How does the insurance claims process work?
The claims process usually proceeds in predictable steps. Before you file a claim, you or your personal injury attorney will notify people who may be responsible for the accident that you have been hurt and intend to file a claim for your injuries. This increases your chances of getting a quick settlement and prevents others from later saying that your claim unfairly surprised them.
Next, after you and/or your attorney have taken time to thoroughly investigate your claim by gathering evidence, establishing who is responsible for the accident, estimating what your claim is worth, and planning good arguments, your attorney will write a formal demand letter and submit it to the insurance company of the person he/she believes is responsible for your injuries. (This may include your own insurance company for example, if you are covered by a automobile policy or need to make a claim for uninsured or underinsured motorist coverage.) From there, he/she will engage in informal negotiations with the insurance company.
Sometimes your attorney may be dealing with a stubborn or unreasonable claims adjuster. If that is the case, your attorney may have to take your case to court.
What guidelines should I follow when another person’s insurance company calls me to talk about my injuries?
After you notify others that you have been hurt in an accident and intend to file an injury claim, you may receive phone calls from one or more insurance companies that want to talk to you about what happened. These first conversations will most likely occur before you file your claim for compensation or hire an attorney. If that is the case, you should abide by the following principles:
remain calm and polite;
identify the person you’re speaking with, the company he or she represents and the person who is insured;
give limited personal information (your name, address and phone number is sufficient);
do not give details about the accident or your injuries;
resist any push to settle your claim immediately;
set limits on further phone contact; and,
take notes about any important information you received during the phone call, as well as whatever information you gave to or requests you made of the insurance adjuster.
Remembering these important rues will help you maintain your chances of receiving a good settlement for your injury claim. If you have already hired an attorney when you are contacted by an insurance adjuster, notify your attorney and let him/her arrange any discussions with the insurance company.
How do insurance companies decide how much they’ll pay to compensate someone for an injury?
While the final payment figure depends on negotiations with the injured person, insurance companies and lawyers do use a formula to calculate a range of compensation for an injury. In general, if you’ve been injured you can expect to be reimbursed for:
temporary and permanent pain and other physical discomfort; and loss of family, social and educational experiences.
In calculating the range of compensation, a claims adjuster begins with the medical expenses. Then the intangibles pain and other non-economic losses are added in by multiplying the medical expenses by 1.5 to 2 times if the injuries are relatively minor, and up to 5 times if the injuries are more significant. The multiplier can go still higher sometimes as much as 10 times medical expenses if the injuries are particularly painful, serious, or long-lasting. Finally, lost income is added to that amount.
Will my health insurance coverage or paid sick leave from work limit my compensation for an accident?
The fact that your insurance company, rather than you yourself, may have paid for your medical expenses is not relevant to your right to recover medical expenses from another party. The same goes for whether your time lost from work was covered by sick leave or vacation pay. In fact, it is improper for an adjuster even to ask about such payments. You paid for your health insurance and earned your sick leave or vacation pay; now the insurance for the person who caused the accident has to pay.
Your own health insurance, however, may require that, out of your settlement, you reimburse it for some or all of the amounts it has paid to treat your injuries.