Insurance Claim Settlements

The Insurance Claims Process

When an insurance company is notified that you have filed an accident claim against one of their customers, they will establish a file on you

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Insurance Claim Settlements

The Insurance Claims Process

When an insurance company is notified that you have filed an accident claim against one of their customers, they will establish a file on you and your case.

A claims manager or claims supervisor will subsequently assign an adjuster to your case. The supervisor may assign multiple adjusters to your case as it moves along.

Claims Adjuster

The insurance claims adjuster assigned to your file will keep in touch with your accident attorney.

The adjuster will also conduct an independent investigation of your claim to establish the following:

  • Who is at fault in your case
  • Whether or not you are at fault in any way for your injuries
  • Potential witnesses in the case
  • The site of the scene of the accident
  • The contents of police reports, Department of Motor Vehicle reports, and any other investigative reports that were filed in the case

Following the initial investigation, the claims adjuster will ask for medical reports and any other reports about your injuries and examine documents about your time lost from work.

More importantly, they will make it a priority to receive accurate records of your medical bills, prescription bills, hospital bills, therapy bills, and additional actual expenses you took on because of your injury. Therefore, you must keep a precise record of your medical bills, lost wages, and other costs resulting from your injury.

Valuing the Case

The claims supervisor or claims manager understands that a certain amount will be “set aside” as a potential value of your case, a figure commonly referred to as “reserves.” The reserves are the outside value that the insurance company has established on your claim.

The claims supervisor might modify the funds as your case moves along. In severe cases, such reserves could equal what is called “policy limits,” which are the outside amounts of liability established in the individual’s insurance policy or individuals liable for your injury.

Dealing with Insurance Companies

Insurance companies’ business objective is to make a profit, which requires them to collect more money in insurance premiums than pay out in claims. They have an incentive to undervalue allegations and take further actions to pay the minimum amount to accident victims. 

Suppose you are a victim of an accident. In that case, you must be expertly represented by a qualified accident attorney who can uphold your rights and protect your interests in the face of aggressive insurance companies.

Watch What You Say

Your statements to your insurance company may affect the outcome of your insurance claims. Consult with an accident attorney right away following an accident, preferably before conversing with an insurance company representative.

Insurance companies may attempt to avoid paying your claim by taking one or more of the actions below:

  • Requesting a recorded statement that will be used against you in the future
  • Asking you to sign ambiguous “authorizations”
  • Offering you a quick settlement that is significantly less than the amount you could achieve in court
  • Refusing to pay your medical bills
  • Reluctant to agree to a settlement

Why You Need an Attorney

An insurance adjuster will examine the nature of your claim and decide on paying it based on the company’s rules. If an adjuster intends to lessen your settlement amount, he may apply those rules selectively or falsely categorize your claim.

While your accident attorney is preparing your case, the insurance company will consider the strength of evidence against their insured. Likewise, your accident attorney will assess your witnesses and their witnesses’ credibility, the degree of liability on your part, and other relevant factors, such as past injuries. If you suffered a previous injury in the same area of your body, the insurance carrier would want to see medical records related to that injury.

While your claim is progressing, your accident attorney will be informed by the insurance company regarding the essential factors examined in your particular case. An experienced accident attorney will get the medical and financial support necessary for your recovery. 

An accident attorney will thoroughly review your case and resolve many of your most pressing questions: 

Will I get the medical treatment that is required for my injuries? 

How do I support my family while I miss time at work? 

Will I be able to go back to work? 

How do I choose the appropriate physician to treat my injuries? 

An accident attorney will negotiate with the insurance companies to obtain the maximum value for your case.


Temporary Workers More Likely to Be Injured on the Job

Temporary workers are more likely to be injured or killed on the job, according to the Bureau of Labor Statistics (BLS). Since 2012, contract worker deaths account for more than 15 percent of all workplace fatalities in the United States. That number was even higher in 2016 when almost 850 contract workers, or about 16 percent of the workforce, suffered a fatality.

Why Are Temporary Workers at a Higher Risk?

Temporary workers are often treated in a different manner than regular workers, according to the National Safety Council (NSC). In many cases, they do not receive the same job training given to regular employees, plus they may suffer from a lack of standard protective equipment. Also, employers frequently assign their most dangerous jobs and repetitive tasks to temporary workers in order to lower the employer’s cost of workers’ comp for regular employees.

Safety experts also say the higher risk of injury may be due to the contract worker’s unfamiliarity with the workplace and its potential hazards, especially when employers reassign workers to a less familiar job without notifying the contract agency. Temporary employees may also be reluctant to speak out about a potential danger for fear of losing their job. They may even volunteer for the more dangerous jobs in the hope of being offered permanent employment.

