If you’ve been injured in an accident, you understand the pain and stress involved when the situation is not your fault. Unintentional injuries can keep you from earning a living and can harm your quality of life, as well as the lives of your family. Injuries can also create a permanent disability that hinders future employment.
Often, you need the at-fault party’s insurance company to make you financially whole again by reimbursing you for your medical bills and other expenses. That is, after all, what an insurance company is supposed to do—pay a fair settlement when a legitimate claim is submitted. But dealing with insurance companies is frequently fraught with pitfalls. Insurance companies are in business to make money, not to provide fair and equitable settlements. When you are injured due to someone else’s negligence, the maze of “gotchas” you must avoid can daunt even the hardiest individual. You need to file a claim, of course, but you must also avoid the pitfalls.
A personal injury lawyer, such as Mike Stephenson and Brady Rife at McNeely Stephenson, is often your first and best step in the process. A skilled attorney can keep you from making mistakes through no fault of your own that jeopardize your insurance claim.
What are the Stages of Filing a Claim?
If you’ve been injured by another party, the first thing to do is file your claim with the at-fault party’s insurance company. You must file your claim promptly to start the process; a number of companies give you only 24 hours to do so. Here’s what happens next, in order:
- The insurance company will reply to your claim with a “reservation of rights” letter. It is important to understand that the letter does not admit any fault on the part of the insurance company, but it notifies you that the company will begin its own investigation.
- A “demand letter” from you should follow the “reservation of rights” letter. If you have not yet done so, it is wise to secure an attorney who can assist you with this and the following steps. You will need to outline your “special damages,” meaning your medical bills, lost income, and other related expenses. You can also ask for “general damages” in the letter, which is an amount that covers your pain and suffering.
- You will generally receive an offer from the insurance company, but their offer may be much lower than what you requested. In fact, the amount may not even cover your bills. Try not to feel upset or personally attacked; it is only the first step in the negotiation process.
- You will send the insurance company a counter-offer that clearly states your costs and why the amount you have asked for is fair. Again, an attorney can provide valuable assistance.
- Offers may then go back and forth between you and the insurance company. A personal injury attorney who is savvy in their dealings with insurance companies can make counter-offers that can get you the result you are entitled to.
- Be aware that your claim may not settle. In this case, the insurance company may be acting in bad faith. For example, they might misrepresent facts, not respond in a timely manner, or not attempt to settle in a fair fashion. In such a case, the insurance company may leave you with no alternative but to pursue your case in court.
What Are the Pitfalls?
Without knowing it, you can make a number of mistakes in your encounters with the insurance company right from your first contact. Here are the pitfalls to keep in mind:
- Never sign a “medical release” from the at-fault party’s insurance company. They may claim that the release will enable them to “verify your injuries” or something similar. Instead, the release may allow them to read your entire medical record and other details of your private life. At the very least, do not sign any medical release until you have consulted with an attorney. The less the insurance company knows about your personal life, the better.
- Do not discuss any pre-existing conditions or injuries with the insurance company.
- Do not give a “recorded statement” to the insurance company. Your attorney will advise you on how best to proceed, but be aware that adjusters can frame their questions so that your answers may not reflect what actually happened.
- Do not settle your claim too quickly. Insurance companies want to settle as cheaply and swiftly as possible. But once you settle, they are no longer responsible for any additional expenses related to the accident.
- Don’t believe any number that the insurance company’s adjuster may give you, saying that it is “what your case is worth.” Adjusters often get promotions and bonuses for convincing people like you to settle for less than your adjuster knows the case is worth. Adjusters also know the situations when a jury might award you much more. You and your attorney must consider each offer carefully.
- Don’t make demands that you can’t substantiate with supporting evidence, such as medical records, police reports, and statements from your employer concerning lost wages. For circumstances where it is difficult to provide documentation, your attorney can employ private investigators and also ask for narrated reports from doctors and other medical personnel.
- Don’t lie or exaggerate your injuries or situation to the insurance company. You are legally bound to tell the truth.
- Remember that you do not have to answer every question that the adjuster asks you. It’s better to say “I don’t know” than something that might come back to haunt you. Be especially careful when it comes to using terms with specialized legal meanings that you may not fully understand, such as “negligence.” Be aware that the term “whiplash” is considered a red flag to an adjuster that it’s best to avoid.
- Do not give the adjuster any personal information you are not required to give. It is important to note that you are not required to provide your social security number to the adjuster. Having your social security number can unlock a lot of information for the insurance company. If you have any concerns about the specific information you ae required to provide to them, consult with your attorney.
- Never assume the adjuster is your friend. They may try to draw you into friendly conversation in an attempt to gain an admission from you. Don’t let down your guard. It is often best to say as little as possible. Be polite, but close-mouthed.
The process of pursuing an insurance claim can feel daunting. It is important to persist so you can keep your claim moving along. At the same time, you also need sufficient patience to wait-out developments when waiting is called for. Always be polite to the adjuster and to the others you might encounter at the insurance company. Adjusters in particular have a lot of power and discretion. If you are unpleasant, they can go against you.
Because of the many challenges involved in pursuing an insurance company claim, you are more vulnerable to unfair treatment if you go it alone. Insurance companies have knowledgeable employees and access to experts in order to help them make decisions. Therefore, it is in your best interests to work with a capable and caring attorney who can guide you through the settlement process and, if necessary, represent you well in court.