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1. What will
the insurance company for the person, persons, or company who
caused my injury do about my claim?
After the insurance company has been notified about the claim,
a file is established on you and your case. An insurance claims
adjuster is assigned to your file by a claims manager or claims
supervisor. The supervisor may assign different adjusters to your
case as it progresses.
The insurance claims adjuster responsible
for your file will maintain contact with your lawyer. The adjuster
will also perform an independent investigation of your claim to
ascertain the following:
a. Who is at fault in your case?
b. Whether or not you bear any fault for your own injuries. This
is also referred to as comparative negligence or contributory
negligence.
c. Potential witnesses in the case.
d. The location of the scene of the accident.
e. The contents of police reports, Department of Motor Vehicle
reports, and any other investigative reports that have been filed
in the case.
After the initial investigation, the claims adjuster will request
medical reports and any other reports dealing with your injuries.
The adjuster will also review documents about your time lost from
work. Most importantly, the insurance claims adjuster will want
to receive accurate records of your medical bills, prescription
bills, hospital bills, therapy bills and any other actual expenses
incurred as a result of your injury. That is why it is very important
for you to maintain an accurate account of your medical bills,
lost wages, and other expenses which result from your injury.
2. How does
the insurance company put a value on my case?
This question is quite complicated. First, the claims supervisor
or claims manager will provide that a certain amount be "set
aside" as a potential value of your case. This figure is
usually called "reserves." Such reserves are the outside
value that the company has established on your claim. The reserves
may change as the case progresses. In serious cases, such reserves
may equal what are called policy limits. Policy limits are the
outside limit amounts of liability established in the insurance
policy of the person or persons who caused your injury.
During the preparation stages of your case,
the insurance company will keep track of your medical bills, lost
wages, and permanency regarding your injury and other factors.
The company will also take into consideration the quality of evidence
against their insured, the quality of your witnesses and their
witnesses, extent of liability on your part and other important
considerations such as previous injuries.
If you had a previous injury in the same
area of your body, the insurance carrier will want to see medical
records pertaining to that injury. During the course of your claim,
your attorney will be notified by the insurance company about
the important factors that are being considered in your particular
case.
3. Should I
communicate with or contact the insurance company for the person
who caused my injuries?
ABSOLUTELY NOT! Under no circumstances should you contact the
insurance company once you have retained an attorney. If you contact
the other person's insurance company for any reason, you could
ruin your entire case with one question or one statement.
Secondly, because you are now represented
by a lawyer, the insurance company, in most states, is absolutely
prohibited from having any personal contact with you for any reason.
4. Can I contact
my own insurance company?
If you have health insurance, medical payments insurance, automobile
uninsured motorist and/or underinsured motorist coverage, ("UM
Coverage") there may be occasions when it is appropriate
for you to contact your own company. However, you should always
ask your lawyer whether or not such contact is appropriate. Never
contact an insurance company without first obtaining approval
from your attorney.
5. Will the
insurance company for the person who caused my injuries dispute
my claim?
If liability and responsibility are well-established in your case
- that is, if fault clearly rests with the insurance company's
insured (the person or persons who caused your injury), they will
try very hard to settle your claim. Insurance companies usually
dispute the following types of claims:
a. Claims in which the fault rests with someone other than their
insured. This could mean you or someone else involved in the incident
who may have caused your injuries rather than the person who is
insured by the insurance company.
b. Claims in which the insurance company and its representatives
do not believe that you are injured, or that you were injured
as badly as you claim. For this reason, documentation of medical
bills, lost wages and other expenses are extremely important to
establish credibility and the existence of your injury.
c. Cases in which you or your witnesses have lied, exaggerated
or fabricated the nature and extent of your injury or how the
incident occurred.
6. What can
I do to convince the insurance company that my claim is valid?
As stated above, the most important thing you can do is to recover
as quickly as possible from your injury. Insurance company personnel
tend to believe those people who actively try to recover from
their injuries. That is why you must cooperate with your doctor,
physical therapist and other personnel who are trying to help
you improve from your injury.
Secondly, insurance companies believe those
people who can document their injuries through medical bills,
credible medical reports and accurate lost wage information that
is neither exaggerated nor subject to dispute and interpretation.
Thirdly, insurance companies usually settle
cases easier with those clients who have been in active contact
and cooperation with their attorney.
In summary, it is important for you to try
to get better, keep an accurate record of your expenses and cooperate
with your lawyer and his or her staff.
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