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faqs

The insurance company

1. What will the insurance company for the person, persons or company who caused my injury do about my claim?

After the insurance company has been notified about the claim, a file is established on you and your case. An insurance claims adjuster is assigned to your file by a claims manager or claims supervisor. The supervisor may assign different adjusters to your case as it progresses.

The insurance claims adjuster responsible for your file will maintain contact with your lawyer. The adjuster will also perform an independent investigation of your claim to ascertain the following:

  • Who is at fault in your case.
  • Whether or not you bear any fault for your own injuries. This is also re­ferred to as comparative negligence or contributory negligence.
  • Potential witnesses in the case.
  • The location of the scene of the accident.
  • The contents of police reports, Department of Motor Vehicle reports, and any other investigative reports that have been filed in the case.

After the initial investigation, the claims adjuster will request medical reports and any other reports dealing with your injuries. The adjuster will also review documents about your time lost from work. Most importantly, the insurance claims adjuster will want to receive accurate records of your medical bills, prescription bills, hospital bills, therapy bills, and any other actual expenses incurred as a result of your injury. That is why it is very important for you to maintain an accurate account of your medical bills, lost wages, and other expenses which result from your injury.

2. How does the insurance company put a value on my case?

This question is quite complicated. First, the claims supervisor or claims manager will provide that a certain amount be “set aside” as a potential value of your case. This figure is usually called “reserves.” Such reserves are the outside value that the com­pany has established on your claim. The reserves may change as the case progresses. In serious cases, such reserves may equal what are called policy limits. Policy limits are the outside limit amounts of liability established in the insurance policy of the person or persons who caused your injury.

During the preparation stages of your case, the insurance company will keep track of your medical bills, lost wages, any permanency regarding your injury, and other factors. The company will also take into consideration the quality of evidence against their insured, the quality of your witnesses and their witnesses, extent of liability on your part, and other important considerations such as previous injuries.

If you had a previous injury in the same area of your body, the insurance carrier will want to see medical records pertaining to that injury. During the course of your claim, your attorney will be notified by the insurance company about the important factors that are being considered in your particular case.

3. Should I communicate with or contact the insurance company for the person who caused my injuries?

Absolutely not! Under no circumstances should you contact the insurance com­pany once you have retained an attorney. If you contact the other person’s insurance company, for any reason, you could ruin your entire case with one question or one statement.

Secondly, because you are now represented by a lawyer, the insurance com­pany, in most states, is absolutely prohibited from having any personal contact with you for any reason.

4. Can I contact my own insurance company?

If you have health insurance, medical payments insurance, automobile uninsurance or underinsurance coverage, there may be occasions when it is appro­priate for you to contact your own company. However, you should always ask your lawyer whether or not such contact is appropriate. Never contact an insurance company without first obtaining approval from your attorney.

5. Will the insurance company for the person who caused my injuries dispute my claim?

If liability and responsibility are well‑established in your case -‑ that is, if fault clearly rests with the insurance company’s insured (the person or persons who caused your injury), they will try very hard to settle your claim. Insurance compa­nies usually dispute the following types of claims:

  • Claim in which the fault rests with someone other than their insured. This could mean you or someone else involved in the incident who may have caused your injuries rather than the person who is insured by the insurance company.
  • Claims in which the insurance company and its representatives do not believe that you are injured, or that you were injured as badly as you claim. For this reason, documentation of medical bills, lost wages, and other expenses are extremely important to establish credibility and the existence of your injury.
  • Cases in which you or your witnesses have lied, exaggerated, or fabricated the nature and extent of your injury or how the incident occurred.

6. What can I do to convince the insurance company that my claim is valid?

As stated above, the most important thing you can do is to recover as quickly as possible from your injury. Insurance company personnel tend to believe those people who actively try to recover from their injuries. That is why you must cooperate with your doctor, physical therapist and other personnel who are trying to help you improve from your injury.

Secondly, insurance companies believe those people who can document their injuries through medical bills, credible medical reports and accurate lost wage information that is neither exaggerated nor subject to dispute and interpretation.

Thirdly, insurance companies usually settle cases easier with those clients who have been in active contact and cooperation with their attorney.

In summary, it is important for you to try to get better, keep an accurate record of your expenses, and cooperate with your lawyer and his or her staff.

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