In most cases, personal injury claims are made against insurance companies. The policy in question may be held by a negligent motorist, a business, a manufacturer, or property owner. Alternatively, you may also make a claim through your own insurance policy. Regardless, navigating the insurance claims process can be challenging. Injured victims need to know how to protect their interests.
At Walker Morgan, we want to make sure that everyone has the tools and information that they need to protect their rights. Here, we provide an overview of how insurance works in personal injury claims. If you have any questions or concerns about your specific case, please do not hesitate to contact us for free legal guidance.
First Party Claims vs. Third Party Claims: Explained
A first-party insurance claim is one that is between the policyholder and their own insurer. For example, if you were injured in a one-car accident and you have some form of Personal Injury Protection (PIP) coverage or MedPay coverage, you can seek financial compensation through your own insurance provider. When you do so, you are filing a first-party claim.
A third party insurance claim is one that is brought against the other party’s insurance policy. For example, if you suffered a burn injury that was caused, at least in part, by a negligent property owner, you can make a premises liability claim against them. Generally, that claim would be handled by their insurer.
How Do Insurance Adjusters Value a Claim?
To truly understand how insurance works, you need to understand the objectives of the insurance company. An insurer is a profit-making business — its primary goal is to resolve your case for the lowest settlement amount possible. If they can deny your claim, they are more than happy to do it. In determining the value of case, insurance company representatives will generally consider the following three factors.
- The Damages: In assessing the baseline value of your case, insurers will start by considering your damages. Among other things, this may include medical expenses, lost wages, pain and suffering, and long-term disability. No insurance company wants to push a case to trial if it is going to lose before a jury. When an insurance company is presented with well-documented damages and clear liability, it will be far more likely to offer a fair settlement. Notably, the Bureau of Justice Statistics (BJS) provides that only about three percent of tort cases in the United States actually receive a jury verdict.
- The Policy Limits: A policy limit is the maximum amount that an insurance company will pay out in relation to a specific claim. For example, if a business purchases an insurance coverage that carries a $100,000 policy limit per injury, then $100,000 is the maximum amount of compensation that an injured victim can seek through that specific insurance policy. If you suffered damages beyond the policy limit, you can still seek financial relief, but you will have to do it directly against the defendant or against another insurance policy. Each insurer is only liable for paying out the policy limit.
- The Strength of the Case: Finally, the strength of the case must be considered. If an insurance company believes that you have a weak case, it is unlikely to offer you full and fair financial compensation. It is imperative that injured victims seek professional legal support as early on in the process as possible. An experienced personal injury attorney can help you build the strongest possible claim.
Four Tips for Dealing With Insurance Companies
In the aftermath of a serious accident — whether you suffered a severe burn or any other type of injury — it is crucial that you keep pace with the insurance company. Often, insurers will begin building a legal defense in the hours or days after finding out that an accident occurred. There are some important steps that you can take to protect your rights. Specifically, you should:
- Report the accident to the appropriate parties. This may include your own insurance party, a business, a property owner, or the local highway authorities.
- Secure any relevant evidence. Successful insurance claims are generally built on a foundation of strong, well-organized supporting evidence.
- Avoid giving a statement to an opposing insurer. Remember, a third party insurance company is simply not looking out for your best interests. Do not give a recorded statement without first consulting with an attorney.
- Call a lawyer for help. In most cases, the best way to start the insurance claim process, especially if you are making a third party claim, is to work with a lawyer who will draft a formal demand letter than will provide an overview of your claim and make a specific demand for financial compensation.
Get Help From an Experienced Personal Injury Attorney
At Walker Morgan, we are a nationally recognized personal injury firm with experience handling burn injury claims. If you or your loved one suffered a serious injury, or if you just have questions about insurance policy limits for personal injuries, our legal team is here to help you deal with the insurance company. To set up a free, no commitment case evaluation, please contact us today.