Handling Your Own Personal Injury Claim

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 accidents?

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.

Indemnification:

"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:

1. Don't leave the scene. If vehicles are operable, move them to the shoulder, out of the way of oncoming traffic.
   
   
2. 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.
   
   
3. 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 negligence."

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 for:

• 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 fault.

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 my compensation?

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 your injuries.

top of page

©1999-2000 4LawSupport.com All Rights Reserved