If you were injured in an accident and someone else is responsible, you could be entitled to compensation through insurance benefits. Many personal injury claims do not end in a lawsuit and instead are resolved by settling a personal injury claim with an insurance company.
But how can you ensure you’re treated fairly in the settlement process? It helps to understand some basic information about insurance claims, how the settlement process works, and what to do if you don’t think the offer you’ve received is fair or if your claim is denied.
What Are the Different Types of Insurance Claims?
You might have heard the terms “first-party claim” and “third-party claim” in connection with car insurance or other personal injury claims. What kind of claim do you have?
First-Party Claims
An insurance policy is a contract between two parties–the insured (the first party) and the insurance company (the second party). A first-party claim is a claim filed with your own insurance company. A home insurance claim, for example, is a first-party claim.
Third-Party Claims
A third party becomes involved when someone other than the insured files a claim to collect benefits under the policy. A third-party claim is often referred to as a liability claim because it’s filed by someone who is claiming that the policyholder is financially responsible (liable) for their loss.
For example, if you’re in a motorcycle accident caused by a drunk driver, you might be entitled to compensation from the drunk driver’s liability insurance policy. In that case, you’d file a third-party claim. Likewise, a slip and fall accident could give rise to a premises liability claim filed against the property owner–that’s also a third-party claim.
What About Workers’ Compensation Claims?
Workers’ compensation claims are considered first-party claims. Your employer is the policyholder. And even though you didn’t purchase the policy, as an employee, you’re an insured party.
However, there is also a possibility for a third-party claim in workplace accidents. If a party other than your employer is responsible for your injuries, such as a contractor or a government agency, you might be able to file a third-party claim or lawsuit to recover compensation in addition to workers’ comp benefits.
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What Is the Personal Injury Claims Process?
There are five general steps in the claims process:
- Contact the insurance company and file a claim: You should do this as soon as possible after the accident. You have limited time to file a claim.
- Send a demand letter: This letter tells the insurance company how much money you’re requesting and why you’re entitled to it.
- Wait for the insurance company’s response: Insurance companies may ask for additional information, or they may delay responding to you.
- Evaluate the insurance company’s offer or denial: You don’t have to accept an offer that you don’t think is fair. If your claim is denied, you have options.
- Determine next steps: You could accept the offer, make a counter-offer, appeal the denial, or file a lawsuit.
Hiring an experienced personal injury attorney can save you time, money, and stress. Consider consulting a reputable lawyer in your area early in the process. Most offer free consultations.
Where Do I File My Claim?
Insurance claims can be complicated. You have to know which policy covers the party responsible for your injuries so you can file your claim with the right insurance company. If you’re in a car accident–even with just one other vehicle– multiple insurance companies may be involved. Multi-car accidents, especially ones involving trucks, government entities, or uninsured motorists, can be especially complex.
If you have Personal Injury Protection Insurance (PIP), you can file a claim against your PIP policy. PIP is not required in Texas, but many people opt to carry it.
If someone else was responsible for your accident, you’d file a third-party claim with the at-fault party’s insurance company. If you’re in an accident, make sure you get the contact information for insurance companies of everyone involved.
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What Should I Include in My Insurance Claim?
Your insurance claim contains basic information about your accident. Insurance companies will guide you through filing a claim. They may even have a form that you can fill out online.
To file a claim, you’ll need as much information as possible about:
- Identifying information about the parties and vehicles involved
- The property damage or bodily injuries caused by the accident
- The date, time, and location of the accident
In addition to your insurance claim, you’ll submit a demand letter. Your demand letter is your chance to request the amount of money that is sufficient to pay for the damages you suffered in the accident. You’ll include a calculation that accounts for your medical bills, lost wages, and pain and suffering.
It’s important to include evidence in your demand letter that supports your request for compensation. You can include accident reports, witness statements, photographs, medical records, and anything that helps show the financial, physical, and emotional strain the accident has caused you and your family.
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Do I Have to Accept the Insurance Company’s Offer?
The short answer is no. If you don’t think the insurance company’s offer is fair, you can reject it. You deserve to be compensated fairly for your injuries, but insurance companies are notorious for trying to pressure injured victims into taking lowball offers.
Insurance companies will sometimes submit an offer quickly after an accident, hoping that you’ll feel desperate for cash to pay for your mounting medical bills. Or, they’ll try to convince you that you’re to blame for the accident and don’t deserve more than they’re offering. These are common tactics, and you can fight them.
But if you reject the offer, you should have a plan in place for submitting a counteroffer with a strong argument supporting the damages you’re seeking. An attorney can help you evaluate the offer, determine whether it’s fair, and help you understand your options.
What if the Insurance Company Denies My Claim?
It’s not unusual to have your claim denied. Insurance companies routinely deny or devalue claims in an attempt to get out of paying what they owe. If the insurance company denies your claim, you can appeal their decision.
Additionally, you might be able to file a lawsuit to get the money you deserve. There are important deadlines involved in filing a claim and challenging a denial, so it’s often helpful to involve an experienced personal injury attorney if your claim has been denied.
Do I Need a Lawyer to Settle a Personal Injury Insurance Claim?
There’s no requirement that you hire a lawyer, but you’re more likely to get a fair settlement if you have a lawyer handling your claim. That’s because personal injury lawyers deal with insurance companies day in and day out. They know the tricks that insurance companies use to get out of paying injured victims like you, and they’ll protect your rights.
Insurance companies have extensive resources that they’ll use to fight your claim—and personal injury law firms have ample resources to help you fight back. Hiring a lawyer helps put you on equal footing and forces the insurance company to take your claim seriously.
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