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4 Things YOU Should Know About Insurance Claims After an Accident

June 13, 2022

If you’ve been injured in an accident, first contact the police to come and investigate and file a police report; seek any necessary medical treatment, and then file an  insurance report with both your insurer and the insurer of the at-fault party. These claims are the first necessary step to document your claim and treatment for injuries and pave the path to obtaining compensation for damages, including lost wages and medical expenses.  Keep reading to learn 4 things YOU should know about insurance claims following an accident in Arizona. 

  1. First (1st) Party  vs. Third (3rd) Party Claims 

Most insurance claims can be put into two primary categories: 1st, and 3rd-P claims. A 1st P claim is filed with one’s own insurance company and is based on your own 1st P Insurance Policy CONTRACT and existing coverages with your insurer (with designated contractual rights and responsibilities).   A 3rd P claim is filed with another person or business’s insurance (you as the  injury victim are a 3rd P to the at-fault driver’s insurer / and you do NOT have a written contract with that insurer).  Most at-fault drivers – if they have auto insurance – have 3rd P coverage for cases where a 3rd P is injured due to the at-fault insured driver’s actions. 

The type of claim you file is dependent on who was at fault for the accident and the kind of accident that occurred. For example, if you cause an auto accident while driving your car, you should file a first-party claim with your insurance.  But, if you were involved in an accident while you were a passenger in someone else’s car, a third-party claim should be filed with the driver’s insurance provider. These claims can apply to both bodily injury and property damage. 

  1. The Insurance Claims Process 

Whether your injury occurred in a car, home, or business, you’ll want to file an insurance claim as soon as possible.  Regardless of the location of the accident, you will likely be asked to provide information about the circumstances of the accident and the extent of your injuries.   

You are NOT required to give a 3rd P insurer a “Recorded Statement.”   The 3rd P Adjuster may ask for a “Recorded Statement” which you can and should decline.  The 3rd P Adjuster can take notes, contact their own 1st P at-fault insured driver, and review the police report for facts of loss.   Be professional and brief dealing with 3rd P insurance adjuster – but,  politely decline 3rd P “Recorded Statement” as it is NOT required and will only be used to:  get you to make admissions against your interest;  minimize your injury and damages; and, to be used against you later (that’s why they want to record it =  to use it as evidence against you later. 

The Insurance company will then open an investigation into your claim. At this point, you may be asked to provide a more detailed account of the accident, photos, witness names, or any other evidence you may have gathered from the scene. After calculating the value of your claim, you may be issued a settlement check. If the claim is denied, or you feel the amount is inadequate, you may be able to negotiate with the insurance company. If negotiation isn’t an option, you may appeal the decision. At this point, it’s likely time to consult an attorney

  1. Denial of Claims and the Appeal Process

There are a multitude of reasons your claim could be denied. You may have waited too long following the accident, failed to submit proper medical records, or the specifics of your injuries aren’t covered by your 1st P plan or the at-fault 3rd P plan. Whatever the circumstances, you will receive notice from the insurance company if your claim is denied. It is then up to you to appeal the decision. Each company’s policies for this process are likely different, so being familiar with the policy in question is essential.   If you have questions about the appeal process or if your appeal is denied, it’s important to consult with an attorney. 

  1. Calculating Value of Insurance Claims 

While actual monetary losses like lost wages or medical expenses are reasonably straightforward to calculate, it’s difficult to put a dollar amount on any pain and suffering following an accident and injury. Insurance companies have developed formulas to determine the amount owed for these damages. 

Insurance companies will typically add up all medical expenses and multiply it by 1.5 or 2 to determine the amount of your damages with specific, measurable costs. This is opposed to general damages that aren’t associated with a specific dollar amount, like pain and suffering. The more severe the injuries, the more times your total expenses will be multiplied to determine compensation. Extremely severe injuries sometimes reach 5 or even 10 times the initial cost for medical expenses. Once the special damages amount is determined, the value of your lost wages is added to calculate the amount of your settlement.

Filing an Insurance Claim After an Accident? 

If you are unsure of why your claim was denied or are unhappy with your ongoing settlement negotiations or offers, having a legal professional like Jeff GOULD Law, the Attorney in YOUR Corner, is extremely helpful. An experienced injury attorney will be able to answer any questions you have about the claim and advise you on your options moving forward. 

DISCLAIMER: The information on this blog/site is NOT, nor is it intended to be, legal advice.  It is for general informational use only.  You should consult an attorney for advice regarding your individual situation. Further, this information does not create an attorney-client relationship.

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