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Following an accident in which you were injured — for instance, a car accident or a slip and fall — it may be necessary to file a claim with an insurance company. Although filing a claim may provide you with an opportunity to seek compensation for your injuries, the claim filing process is often regarded as being notoriously frustrating. Dealing with insurance companies and claims adjusters can be intimidating, particularly for people who are unfamiliar with the claim filing process.
What is an Insurance Claims Adjuster?
After filing a claim with an insurance company, the claim will be assigned to an insurance claims adjuster. The adjuster is responsible for carrying out a majority of the work required to process your claim. Thus, it is the adjuster’s job to make contact and communicate with you throughout the claim filing and claim settlement process. In other words, the claims adjuster is the person you will be dealing with in resolving your claim.
In most cases, the adjuster’s first task will be to determine whether your loss or injuries are covered by your policy or the at-fault party’s policy. If coverage is found, the adjuster will proceed to investigate the details of your claim. This investigation phase of the claim filing process can take some time, and will likely involve the adjuster taking steps such as:
- Conducting interviews with the parties involved in the accident;
- Interviewing witnesses or bystanders to the accident;
- Inspecting the injuries or damaged property;
- Reviewing medical records;
- Taking photographs, and
- Gathering other important information and evidence.
After the adjuster is done investigating the accident, he or she will likely draft a damage report. The damage report will consist of a detailed breakdown of the financial aspect of the accident, including the total losses incurred as a result of the accident. However, because the damage report is often created using specialized software, the data may overlook some important aspects of your claim, such as the emotional impact that your injuries have had on you. The adjuster will then use the information produced in the damage report to begin the claim settlement and negotiation process.
It is important to keep in mind that many adjusters are responsible for representing the best interests of the insurance company which employs them, not yours. This means that adjusters will often try to hastily settle claims without paying a dollar more than is necessary. In order to accomplish this, the adjuster may find ways to lessen the value of your claim. For instance, the adjuster may ask you questions which are craftily phrased in order to induce you to admit fault for all or some of the accident. The adjuster may also propose a low settlement offer, hoping that your need for money outweighs your willingness to negotiate.
What to Expect in Negotiation
Based on the information contained in the adjuster’s damage report, the adjuster will propose an initial settlement offer. It is often the case that the initial settlement offer is lower than what the claimant was anticipating or hoping for. However, it is important to remember that the settlement offer can be negotiated.
The claim negotiation process consists of back-and-forth communication between you and the insurance company’s claims adjuster. The goal of the negotiation process is to convince the claims adjuster that your claim is worth more than what his or her damage report says it is. Although this process may be frustrating, there are several important steps that you can take to facilitate the efficiency of the settlement:
Establish a Minimum Settlement Amount
One of the most important parts of the claim settlement process is understanding what your claim is actually worth. Knowing the value of your claim may allow you to negotiate more effectively. You can estimate the value of your claim by considering important factors such as:
- The cost of your medical bills;
- The cost of your damaged property;
- The amount of lost wages; and
- Other miscellaneous expenses.
Determining the actual or approximate value of your claim can place you in a position to effectively negotiate your claim. You should not hesitate to reject the adjuster’s proposed settlement offer if the settlement amount is substantially lower than your estimate.
Emphasize and Reemphasize the Severity of the Accident and Your Injuries
It is critical that you defend your position throughout the claim negotiation process. You can defend your position by emphasizing and reemphasizing the severity of the incident, the extent of your injuries, and how those injuries have impacted and will impact your life both physically and mentally. To support your position, you can refer to important evidence such as medical records and photographs of your injuries. Referring to this evidence can make it difficult for adjusters to lowball you.
Do Not Admit Fault for Any Part of the Accident
As previously mentioned, adjusters may ask you questions that are designed to get you to admit fault. Although it is important to be honest and cooperative with the adjuster, you should refrain from admitting any fault for the accident. Doing so can provide the adjuster with leverage to lessen or destroy the value of your claim.
In ideal situations, a settlement amount that is satisfactory to both you and insurance claims adjuster will be reached. In this scenario, it is important to confirm the agreement in writing. If an agreement cannot be reached, you may need to explore the possibility of filing a personal injury lawsuit. In any event, it is important to remember that the negotiation process will require you to be patient and persistent.
What Evidence Do I Need to Support My Settlement?
In order to defend your position throughout the settlement process, it is crucial that you keep and maintain a thorough record of every important document relating to your accident. Examples of such documents include:
- Photographs of your injuries as a result of the accident;
- Copies of a police report or accident report;
- Photographs of the scene or area of the accident;
- Witness statements, if any;
- Medical bills
- Photographs of your vehicle (if applicable); and
- Car repair estimates (if applicable)
In addition to helping you stick to the facts of your accident, these documents can be referred to throughout the entirety of the settlement process. Referring to these documents early and often during settlement and negotiation may help support your position that your claim is worth more than what the adjuster’s damage report says it is.
You Don’t Have to Negotiate Alone
Negotiating against big insurance companies who have years of experience is handling and settling claims can be an intimidating task even for a seasoned negotiator. In most cases, claimants have little to no experience negotiating claim settlements with their insurance company or claims adjuster.
