seek compensation for your damages.

Denial of Claims and the Appeals Process

There are several reasons why your claim may be denied. You may have waited too long after an accident to file your claim. You may have failed to submit to an independent medical examination. Or the type of car accident you were involved in may not be covered under your insurance plan.

Whatever the case, you'll receive a notification from the insurance company if your claim is denied. It is then up to you to appeal the company's decision. Appeal procedures can differ from company to company. You should look at the policy in question to learn about the appropriate next steps.

You may also be able to file an insurance company complaint with your state's insurance department or file a lawsuit against both the insurance company as well as the party they've insured. If you have questions about the appeals process, consult an insurance attorney.

Calculating the Value of Insurance Claims

While calculating medical expenses and lost wages is usually fairly straightforward, it's difficult to place a dollar amount on the pain and suffering a person experiences due to their injury. Insurance companies have developed damages formulas to calculate how much to pay the injured for nonmonetary losses.

The insurance claims analyst first adds up all your medical expenses. If the injuries aren't too serious, this total is typically multiplied by 1.5 or 2. (Usually, the multiplier ranges from 1.5 to 5 depending on the severity of the case.) This calculation determines the amount of your special damages — damages with finite, measurable costs. This is opposed to general damages, which don't have explicit dollar amounts associated with them.

If the injuries are severe, the total may be multiplied by a higher number, such as 5. Once the special damages amount is determined, the analyst adds the value of your lost wages to determine the amount of your settlement. You can often negotiate with the insurance company to get a higher amount.

Statute of Limitations in Personal Injury Cases

In the context of personal injury law, a statute of limitations is a law that sets the maximum time after an event within which legal proceedings may be initiated. When the period specified in the statute of limitations passes, a claim can no longer be filed.

The specific duration of the statute of limitations varies by jurisdiction and the type of claim. Personal injury claims often have a different statute of limitations than claims for contract disputes. In many jurisdictions, the statute of limitations for personal injury cases is between one to three years from the time of the accident. Act promptly and consult with a car accident attorney to meet the deadline in your jurisdiction.

Car Accident Attorney's Role in Serious Injuries

In cases of serious injuries, hiring a car accident attorney is crucial. An experienced attorney can:

  • Guide you through the complexities of the legal and insurance claim process
  • Help you understand your rights
  • Gather and preserve evidence
  • Ensure you receive the financial compensation you deserve

Addressing Hit-and-Run Cases

In the case of a hit-and-run accident, the process for filing a claim may be different. Depending on the laws in your jurisdiction and the terms of your insurance policy, you may be able to claim compensation under your own uninsured motorist coverage.

However, it's important to report the accident to the police immediately. Some insurance companies require a police report for hit-and-run claims. If the hit-and-run driver is later found, your personal injury lawyer can help you file a claim against their insurance company as well.

The Role of Time in Personal Injury Cases

Timing is crucial in personal injury cases. The time of the accident not only starts the clock ticking on the statute of limitations. It also influences other aspects of the case. Memories fade over time. Physical evidence may be lost. Gather as much information as soon as possible after the accident.

In addition, some injuries may not become apparent until sometime after the accident. Seek medical attention immediately following an accident. Do this even if you don't initially think you're seriously hurt. A complete medical examination can reveal any injuries that aren't immediately apparent. It can provide documentation that could be critical in your claim.

Remember, the goal of the insurance claim process is to return you, as much as possible, to the state you were in before the accident occurred. Ensuring you receive fair compensation for your injuries and losses is key. An experienced personal injury attorney can help guide you through the process, protecting your rights and interests along the way.

Filing an Insurance Claim After an Accident? Get Professional Legal Advice

If you're wondering why your insurance claim was denied or you believe the amount of your settlement is inadequate, you may want to reach out to a legal professional. An experienced personal injury attorney will be able to answer any questions you may have about your claim. They can also advise you about your options moving forward.

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