Protection for Temporary Workers

As a temporary worker, it is important that you protect yourself from injuries as much as possible. Begin by inquiring into the safety training that you will receive from the contract agency. Find out what you should do if you are asked to perform a task that is potentially dangerous or one in which you have not been properly trained.

Always have the contract agency’s name and phone number handy so that you can contact them whenever you feel unsafe on the job. Finally, make sure that the contract agency carries workers’ comp insurance that will adequately compensate you if you get hurt on the job. If there is any doubt about how to do that, you may want to hire an attorney with experience in workplace injuries.

Car Accidents Settlements

FAQs About Injury Claims and Car Accidents

If you or a loved one are facing serious injuries, wrongful death, pain and suffering, financial losses, and other losses, you should know that you have legal options and help available.

If you are confused about what to do after an accident, review the list of frequently asked questions to ease your discomfort and confusion.

How Can an Attorney Help Me?

There are many ways a personal injury attorney can help you. They can help you understand your legal options and rights, negotiate a settlement with an insurance company, and ensure that you recover the compensation you deserve.

Should I File a Car Accident Claim?

If you suffered any damages, you have the right to pursue compensation for those losses. However, it is important to note that after an accident, insurance may not cover the full cost of your losses, especially if serious injuries are involved. This may leave victims suffering for years of medical treatment and an inability of being able to work. This is why it is important to file an injury claim, that way you can take actions to protect your entitlement.

How Much Compensation Am I Entitled To?

There is really no way of knowing the exact amount of compensation you are entitled to since every case is different. The outcomes are based on negotiations with your attorney and the insurance company. The compensation awarded depends on the damage.

In car accidents and other personal injury claims are often categorized as either non economic or economic damages.

Noneconomic Damages May Include:

  • Loss of earning capacity
  • Pain and suffering
  • Loss of ability to enjoy life
  • Loss of companionship

Economic Damages May Include:

  • Lost wages
  • Medical treatment
  • Out of pocket expenses
  • Property damage

What if The Car Accident Was Partially My Fault?

Texas follows the 51% bar rule. This means that if you are more than 51% responsible for the accident then you will not be compensated. However, below 51% entitles you to compensation.

Always speak with an attorney first, they can assess your case and let you know where you stand.

What If The At Fault Driver Doesn’t Have Enough Insurance?

If the minimum amount of their insurance is not enough to cover for damages, under insured motorist insurance (UIM) can compensate the rest. UIM covers bodily injuries, as well as property damage.

What If My Auto Insurance Claim Is Denied?

You can request a reconsideration if you do not agree with the list of reasons why your insurance claim has been denied. Your lawyer can evaluate your auto insurance policy and the accident to determine if you were wrongfully denied coverage.

If the insurance company denies your claim again, you may be able to file an appeal with the Texas Department of Insurance. Your attorney will assist you with the process and walk you through the appeals process, as well as build a strong to ensure you get the compensation you are entitled to.

Insurance Claim Settlements

How Much Money Do You Get From A Car Accident Settlement?

Why Should I Settle My Claim? Shouldn’t I File A Personal Injury Lawsuit?

After a car accident, you have the legal right to pursue compensation for your injuries and losses through the court system. It is highly advised that you first contact a board certified personal injury law firm.

However, there is usually an insurance policy in place designed to cover your losses. Your insurance provider will usually prefer to pay you a settlement amount in return for your agreement not to pursue a lawsuit in court. It will save them the cost of taking your case to court.

It’s also usually beneficial to you and the injured party, because you don’t have to wait for the court system to resolve your case, which can take many months or even years. Before accepting a settlement, you can decide whether or not you want to take your case to trial. However, you run the risk of getting nothing if you lose.

How Does An Insurance Company Decide To Offer A Settlement?

An insurance policy always comes into when you’re injured. Especially where someone else may be at fault, whether involving a slip and fall, a car accident, or any other kind of incident.

If you file a claim under your own insurance policy, you insurer might turn around and seek reimbursement from the insurance company of the person at fault. Or you might file a third-party claim directly with the insurance company of the party at fault.

In both cases, an insurance company handles a claim by doing two things, minimizing costs and managing risk. Your insurer will do everything it can to resolve the claim before it gets to court. This means reaching a settlement agreement in which you receive a sum of money and the insurer and/or the defendant are released from any further liability in connection with your injuries.

An insurer is not going to let a personal injury case go to trial since it can be put in the hands of an unpredictable jury. A jury that could just as easily award the plaintiff hundreds of thousands of dollars that could free the defendant and the insurer of any liability.

Should I Trust An Online Settlement Calculator?

