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Tips for Dealing with Insurance Claims

Posted by attorney Alex Ferguson

Navigating insurance claims can be challenging and frustrating. It is important to keep in mind that auto insurance is a for-profit industry. The other driver’s insurance company (the third party insurer) has absolutely no incentive to compensate you for your injuries. Your own insurance company (the first party insurer) knows that even though they have to pay your medical bills if you have Personal Injury Protection (PIP) coverage, they will not be able to recover all of their medical payments. Your insurance company, therefore, has a financial incentive to challenge the treatment that you seek, even if your doctor orders it.

What kind of coverage do you have?

PIP coverage is very important. If you are unsure whether you have PIP on your auto policy, check. If you don't have PIP coverage, you won’t be able to recover the costs of your medical bills until you have finished your treatment and negotiated a settlement with the third party insurer. If you have medical insurance you can cover the bills while you treat, but this can raise other complications depending on the type of coverage you have. If you have neither PIP nor health insurance, you will be personally responsible for paying for your treatment, which can become prohibitively expensive. If the latter case applies to you, we have good relationships with a variety of doctors, chiropractors, physical therapists, and massage therapists that will provide treatment on a lien basis based on our reputation for successful resolution of claims.

What is Underinsured Motorist Protection?

You should also check to see the amount of Underinsured Motorist Protection (UIM) coverage you have. UIM is critically important if you are injured by someone that does not have insurance or does not have enough insurance coverage to adequately compensate you for your injuries. If that is the case, UIM coverage will allow you to be compensated for your injuries by your own insurance company.

I have been in an accident. Now what?

When you are in an accident, it is imperative that you call the police and write down the other driver’s insurance information. From the outset, it is likely that everyone you deal with will try to assign some level of blame to you. Do not let anybody, particularly the other driver, intimidate you into saying that you might have been at fault. Remember to be polite with the other driver, but be sure to get his or her insurance information. That includes the name of the driver, the insurance company, and the policy number.

Report the claim.

As soon as you are able, call your insurance company to report the claim. The phone number to call should be highlighted on your insurance card. Try to remain calm and report the facts as best you can recall them. Once again, even if you are unsure, do not say that you were at fault. Your insurance company will open a claim and send you correspondence regarding what they need from you. If you call us after your claim is opened, we can take over and handle all communication with your insurance company.

You can also expect to get a call from the other driver’s insurance company. This is a very perilous part of the claims process. If you have not done so already, it is highly beneficial to hire an attorney before the other party’s insurance company tries to secure a statement from you. The insurance company will often tell you that they are going to take a recorded statement. They have a right to get your statement, but they DO NOT have a right to record your statement. The purpose of the recorded statement is to see if you say something to damage your claim. They will try to use this information against you later. If you don’t have an attorney on the line with you when they take the statement, tell them that you will give a statement but that statement cannot be recorded. Additionally, tell them that you will limit your statement to the facts of the accident, but you will not discuss your injuries or your treatment.

Who is going to pay for the damage to my car?

Within a week of your accident, the other insurance company will send someone to examine the damage to your vehicle. Make your vehicle available to them and allow them to take photographs. If your vehicle is drivable, take it to a body shop that you trust for an estimate. You can submit this estimate to the third party insurer and they will compensate you for the damage to your vehicle. If the damage to the vehicle is more than the vehicle is worth, they will compensate you for the fair market value of your car.

The other insurance company is offering money to settle but I am hurt. Should I just take the money?

If you don’t have an attorney, the third party insurance will try to get out of the accident claim as quickly as possible. Don’t be surprised if you get a call or a letter stating something along the lines of, “We are so sorry you were injured by our insured. We will give you $500/$1,000/$5,000 to compensate you for your injuries and pain and suffering." NEVER ACCEPT AN OFFER IF YOU ARE SEEKING MEDICAL TREATMENT. This is the insurance company’s way of getting you to permanently sign away your rights to bring a claim against them. It guarantees that you will not be adequately compensated for your injuries.

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