Handling Your Own Personal Injury
Processing Your Claim
In general, settling a minor injury claim with an insurance company
is usually quite simple. In some cases, you do not need a lawyer, and
you don't need to know technical language or complex legal rules. But
there is a simple procedure that you must follow in order to obtain
a fair settlement.
Your right to be compensated usually depends on nothing more than common
sense, such as who was the negligent (at-fault) party. No one knows
more about your injury and how the accident happened than you. All you
need is some information about how the insurance claims process works,
and how to correspond with the insurance company.
Keep records of all telephone conversations by confirming the conversation
via mail or fax. As minor and simple as it may seem, don’t forget that
an adjuster is highly trained and experienced with only one thing in
mind: to save the insurance company money. Don’t let their friendly
approach distract or fool you. They don’t need to know personal questions
that are not related to your accident. You don’t have to provide a recorded
statement to the other party’s insurance company. Remember, once you
provide a recorded statement, you can’t change any errors you may have
unknowingly made. The recorded statement can only hurt you. If the adjuster
tells you that they need your statement in order to conclude their investigation,
you should contact an attorney and prepare for a lawsuit. Efficient
record keeping will help you later if you decide to hire an attorney.
Determining fault is important because this will generally place either
your insurance company or the adverse party in a position that requires
them to cover the losses. Regardless of who caused the accident, you
may be able to recoup at least your property damage, lost wages and
medical expenses, depending on your own insurance coverage.
Immediately after being injured in an auto accident, you are thrown
into an adversarial legal system that is complex and confusing. While
you are still receiving initial treatment for your injuries in a hospital
emergency room, the parties at fault may have already notified their
insurance company of the accident. Every insurance company has a team
of adjustors, investigators and attorneys whose sole responsibility
is to limit the liability of the insurance company and minimize the
amount of money they will be required to pay "innocent" auto accident
victims. There are many mistakes that can be made during the initial
stages of a personal injury claim that cannot be undone by even the
most experienced attorney.
First of all you need to ask yourself DO-I-HAVE-ACASE.
What is the basis for personal injury law related to automobile
It is based on negligence. Under negligence theory, the issue is whether
the defendant (the person that hit you) failed to use “ordinary care”
in the circumstances that led to the injury.
What is insurance:
Insurance is a risk transfer vehicle. If a party faces the possibility
of a financial loss, he or she could transfer this risk to an insurance
company by purchasing insurance. By paying a premium for a certain covered
loss, you are transferring the risk of loss (above your deductible)
to the insurance company. Insurance is often called an indemnity contract.
"Restoring" the insured to the same economic position after suffering
a loss "without profiting".
In case of an accident:
You should do the following when involved in an accident:
- Don't leave the scene. If vehicles are operable, move them to the
shoulder, out of the way of oncoming traffic.
- Call for medical assistance if there are any injuries. Provide basic
first-aid, but don't move an injured person unless you possess medical
or lifesaving expertise in many areas. Call the police.
- Get the officer's name, badge number, police station address, and
phone number. Ask when the accident report will be filed, its case
and report number, and how you can get a copy.
Take careful note of the date and time of the accident, the street
and city, weather and road conditions, direction and speed you and other
drivers were going, and how the accident occurred.
Every applicable insurance company should be promptly notified
if a claim is going to be made. In most instances, a person injured
in a traffic accident has a duty to notify their own insurance company
within a certain period of time, or the insurer may deny their subsequent
claims. It is very important when making an insurance claim to know
what information must be given to an insurance company, what information
need not be given, and what information should never be given. Providing
more information than required by law may seriously damage the value
of a personal injury claim in the long run.
Who Is At Fault?
The investigating officer may have ticketed one of the parties at the
accident site. This is generally an indication that a particular law
was broken, but does not necessarily establish who caused the accident.
Sometimes the police report will reveal which driver, in the investigator's
opinion, should be held responsible for the accident.
If no one was ticketed, or you wish to clarify who may be at fault,
we can help you, by you answering as many question as you can on the
DO-I-HAVE-A-CASE page. We then view
one the following sections for you: (In near future we should have all
of the following citations on our page).