Fortunately, you do not have to negotiate alone. A lawyer who understands the claim filing and claim settlement process can help. Personal injury lawyers with this type of experience may protect inexperienced claimants from insurance companies and offer protection from bad faith practices.
For instance, during the discussion and investigation phase of the claim filing process, an insurance company may trick a claimant into admitting fault for all or part of the car accident. An unwitting claimant who admits to fault may decrease or destroy the value of his or her claim. An attorney can guide a claimant throughout this process, thus protecting the claimant from making any unnecessary statements that could hurt the value of the claim.
A personal injury lawyer can also deal with insurance companies and claims adjusters by strategically negotiating the settlement amount. In many cases, the claims adjuster’s initial settlement offer will actually be less than the claim’s actual value.
A claimant who is unfamiliar with claim negotiation may accept this initial offer without even considering the possibility of negotiating a more favorable claim settlement amount. Even if the claimant did want to negotiate, he or she may not even know where to start. A personal injury lawyer can act on the claimant’s behalf by negotiating a more favorable dollar amount for the claimant. Throughout this process, the lawyer will use careful negotiation strategies and use important evidence in an attempt to reach a more favorable settlement amount.
Types of Compensation Your Attorney Can Seek
In personal injury cases, the at-fault party or the at-fault party’s insurance company faces the possibility of having to compensate the victim for the harm caused. This form of financial compensation referred to as “damages,” can be separated into two broad categories: Economic damages and non-economic damages.
Economic damages correspond to a victim’s injuries which can be accounted for and calculated. The main parts of economic damages involved in most personal injury cases include:
- Medical bills;
- Pharmacy bills;
- Rehabilitation bills;
- Lost income (present and future); and
- Property damage
Medical, pharmacy and rehabilitation bills include costs paid by the victim for medical services received as a result of the accident or injury. Lost income reflects money lost due to time missed from work as a result of injuries sustained. Property damage refers to damage inflicted to the victim’s vehicle and personal belongings.
Non-economic damages correspond to intangible losses which cannot be calculated but instead are subjectively evaluated by a jury. Although it is difficult to assign a dollar amount to non-economic damages, non-economic damages are often more valuable than economic damages. Types of non-economic damages may include:
- Pain and suffering
- Emotional distress
- Loss of consortium
In many cases, insurance companies and claims adjusters will be reluctant to account for non-economic damages when formulating their settlement offers. Instead, claims adjustors will insist that the settlement should reflect economic damages only. However, a personal injury attorney can help you negotiate with adjusters in order to get them to properly consider the intangible harms that have been sustained as a result of an accident.
Punitive damages are a third type of damages that can be awarded, depending on the jurisdiction. Punitive damages, when awarded, are meant to punish the at-fault party. Although punitive damages are rare in personal injury cases, they may be awarded in certain situations where the at-fault party’s conduct was found to be especially reckless or intentional.
The Negotiation and Claims Process with a Lawyer
Described below are the steps which comprise the lawsuit filing process.
1. Call a Personal Injury Lawyer
If you wish to file a claim after being injured in an accident, one of the first steps you should take is to contact a personal injury lawyer. A lawyer will likely want to set up a meeting to discuss the facts and circumstances regarding your accident. During the meeting, the lawyer will ask important questions to determine where and how the accident occurred. The lawyer will also ask about any injuries you sustained due to the accident. Based on your responses to these questions, the lawyer will provide legal advice regarding your claim-filing options.
The next step in the process is referred to as the investigation phase. During the investigation, your lawyer will conduct a thorough search of the facts of your case. By doing this, the lawyer’s goal is to strengthen the value and credibility of your claim. Part of the investigation may involve your lawyer gathering important details about the accident. This can be accomplished by means such as interviewing witnesses and review police records and accident reports. The investigation process will also involve accounting for each of your damages, such as medical bills, lost wages, and property damage.
3. Case Settlement and Litigation
During or after the investigation phase, it is possible that the at-fault party or the at-fault party’s insurance company will offer to settle your claim. This will likely lead to negotiation. If the insurance company ultimately refuses to pay an amount that is satisfactory, it may be necessary to litigate your claim in court. In this event, your lawyer will be prepared to file a formal lawsuit and begin the process of preparing your case for trial.
Read More: Can I Sue the Insurance Company?
How Long Do I Have to Make a Claim?
State legislatures enact time limits, called a “statute of limitations,” on which an injured party must pursue a personal injury claim. If an injured party fails to file a claim within the applicable statute of limitations time period, that personal injury claim will effectively be barred from being litigated in court.
Although the precise time limits for statutes of limitations vary from state to state, most states have a two- or three-year statute of limitations for personal injury cases. Thus, a lawsuit must be filed within two or three years, depending on the state, of the date of the misconduct that caused the injury. For example, if a person was injured in a car crash on January 1, 2019, a personal injury suit must be filed before January 1, 2021 or January 1, 2022, depending on the state, or else the claim will be barred from being litigated in court.
Because statutes of limitations is a critical factor that can destroy a case, it may be wise to seek the advice of an experienced personal injury attorney following your accident. An attorney can provide you with legal advice regarding the status and viability of your claim.
TELL US ABOUT YOUR CASE
If you want to discuss your case with a personal injury lawyer before dealing with insurance claims adjusters, feel free to reach out to Zinda Law Group on 512 246 2224 for a FREE consultation about your case.
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