When you’re involved in a motor vehicle accident (a slip-or-trip and fall accident or premises liability case), you are most likely to deal with an insurance company, the financially responsible party and the real party in interest. Insurance companies are in the business of making money; they really do not like giving it away, which is why you need to be extremely careful—if they can get away with it, they will and they will give you the least amount of compensation possible (if not deny your claim).
It is NOT advised in any way that the accident victim, worker or consumer engage in an insurance liability claim without the legal representation or assistance of a lawyer. Period!
Here are some steps involved in the insurance claims process:
The loss is reported to the insurance company: You first want to see if you can settle this situation privately (outside of court & litigation). You need to contact the insured’s insurance company and tell them about your accident (usually in writing). You become the claimant. The insurance representative will take some basic information about the incident. BE CAREFUL when answering these questions. Insurance companies like using your own words against you down the road.
A claim number and an adjuster will get assigned. Once the representative takes relevant info, they will assign a claim number for your incident/accident to readily identify it in their system. Remember, they deal with hundreds of incidents/accidents. After that, they will assign your claim # to an insurance adjuster—someone who will be handling your file and has the authority to determine the amount of compensation.You will receive an acknowledgment letter from the insurance company. Once a claim number and an adjuster have been assigned, the adjuster will send an acknowledgment letter in which they acknowledge they represent the insured—the person/entity responsible for your injuries.
Deal with the insurance company to see if they will make a pre-suit settlement offer. This is where things can get complicated and requires a certain level of skill and craftiness in negotiation. One needs to truly understand the nature of the transaction and be familiar with insurance practices to not be at a disadvantage. After an adjuster is assigned, they want you to provide them with documents (i.e. medical records relating to the incident, photos, evidence, etc.) so they can conduct an investigation to determine if their insured is liable for the incident/accident. This phase is usually ongoing and requires a lot of communication with the insurance adjuster.
Pre-suit settlement offer. After the investigation, the insurance adjuster will either make an offer for compensation or not. If the adjuster makes an offer and you accept it, you won’t have to start a lawsuit against the insured in court. If you don’t accept the offer or the adjuster doesn’t make an offer (denies liability), your only other option is to start a lawsuit in court (assuming the statute of limitations has not expired).
The above is a general and simplified process of submitting a claim pre-lawsuit. In the overwhelming (if not all) instances, the injured person will not receive the compensation he or she is entitled to without a lawsuit and certainly without the representation of experienced personal injury counsel. Furthermore, if a claimant on his or her own engages in the claim process, he or she will – unknowingly – compromise his or her case. That is, either the case will settle and the claimant will afterwards realize he or she got pennies on the dollar or the claimant will realize that the settlement offer is way undervalued but by having engaged in the claim process without counsel the claimant would have damaged or compromised his or case claim without even knowing it.
Remember, if you’ve never dealt with insurance companies before, you may be in over your head. It’s you against an adjuster who has hundreds of files similar to yours. You won’t know if they’re tricking you or playing games for you to accept a low settlement offer. Your rights and entitlement to fair compensation can be greatly affected. You must understand the nature and interests of insurance companies – which are plainly not the same at all as yours.