An Overview of the Injury Claims Process - Understanding the Process



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This is a brief guide to understanding what is a compensable injury how the bodily injury claims process works. It is intended for someone who is making or considering making a bodily injury claim for the first time.

An Overview of the Injury Claims Process

What is a compensable injury or one for which a personal injury claim can be pursued?

The legal definition of a personal injury is any injury to your body mind or emotions. Personal injury claims cover physical harm, such as broken bones, bruises or any serious injury caused by the negligence or intentional conduct of another. These claims also include the emotional and psychological injury you may have experienced as a result of trauma sustained through a humiliating or life-threatening experience. The purpose of this article is to provide a brief overview of the claims process in the context of a personal injury claim.

How is an injury claim processed?

Personal injury claims must be brought to the attention of the responsible party or their insurance carrier prior to the expiration of your state’s statute of limitations. In the state of California the Statute of Limitations for most personal injury claim is two years from the date of injury. It is important to notify all insurance companies involved of claims for injuries and property damages immediately after the accident or shortly after seeking initial medical attention. The recovery process, with related medical treatment for many injuries, even minor “soft tissue injuries” can take many months. Therefore you should not wait until you have healed before reporting your claim. If you delay notification until nearing the statute expiration date, you greatly reduce your chance of reaching a voluntary settlement without litigation.

To support your claim it is also important to collect and maintain physical evidence of your injuries and any property damage. One should take photographs of any visible injuries, and update them throughout the healing process. Photographs of property damage should also be taken in order to prove damages, especially if there can be any argument as to whether the collision actually occurred. It is also important to take pictures of any skid marks, road conditions and damages to the other vehicles involved. It is advised that you keep a written journal documenting how your injuries hindered your daily life. Many injuries can interrupt daily routine tasks that one may take for granted, such as, dressing, cooking, cleaning, lifting a child etc. Time off from work should be documented and copies of work releases from your doctor should be submitted to your attorney or claims adjuster.

Once the insurance carrier has received notice of the claim, a claims examiner will be assigned to determine who they feel is at fault or liable. In nearly every accident, someone was at fault and fault can be spread or apportioned between the parties, if appropriate. Determining liability is a way to assess legal responsibility. Once liability has been established, it will be important to update your attorney on a regular basis, keeping them informed of your current medical condition. During your recovery it is especially important to follow your doctor’s recommendations. Even if you are feeling better, you should continue to receive medical treatment until your doctor determines that you have reached a point known as maximum medical improvement (MMI). Although medical treatment is time consuming and expensive your attorney will seek reimbursement for all of your expenses in a formal demand for settlement.

Once you have completed your medical treatment, your attorney will gather all supporting evidence from your medical providers, police departments, employers and witnesses. Your attorney will then prepare a demand for settlement. This is the centerpiece of the insurance claims negotiation process. The demand letter will vividly summarize your injuries, state why the other party is at fault, discuss the types of medical treatment you received and clearly and completely outline the amount of costs or damages incurred. Any lost income will be documented along with any other economic damages suffered. Your demand will also “personalize” your claim in an effort to separate it from the hundreds of other cases the adjuster may be handling.

Once your demand has been submitted, the negotiations process will begin. The claims adjuster will speak with your attorney about your claim for injuries. More often than not, the claims adjuster will respond with a much lower offer than was originally demanded. If a fair offer is not made, your attorney will discuss with you the particular areas of concern by the adjuster. As negotiations continue it could be the insurance carrier is seeking additional documentation. Your attorney will assist and coordinate the exchange of additional documentation. Back and forth offers and demands are common.

During the negotiation process your attorney should keep you up to speed as each offer comes in and/or discuss what additional information the carrier is seeking. During this time your attorney may also be negotiating with your medical providers and health insurance companies as well. In many cases, your attorney is able to negotiate a bill or lien reduction with the medical providers and insurance companies who may be seeking reimbursement. Any such reduction of bills or liens will maximize your ultimate recovery.

Should negotiations fail to resolve your claim, another option might be to request a pre litigation mediation. Mediation is an informal, voluntary and confidential way to resolve disagreements without giving the decision making power to someone else, like a judge. Mediation is a confidential, non-binding process in which a trained Mediator acts as a neutral person who facilitates communication between disputants and assists parties in reaching a mutually acceptable resolution of all or part of their dispute. If the matter has not been resolved by negotiations or mediation your attorney will speak with you regarding filing a lawsuit against the adverse party.

Generally, you have a short amount of time and limited opportunities to prove your case with the adjuster in order to maximize your pain and suffering recovery. Hiring an attorney that knows the law, understands the process and utilizes their resources is key. It is not recommended you try to resolve a personal injury claim on your own. Once an adjuster has assessed or evaluated the claim, they often set hard “reserves” on the case which are never changed. In other words, there may be nothing a lawyer can do if the adjuster evaluates your case below it’s true value. Don’t take this chance, call an experienced personal injury attorney before you try to settle your own.

ABOUT THE AUTHOR: Evan A. Gould, Esq., Hollander & Gould, LLP
If you have been injured as a result of someone's negligence you need an advocate who is experienced with these issues and can quickly determine whether you have a case and who can help you find a means of recovery for your injuries and damages. The injury attorneys at Hollander & Gould can help you answer any questions you have regarding your case and have helped thousands recover compensation for their personal injuries. We are here to help.

Copyright Hollander & Gould LLP
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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer. For specific technical or legal advice on the information provided and related topics, please contact the author.