After you notify others that you've been hurt in an accident and intend to file an injury claim, you may receive phone calls from one or more insurance companies that want to talk to you about what happened. In these first conversations -- which will most likely occur before you file your claim for compensation (called a "demand letter") -- you should abide by the following principles:
Remembering these important rues will help you maintain your chances of receiving a good settlement for your injury claim. To learn more, read Insurance Adjusters: First Discussions.
After you decide which insurance company (or companies) should pay for your injuries, and you gather all the evidence you need to establish your claim, you must send the insurance company a demand letter. This letter is a critical element of your claim negotiation process, so it is essential that you write it carefully and well. In your demand letter, you set out your strongest arguments concerning:
Your letter should conclude with a demand on the insurance company for a lump sum to settle your entire claim. For more information, see Write a Winning Demand Letter.
While the final payment figure depends on negotiations with the injured person, insurance companies and lawyers do use a formula to calculate a range of compensation for an injury. In general, if you've been injured you can expect to be reimbursed for:
In calculating the range of compensation, a claims adjuster begins with a standard damages formula. For details, read Nolo's article How Do Insurers Value an Injury Claim?
Whether you paid for medical care out of your own pocket or your health insurance covered it is none of a claims adjuster's business. The same goes for whether your lost time at work was covered by sick leave or vacation pay. In fact, it is improper for an adjuster even to ask about such payments. You paid for your health insurance and earned your sick leave or vacation pay; now the insurance for the person who caused the accident has to pay.
Your own health insurance, however, may require that, out of your settlement, you reimburse it for some or all of the amounts it has paid to treat your injuries.
For an excellent guide through the insurance claim process, see How to Win Your Personal Injury Claim, by Joseph Matthews (Nolo).
The claims process usually proceeds in predictable steps. Before you file a claim, you must notify people who may be responsible for the accident that you've been hurt and intend to file a claim for your injuries. This increases your chances of getting a quick settlement and prevents others from later saying that your claim unfairly surprised them.
Next, after you've taken time to thoroughly investigate your claim by gathering evidence, establishing who's responsible for the accident, determining what you believe your claim is worth, and planning good arguments, you will write a formal demand letter and submit it to the insurance company of the person who you believe is responsible for your injuries. (This may include your own insurance company -- for example, if you are covered by a no-fault automobile policy or need to make a claim for uninsured or underinsured motorist coverage.) From there, you will engage in informal negotiations with the insurance company until you agree on a settlement you can live with.
Many insurance claims are that simple, though sometimes you may find yourself dealing with a stubborn or unreasonable claims adjuster. If that's the case, you must resort to more determined negotiation tactics -- or perhaps consult an experienced personal injury lawyer. If all else fails, you may even have to take your case to court.