You can get a rough idea of the amount of compensation you might expect to receive using an online calculator. However, results will be inaccurately estimated of your compensable damages.

First you should get all your claim-related documents together. These include, medical bills, pay stubs, records of time missed at work, property damage estimates, and anything else that will give you a strong sense of your losses so far. This will give you an idea of your out-of-pocket damages.

Insurance companies use a multiplier to calculate the damages for pain and suffering, emotional distress, and other damages.

That means multiplying your actual damages by a number between 1.5 and 5. The number will depend on factors like the seriousness of your injuries, your prospects for a complete recovery, the clarity of who was at fault for the accident, and the impact that your injuries have had on your day to day life.

However, resolution of any injury claim usually turns on far too many variables, including the art and skill of successful negotiation for you to reasonably rely on these numbers.

What Damages Should Be Included In My Settlement?

In personal injury cases, the different kinds of compensation you can receive are divided into two main groups: general damages and special damages.

General damages are called non-economic damages while special damages are referred to as economic damages.

General damages are kinds of harm and losses that are from the underlying accident or injury. Yet, are not easily quantified and can be more subjective. For example, this includes compensation for any pain and suffering, loss of enjoyment of life, lost companionship, disfigurement, and similar harm caused by the accident and resulting medical treatment.

Special damages are losses that are easy to quantify. These include, compensation for medical treatment, lost wages, lost of income opportunity, property damage, and other economic losses resulting from the accident. As well as, medical treatment, and any resulting disability or limitation.

You Could Be Entitled To Recover Compensation For:

Car Injury Medical costs

All your medical bills should be paid for, with no co-pays or expenses to you. Any medical treatments should be completely covered.

This includes hospital bills, surgeries, medications, diagnostic procedures, visits to specialists or any other treatments.

Future Care Costs

In some cases, injuries can be permanent or last long after your settlement has been paid or the trial has ended.

Costs that should be included are, ongoing pain management, physical therapy, surgeries or any other future medical treatment.

Adaptive Medical Devices

If your injury caused you to suffer some type of impairment or disability, you may need adaptive devices. From a special vehicle, you can drive when paralyzed, to an electric wheelchair or a ventilator.

There are a variety of medical devices that you may use over the course of your recovery or for the rest of your life. The cost of these devices should be covered.

Pain Management Costs

After an accident, if you have ongoing pain, need pain medication, chiropractic care or other treatments to help you cope with and minimize your discomfort, should be paid by the person responsible for causing the accident.

Rehabilitative Care

If you need physical rehabilitation, either inpatient or outpatient, these costs should be included in your compensation.

Personal Care Assistance  

Costs that should be covered are, someone who needs ongoing nursing care or will need to go into a nursing home.

Along with, someone who may be able to remain in their home but need help doing basic tasks.

Lost Income/ Wages

You should be compensated for the missed work, if you have to miss any work because of your injuries, or if you used sick leave or vacation time.

A Reduction In Earning Capacity

At times, a car accident may injure someone so badly that they can no longer work. Your injuries can also prevent you from earning the amount you did before the accident.

If you lose the ability to earn a living or if your income is reduced, you should be compensated for that.

Damage To Your Property

The cost of repairs or replacements should be included in your compensation, If your car or other property was damaged in the accident.

Permanent Injury/ Disfigurement

You should be compensated, If you were disfigured or suffered a permanent injury.

The serious effects of your injuries and its impact on your quality of life should be taken into account

Pain And Suffering

Calculating pain and suffering damages can be difficult because it is hard to put an appropriate amount on how much your pain is worth.

However, the law says that victims are entitled to compensation for the physical pain the injuries may have caused.

Emotional Distress

You could be entitled to compensation, If you suffered emotional problems as a result of the crash or injuries.

Common examples of emotional problems are, Post traumatic stress disorder (PTSD), depression and insomnia.

Monetary compensation could be available for those who have lost a close relative in a car accident. Wrongful death damages include payment of medical expenses, funeral costs, loss of companionship damages, and loss of financial support.

Should I Receive Money For Pain And Suffering In My Settlement?

If you were injured in an accident, and you were not at fault, you should receive some amount of money for your pain and the impact the injury has had on your daily life.

In accidents with minor injuries, or short-term injuries, it may be a small amount. When injuries are more serious, painful and/ or long lasting, the settlement of the pain and suffering of your claim sharply increases.

Are My Medical Bills Paid For In An Injury Settlement?

Yes, payment or reimbursement of medical bills will be crucial to any settlement that is reached in an injury related insurance claim or lawsuit.

The plaintiff & claimant will be compensated for all medical treatment necessary by the accident. That includes reimbursement for medical bills already paid for, and a plan for payment of all future medical treatment that will be necessary.

