After you have been hurt in an accident, it is important that you immediately file a claim either with your insurance carrier or that of the business or person at fault. If you have to miss work, have injuries treated and have pain and suffering associated with the accident, filing an insurance claim is the only way to make sure that you are compensated. The following paragraphs will break down the process of filing claims, the way that insurance companies determine what your claim is worth, and the two types of claims.
Your Insurance or the Person Responsible – Who Do You File With?
First party and third party claims are the two types of insurance claims that you can file following an accident. If you file a claim under your insurance, that is known as a first-party claim. A claim filed under the other person or business’ insurance provider is known as a third party claim. The majority of people and businesses have insurance that will cover third parties who are hurt due to something they did or failed to do.
There are several factors that determine what type of claim you will file. Who is at fault and the type of accident as well as what type of insurance coverage you have are all points to consider when deciding which claim to file. If you caused a car accident, for example, you would most likely have to file a first party claim. For a car accident caused by someone else, however, you would file a third party claim with their car insurance. If you are injured while in a business, such as a shopping center or a bank, you would file a claim with the company that insures that business.
Understanding the Claims Process
No matter where or how you were injured, most insurance companies require you to contact them regarding the accident within 24 hours after it occurs. Assuming you were not responsible for the accident, this means calling insurance provider of the driver, business owner or another person who is at fault. Make sure you have as many details possible about the accident and the nature of your injuries since you will probably be asked for this information.
Once you have reported the accident, the insurance company will investigate your claim. Any pictures were taken at the scene of the accident, people who might have seen what happened or additional details that you may not have provided before will be useful at this point. The insurance company will probably require you to undergo an independent medical examination by a doctor that they choose. A claims adjuster will inspect a property if you say that an accident was caused by the condition of a building.
Once they have determined how much your claim is worth, the company will send you a check to settle the case–assuming the claim is accepted. There are times when a claim will be denied or when you and the insurance company may disagree on the value of the claim. Appealing their decision may mean that you have to provide more details or evidence concerning the incident and be subject to more doctor’s exams.
Appealing a Denied Claim
The reasons your claim might be denied include failure to file the claim in a timely manner or undergo a required medical exam. Your claim might also be denied if your insurance does not cover the type of accident that you were involved in.
Regardless of the reason, the insurance provider will send you a denial notification if your claim is not approved. You are then responsible for appealing the claim denial. The next step in the appeals process will depend on the company and will usually be outlined in the policy. You may wish to speak with an insurance attorney if you do not understand the appeals process or if the company denies your appeal.
Determining A Claim’s Value
It is usually easy to determine loss wages and medical expenses, but hard to put a dollar value on intangibles like pain and suffering. Damage formulas have been developed by insurance companies to put a monetary value on this type of loss.
These damage formulas often involve multiplying the cost of all your medical treatment by a number between 1.5 and ten–depending on the type of and severity of the injuries you suffered–to determine the amount allocated for “special damages.” A number of lost wages is then added to that value and this is how the company determines how much your settlement check should be. From there, you may be able to negotiate a higher settlement.
Free Claim Evaluation
Has your claim been denied? Do you think your claim amount is inadequate? You can have an attorney experienced with claims evaluation to take a look at your claim for free.