Dealing with the aftermath of an accident can be challenging, especially when it causes injuries that require compensation. If you think the process of filing a claim with the insurance company of the person who causes an accident is easy, you might need to think again. This is because the typical insurance claims process is anything but straightforward, and it’s ideal that you have an attorney by your side. So, how do insurance companies handle personal injury claims?
The Insurance Claims Process
The complexities of filing a personal injury claim might make you feel overwhelmed, but understanding the process can ease the burden significantly. This is how it unravels.
- Initial notification. You need to contact the other party’s insurance company as soon as possible, and any delay in notifying might complicate the process.
- Claim filing. You’ll need to file a formal claim by completing a claim form. You also need to provide evidence to support your case. This can include photos, videos, medical records, and police reports.
- Investigation and assessment. The insurance company assigns an adjuster to your claim. The role of an insurance adjuster is to inspect the damage, review your documentation, determine liability, and calculate the extent of coverage.
- Settlement and payment. At this stage of the insurance claims handling process, the adjuster makes an initial settlement offer. You must review it carefully and ensure it covers all your losses and expenses. If you feel the offer is too low, you need to negotiate with the adjuster. If you reach a settlement, the insurance company will process your payment.
- Litigation. If you’re unable to arrive at a favorable settlement, you may consider filing a personal injury lawsuit.
Games Insurance Companies Play
One answer to “How do insurance companies deal with claims?” is that they do it with a very firm hand. Given that insurance companies work for profit, they do their best to minimize their liability, and they even reject several claims. Not surprisingly, they play different tricks to achieve what they’re after. If you’re wondering what happens when you file a personal injury claim, this is what you need to know.
Contacting You Before You Seek Legal Advice
Claim adjusters try to contact accident victims before they can seek legal assistance. They typically express concern about a victim’s situation and make it seem like they’re there to educate and help. However, this effort to build rapport and trust is actually to discourage victims from getting legal advice.
Adjusters might also tell victims that attorneys will take a share of their compensation amount, whereas what they’re really worried about is attorneys getting them to make larger payouts. The fact is that with an attorney by your side, you increase the likelihood of moving past a lowball offer and getting the compensation you deserve.
Insisting on a Speedy Settlement
When it comes to how insurance companies process claims, they often try to take advantage of the fact that victims have medical bills to pay and might also have to spend time away from work. As a result, an insurer might act like it’s doing you a favor by processing your claim quickly and offering to settle.
However, chances are that the offer is very low and will not make up for your short- and long-term injury-related expenses. Again, the reason they insist on settling quickly is so you don’t seek legal assistance.
Asking for Unnecessary Information
There are instances when insurers request information that seems irrelevant or delays the claims process unnecessarily, which can be frustrating for victims who need timely assistance. Besides, requests for highly personal information can feel intrusive, especially in sensitive situations. In this scenario, awareness of your rights is crucial, and you should not hesitate to seek legal counsel if you think an insurance company is acting in bad faith.
Highlighting Delays in Seeking Medical Treatment
One reason why insurance companies deny personal injury claims is a delay in seeking medical treatment. Even if you think you are fine after an accident, you should get a medical assessment as quickly as possible. This is because some injuries might take time to present symptoms.
If you fail to get a health care professional to check you soon after an accident, the insurance company you’re up against might argue about the severity of your injuries, emphasizing that they were not severe enough to warrant immediate medical attention.
Arguing About the Treatment You Receive
Insurance companies may dispute medical treatments for a variety of reasons, generally focused on managing costs and ensuring that claims align with policy terms and medical necessity. However, insurers often have their own definitions of “medically necessary,” which may differ from a doctor’s opinion.
They might also argue that a treatment is experimental, investigational, or not essential for the patient’s condition. In this case, your attorney can use the services of medical experts to add credibility to your claim.
Shifting the Blame to Victims
A fairly common tactic in the insurance claims settlement process is to try and shift all or part of the blame to the victim. Given that New York follows the contributory negligence law, any shifting of blame to you can reduce the compensation amount you receive.
For example, if an insurance company assigns 50% of an accident’s fault to you, the money you stand to receive will reduce by half. If you think an insurance company is pinning fault on you and you’re not to blame, seeking advice from an attorney is the best way forward.
Prying Via Social Media
Insurance companies aim to minimize their payouts, and if they find evidence on social media that weakens a claim, they use it to reduce the amount they have to pay. Insurance adjusters or investigators may check publicly available social media profiles and even hire private investigators to monitor social media activity and gather evidence. As a result, it is best that you stay away from social media until the insurance claims process is complete.
Conclusion
Now that you know what happens when you file a personal injury claim, understand that you should not expect overnight results. If an insurance company is rushing you into accepting a settlement offer, you might have reason to be wary. This may also be the case if an insurer says that your injuries fall outside the policy’s coverage limits. Ideally, you should consider hiring an experienced personal injury attorney to handle the insurance claims process.