If you've been injured in an accident, you'll want to file a police report and an insurance accident claim with both your insurer and the insurer of the responsible party as soon as possible (after seeking medical attention). The claim is the first step toward being compensated for medical expenses, lost wages, and/or other damages resulting from the accident. This article covers the basics of insurance injury claims after an accident, including the following:
- The difference between first party and third party claims
- The insurance claims process
- Denial of claims and the appeals process
- Calculating the value of an insurance claim
First Party Claims vs. Third Party Claims
There are two types of insurance claims: first party claims and third party claims. While 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 are injured as a result of the holder's actions.
The type of claim you file will depend on who was at fault in the accident, the type of accident that occurred, and the extent of available insurance coverage. For example, if you caused an auto accident while driving in your car, you should probably file a first party claim with your auto insurance provider.
On the other hand, 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. Still, it is also helpful to always notify your own insurance company as well. If you were injured while shopping in a store or eating at a restaurant, you can file a third party personal injury claim with the business' or land/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 reasonably 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, or a more detailed account of the incident. Before sharing some of this information, you should consider consulting an attorney to ensure your rights are protected. If the injury was caused by a building's condition, the claims adjuster may make an inspection of the property.
After calculating the value of your claim, the insurance company will then issue a settlement check. If your claim is denied, or if you believe the amount of the settlement 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.
Denial of Claims and the Appeals Process
There are a number of reasons why your claim may be denied. For example, you may have waited too long after an accident to file your claim or failed to submit to an independent medical examination. Alternatively, the type of car accident you were involved in may not be covered under your insurance plan.
Whatever the case may be, you'll receive 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, so you should take a 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 agency/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, or if your appeal is denied, it's probably in your best interests to consult with 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 as a result of their injury. Insurance companies have developed damages formulas to calculate how much to pay the injured for these types of non-monetary losses.
The insurance claims analyst first adds up all of your medical expenses. If the injuries aren't too serious, this total is typically multiplied by 1.5 or 2. (Usuaully, the multiplier ranges from 1.5 to 5 depending on the severity of the case.) This calculation is used to determine the amount of your special damages—damages with finite, measurable costs (as opposed to general damages, which are damages that don't have explicit dollar amounts associated with them, e.g. emotional distress).
However, if the injuries are severe, the total may be multiplied by by a higher number, such as 5 if the injuries are extremely debilitating. 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 then often negotiate with the insurance company to obtain a higher settlement.
Filing an Insurance Claim After an Accident? Get Professional Legal Help
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 injury attorney will be able to answer any questions you may have about your claim and advise you about your options moving forward.