Be aware of when it comes to getting compensation for medical bills that have already been paid for. Your health insurance provider may have a claim on part of your settlement, if your provider already paid some or all of the bills that you later get compensated for.

Is There A Minimum Amount For A Personal Injury Settlement?

When it comes to injury settlements, there is no minimum or maximum amount. In terms of strengths and weaknesses every case is different.

The amount of settlement involved in a personal injury case depends on a whole host of factors, these include:

  • The nature and extent of the plaintiff/ claimant’s injuries, including pain and suffering, and the long-term impact of the injuries.
  • Clarity of who was at fault for the underlying accident
  • The willingness of one side or the rejection of the other
  • Let the case go to court if needed

Can I Reject A Settlement Offer?

Of course you can. If you’ve filed an injury claim with an insurance company, or brought a personal injury lawsuit against the person who caused your injuries, you’re free to reject any settlement offer you receive.

Most injury cases settle before going to trial, and a large number of claims get resolved before a personal injury lawsuit is filed. However, there are a number of valid reasons to reject a settlement offer and take the case to court. You or the other party may disagree on key issues like who was the cause of the accident, or the extent of your injuries. Or maybe you just want to settle your case in court.

It’s a wise decision to take a reasonable approach to any settlement offer, and formulate a strategic response. Discuss with your attorney on the best course of action. Settlement negotiations continue, when an injured person rejects a settlement offer. Typically, the injured person called the claimant or plaintiff makes a counter offer, usually as part of a methodical and professional demand letter.

A demand letter is a chance for you to tell your side of the story. How did the accident happen? Is there evidence that points the blame on the defendant? Does this blame contain police reports, witnesses, etc.? How badly were you injured? What has been the course of your medical treatment so far, and what is your prognosis for future treatment?

Your letter will present detailed evidence that will show why the other side’s initial settlement offer is too low. You’ll end your letter with your own demand, an amount you’d be willing to accept to settle the case.

How Is My Lawyer Paid?

In most personal injury cases, if you decide to retain a lawyer to handle your case, he/ she will represent you under a contingency fee. What this means is that you do not pay anything up front. If your case reaches a favorable solution either through an agreed upon settlement or after a civil court trial, your lawyer will be paid.

In the initial fee agreement that you signed, your lawyer will collect a percentage that was agreed upon. This percentage is typically around 33 percent of the settlement amount. However, the further along the case progresses, the lawyer’s cut will increase gradually.

Can I Get My Lawyer To Accept A Lower Percentage Of My Settlement?

Attorney’s fees are always negotiable. You should bring up the fee arrangement as you interview attorneys to handle your injury case.

It’s true that most lawyers will immediately say something like one-third is the industry standard. However, just like there is no average settlement, there is no average lawyer’s fee.

You should be able to negotiate a favorable fee agreement, if you’ve got an excellent case, liability is clear, the damages are significant, and there’s adequate insurance coverage.

On the contrary, if there’s a disagreement on your case about liability, or the cause of your injury, a lawyer will probably not accept a lower fee, because the risk of losing is high.

How Do I Collect My Personal Injury Settlement?

It depends on the specificity of your case. If the defendant had an insurance policy to cover the accident, chances are that you or your attorney have been negotiating with the insurance carrier. Either before you filed a personal injury lawsuit, or while the lawsuit is ongoing.

Typically, your insurance company will usually just write a check for the agreed upon amount. Then, you will sign a release that discharges the insurer and the defendant of any further liability in connection with the incident that gave rise to your claim.

Things can get more complicated if you sued the defendant directly and there is no insurance coverage at play. Especially when your case has gone all the way to trial and you’ve received a judgment in your favor. An order from the jury that the defendant pay you a certain amount in damages. However, getting a judgment is one thing, and getting your money is another. If the defendant does not have much in the way of assets, it will be a challenging.

Do I Need To Pay Taxes On My Settlement Money?

It all comes down to what the settlement covers.

The award will not be taxable as income, if the settlement is intended to cover physical injuries or physical sickness. However, if you previously claimed any medical expense deductions related to that same injury or illness, your settlement will be taxable.

You don’t need to claim any part of the settlement as income for federal income tax purposes, If you didn’t claim a deduction. However, if you did claim a deduction involving the same injury or illness that gave rise to the settlement, then you’ll most likely need to report the settlement as “Other Income” to the IRS.

There are a few more unorthodox rules when it comes to settlements and whether they’re taxable:

  • Any portion of your settlement that is meant as an interest payment is taxable.
  • Any portion of the settlement that is meant to compensate you for pain and suffering, above and beyond any amount meant to cover your actual medical expenses will be taxable.
  • Any inflicting damages included in the settlement will be taxable.