Making an insurance claim after an accident is typically complex and confusing. The claim process starts by contacting – or being contacted by – a claim adjuster of the insurance company of the party at fault. They will ask you about the accident at issue, what happened, your injuries, where you obtained medical treatment, and your history relative to your injuries and treatment. They will attempt to record this interview to use it in the future in an attempt to discredit your claim.
If the party at fault for the accident is uninsured or has insufficient coverage and you have Uninsured / Underinsured (UM / UIM) coverage, you will also be able to start a claim with your own insurance company. At this point, your own company would consider you an “adversary claimant” because you are now attempting to obtain compensation from them which all insurance companies try to prevent or at least minimize. Make no mistake, any perceived loyalty by your own insurer does not exist as you are now an adverse claimant seeking compensation.
Once the claim is opened by the appropriate insurance company and they have obtained – or attempted to obtain a recorded statement from you, the adjuster will then ask to inspect your vehicle. This will allow them to determine whether it can be repaired or will be deemed a total loss depending upon the blue book value of the vehicle and their own repair estimate. After this determination is made they will then issue you a check for the value of the vehicle or the cost to fix it. This value type is lower than most car repair facilities will charge once the car is disassembled, though the insurance company is legally required to supplement all additional work. You have a right to take the car to be repaired to a shop of your choice and you do not have to go to one of the insurance company’s “preferred facilities” which they often highly encourage. You are also entitled to be provided in a timely manner with a free rental car during the pendency of the car inspection, repair, or “totaling out” process. Insurance companies often delay doing so as long as they can to try and save themselves some of the rental expenses.
After the property damage claim is resolved, the next matter that needs to be addressed is compensation for your injuries, medical treatment, lost wages, and other areas of loss. This area of compensation is typically a major focus of attention by an insurance company because this is where they have the most exposure to potentially having to pay large, expensive settlements. As such, the claim adjuster will usually resort to a number of tactics to minimize this possibly significant expenditure.
The injury claim is initiated by crafting a “demand package” which you present to the insurer once all medical treatment is finished – or your injuries are deemed to be permanent in nature. This process should be carefully and fully documented and you need to include your complete medical chart, separate records of radialogists, attending doctors, etc., and all relevant medical bills. These documents will serve to support and buttress the legitimacy of your injuries and pain & suffering and explain how they were caused by the accident at issue. You will also want to support the legitimacy of your past and future medical treatment, and past and future lost wages as well. Often times it is very helpful to obtain expert reports to further explain the proximate cause and all complex or unclear medical issues that relate to your injuries and necessary medical care.
Once your case is fully documented and presented to the insurance company and they have reviewed all of the records, reports, and bills, the negotiation process is commenced. The insurer will offer a very small sum of money at this point explaining the problems with your claim and why it is not worth much in the way of monetary compensation. They will attempt to diffuse and undermine the legitimacy of your claim through their own information, investigation, research and experience, and often play “hardball” in an attempt to resolve the claim at the lowest dollar amount possible. You will need to explain the basis for a higher settlement figure and counter their arguments with your own rationale why your compensation demand is in fact more fair and equitable.
If the negotiations process results in a mutual settlement, you will be provided a liability release to sign and then a check will be issued to you. Make careful note that you will then have to pay all medical providers with outstanding balances, subrogate (reimburse) all medical insurers including Medicare or Medicaid, med pay from your own insurer, and anyone else who has a lien on the claim. It is advisable to attempt to negotiate all of these bills, liens, and expenses down. After all expenses and doctors, medical insurers, lien holders and possibly the government are paid back, you are left with the net proceeds of the settlement. Such proceeds are not taxable by the I.R.S. Hopefully the net proceeds are a fair amount of compensation for all of the losses that you suffered as a result of the negligence of the party at fault.
If you are not satisfied with the final offer that the insurance company tenders to you and do not agree to settle your claim, you always have the right to file a lawsuit in the jurisdiction where the accident happened or where the defendant lives.