The first step after being injured in an accident should be to file an insurance claim with your insurance provider or that of the person responsible for the accident. And insurance claim allows you to recover compensation for any medical expenses, loss wages, pain and suffering caused because of the accident.
Before we dive deep in this topic, let us first understand the various type of insurance claims.
Two kinds of insurance claims: First Party vs. Third Party
The two kinds of insurance claims are first party claims and third party claims. First party claim is where you file with your own insurance company whereas a third-party claim is when you file the claim with the insurance provider of another. Most insurance holders cover third parties that are injured because of their actions.
The kind of claim you file depends of whose fault resulted in the accident caused, the type of the accident, and the extent of your insurance coverage. For instance, if the accident was caused while driving your car, you should file a first party claim with your auto insurance provider. Whereas, if you get hit by a car while crossing the street you should file a third-party claim with the driver’s auto insurance provider instead. Additionally, if you get injured while shopping in a store of eating at a restaurant, you may file a third-party claim with the business franchise’s insurance company.
The process of claiming insurance:
- Regardless of how and where you get injured, you should report the incident to the insurance company within the first 24 hours of the incident.
- If the accident wasn’t your fault, you should then contact the insurance provider of the party at fault. You’ll be required to provide information surrounding the accident and the extent of your injuries.
- The insurance company will open an investigation of your claim and ask you for more details regarding the case.
- You may also have to submit an independent medical examination report by a doctor of the insurer’s choice.
- After calculating the value of your claim, the company would then proceed to issue a settlement check.
- If the claim is denied or you believe the amount being offered is inadequate, then you may appeal to the insurance company. This appeal would require you to submit additional details and provide further information about the accident.
Process of appeals after denial of the claims:
There can be a variety of reasons behind why your claim was denied. You’ll receive notification from the insurance company this happens and then it if your decision if you’d like to appeal the denial of your claim. The appeals procedure differs from company to company, so it is advisable that you have a look at the policy in question to learn about what the next step could be. For further questions regarding this, it would be in your best interest to consult with an insurance attorney.
Calculating the value of Insurance Claims:
While it is easier to calculate medical expenses, that is not the case with determining the monetary value of the pain and suffering that a person might experience after getting injured. Insurance companies have developed a damages formula to help calculate these losses. An insurance claims analyst first adds up all your medical expenses by multiplying 1.5 or 2 to determine the amount of your “special damages”, if the injuries suffered aren’t very serious. In cases of severe injuries, the total will be multiplied by 5 or even 10. Once this is determined, the analyst will add you lost wages to determine the amount of your settlement. This amount can be negotiated with the insurance company to receive higher settlement amount.
Originally posted 2017-07-14 06:08:54.