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.
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.