Reckless Driving, Following Too Closely, Failure To Control Speed,
Failure To Stop At Proper Place Failure To Stop At Designated Point,
Brakes Not Maintained In Good Working Order, Drove Without Lights, Driving
While Intoxicated, Cut-in After Passing, Fail To Stop For School Bus,
Failed To Yield At Stop Intersection, Failure To Yield At A Yield Intersection
Failure To Yield Right Of Way On Green Sign, Failed To Signal For Stop,
Failed To Signal Required Distance, Failed To Signal Turn, Improper
Turn Signal, Failure To Signal Lane Change, Speeding, Unsafe Speed,
Speed Under Minimum, Disregarded Red Signal, Disregarded Yellow Signal,
Unsafe change of lane, Disregarding Flashing Red Signal, Disregarded
Stop Sign, Turned From Wrong Lane, Turned When Unsafe, Failed To Use
Due Care For Pedestrian.
Once you know who caused the accident:
All you need to know is how to negotiate with the adjuster
on the phone and through letters,
not in a courtroom with lawyers. In a minor fender-bender, you may not
need legal "proof". You may only need to make a reasonable argument--in
plain language--that the other person (or company) was careless. For
example, in a car accident case, you may not need to present measurements
of tire marks or precise angles of collision. You may need only point
out that the other driver hit you from the rear or turned in front of
you. Companies usually prefer to pay a reasonable claim settlement,
rather than risk having to pay later not only for your injuries, but
also court costs and lawyer fees. Be careful not to let the insurance
company take your recorded statement. It is only designed to defend
their insured and ultimately save them money by not paying for what
your case is worth.
In general (with certain exceptions), once a claim is reported, the
insurance company has 10 days to respond, 30 days to investigate and
60 days to pay. (links to Washington Administrative Code)
Can I get compensation if the accident might have been partly my fault?
Even if you might have partly caused an accident yourself, you can
still receive compensation from anyone else whom was careless and partly
caused the accident. The amount of another person's responsibility is
determined by comparing his or her carelessness with your own. For example,
if you were 25% at fault and the other person was 75% at fault, the
other person must pay--through the insurance company--75% of the fair
compensation for your injuries. This rule is called "comparative
What is the formula for “fair compensation”?
Well, there really isn’t one. During claim negotiations, both you and
the adjuster come up with a dollar amount. Then, you both explain why
one bears a greater responsibility for the accident than the other.
It is best to limit your communications by phone. The different percentages
you each arrive at then, simply go into the negotiating box with all
the other factors that determine how much a claim is worth.
How do insurance companies decide how much they'll pay?
Insurance companies and lawyers use a formula to calculate a range
of compensation for an injury. The final payment figure, though, is
the result of negotiations with the injured person.
The formula is no secret. In general, an injured person will be reimbursed
- Medical care
- Lost income
- Temporary and permanent pain and other physical discomfort, and
- Loss of family, social and educational experiences.
A claims adjuster begins with the medical expenses. Then the intangibles
losses such as the pain and other non-economical 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.
If your injuries are not minor, it might be a good idea to consult an
attorney. The multiplier can go still higher--sometimes as 10 times
medical expenses--if the injuries are particularly painful, serious,
or long-lasting. Finally, lost income is added to that amount.
What factors will raise the damages formula from the 1.5-times end
toward the 5-times end:
- More painful, serious or long-lasting injuries
- More invasive or long-lasting medical treatment
- Clearer medical evidence of serious injuries
- More obvious evidence of the other person's fault, and less of your
You, too, can easily use this formula as the starting point for negotiations.
Once the insurance adjuster knows that you understand the range of compensation
for your injuries, negotiating a final settlement is usually fast and
easy. Please let us know how you’re doing by sending us an Email.
Does my health insurance coverage or paid sick leave from work limit
Why should they? Whether you paid for medical care out of your own
pocket or your health insurance covered is none of a claims adjuster's
business. The same goes for whether your lost time at work was covered
by sick leave or vacation pay. You paid for your health insurance and
earned your sick leave or vacation pay, and has nothing to-do with accident.
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
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