Negotiating With Your Own Insurer After an Injury
Tips on handling a "first party" injury claim under your own insurance coverage.
A claim filed under your own insurance policy -- such as the uninsured or underinsured motorist provision of an auto insurance policy, or your homeowner's insurance coverage -- is referred to as a “first-party” claim. The rules for proceeding with a first-party claim are determined by the specific terms of your policy. Often your policy requires a bit more from you than a third-party claim (which is one you file with the other side's insurance carrier), and the claim negotiation process can be a little different.
In general, your own policy will require that you cooperate with your insurance company during the claim. Of course, what cooperation means is subject to different interpretations. It usually comes down to what is reasonable under the circumstances: your right to privacy balanced against the company’s right to get enough information to process your claim.
Most policies spell out the main points of cooperation you are required to provide, such as:
Timely notification. Your policy may provide a specific time limit within which you must notify the company of your claim. Even if you have missed this time limit, however, your insurance company cannot deny your claim unless it shows that it has been prejudiced -- harmed in some way -- by the late notice.
Authorization for release of medical records. You must sign an authorization permitting your insurance company to obtain medical records concerning your injuries directly from your treaters.
Authorization for release of personnel and other income records. If you have claimed income loss, you must sign an authorization permitting the insurance company to obtain directly from your employer information concerning your income and your work record.
The Independent Medical Examination. If your insurance company requests that you have an IME, read the policy carefully to see what the terms are. In general, make sure there is only one examination, that the insurance company agrees in writing to pay for it, and that it is arranged at your convenience, not just the doctor’s. Also, get a statement from the claims adjuster in writing, in advance, of the limits of the examination. You have to undergo an examination only of the injuries you claim, and not a general physical exam.
If you have any dispute with the adjuster for your insurance company over submitting to a medical examination, providing information, or following policy rules, do not take the adjuster’s word as gospel. Read the policy. If you don’t have a copy, the adjuster must provide you with one. And if you reach a stalemate with your own company’s adjuster about any point of negotiations or about the amount of the settlement offer, you may have to switch negotiation strategies.
Be Careful What You Sign
If you’re providing authorization for your insurance company to obtain medical or employment records, read the authorization form carefully. You shouldn’t have to release records about any time period or any medical treatment that is unrelated to the accident for which you are seeking compensation. For example, if your shoulder was injured in the accident, you should not have to provide records from your bunion surgery. If the authorization is too broad, write in a sentence that limits the time period for which records may be obtained or that describes the parameters of the medical records the insurance company is allowed to obtain.
More Information on Handling Your Injury Claim
For a step-by-step guide to the injury claim negotiation process -- and everything else you need to know about dealing with an insurance company after an accident -- get How to Win Your Personal Injury Claim, by Joseph L. Matthews (Nolo).