The personal injury insurance claim process starts when you go to the doctor. As soon as a medical professional treats you, you will be considered “injured”. When people claim headaches or similar injuries, the adjuster will not allow payments for pain and suffering unless they think they can settle the day you filed the claim. Most of the time, however, there will want to see some objective evidence of the injury.
Most insurance companies will try to settle the person injury insurance claim (as oppose of your personal injury “legal” claim) as soon as they think they can get a settlement and release form from you. This document will be an agreement between you and the insurance company in which you agree that you will not present a legal claim against the liable party in exchange of a certain amount of money. This agreement will be honored (most of the time as it can be disputed) in a court of law.
It is not unusual to find insurance adjusters trying to settle in your first conversation. They can have a recorded agreement on the phone that could have the effect of an agreement and release.
If you do not settle, then the personal injury insurance claim will continue. You will follow a treatment schedule and your medical bills will be paid by your insurance company by your Personal Injury Protection Coverage. Both insurance companies will send you a Medical Authorization From. This form entitles them to ask for your medical bills and records. You insurance company will not pay the medical bills until you give them the form. This is perfectly legal. Courts have ruled that if the insurance company is required to pay the medical bill, they are entitled to see the reports. However, you do not have to give this Medical Authorization form to the insurance company of the person that hit you. You can withhold the records until you are ready to settle.
After you insurance company pays, they will be reimbursed by the responsible party’s insurance company but only when you settle. This can take up to three years, depending on your state’s bodily injury statute of limitations. However, your insurance company will not pay for you pain and suffering and general damages. You have to settle those by yourself.
The personal injury insurance claim process will focus in your medical treatment. The insurance carrier will be sending you letter and asking you to report your medical condition. If they believe that you are over treating, they will send a letter to your own insurance company telling them that if they pay for your medical bills, they will not reimburse them. This is a technique to put pressure on your own insurance company to review the medical records and decline payment in anything that does not appear to be accident related.
Once you feel better, you are back to “pre accident condition”, or you are release from treatment, the other person’s insurance company will be asking you for the medical authorization form again. You can declined to turn it in, but you can collect the medical records yourself, review them, exclude whichever ones you believe do not help your case, and submit the rest (just like a lawyer would do). Most people will just sign the medical authorization from, giving the insurance company the right to see every record in your medical history.
The next step in a personal injury insurance claim is the evaluation process. Once the insurance company receives all medical records and reports, they will “compare” your injuries and treatment to similar cases in your area and find the average jury award. Their first offer is the lowest amount they believe a jury would award you. You can negotiate that amount to what you believe a jury would award you.
Once there is an agreement, the insurance company will send you a settlement of any and all claims form. Once you returned signed, they will issue you payment and the claim will be settled. At that point, your insurance company will be reimbursed for your medical bills.
Click here for more information about your personal injury insurance claim.