Tag Archives: Insurance claim

Insurance-claim-deniedAlthough it is from 2007, CNN’s 18 month investigation and subsequent report on how major insurance companies treat claims of car accident victims is still relevant seven years later. The report shows that accident victims who submit a claim for soft tissue injuries are being subjected to un-due scrutiny and falsely labeled as abusing the system. Insurance Companies are putting profits over accident victims to an alarming degree.

Soft Tissue Injury

A Soft Tissue Injury is defined as damage of muscles, ligaments and tendons throughout the body and is not easily visible from the outside or even in an x-ray.

Findings from the CNN Study:

In the mid-1990s most major insurance companies* sought advice on maximizing profits and chose to adopt a very tough “take-it-or-leave-it” strategy when handling claims for accidents involving soft tissue injuries. Essentially this means that the company will fight to not even offer you a settlement and if they do it will be for far less than your injury is worth. The final piece of the strategy involves dragging the process out so long that injury lawyers will start refusing to help clients fight for compensation. According to former Allstate and State Farm employee Jim Mathis, the strategy relies on the three D’s

Personal-Injury-CalculatorIf you have suffered a personal injury at the hands of a negligent person you should be thinking about making an insurance claim for compensation of medical bills, lost wages and maybe even pain and suffering. Getting a fair settlement should be your priority and there are things you can do to improve the outcome of your case. The trick is in understanding what insurance companies are looking for and how they operate. Although you should seriously consider hiring an attorney to help you wade through the process and ensure the best results, knowing the steps that will be taken could also prove useful.

Steps to Take After Suffering a Personal Injury

1. Go to the Emergency Room
The first key to increasing the size of your settlement is to promptly seek out and obtain medical care at the emergency room or an urgent care clinic. You should do this as soon as possible after an injury to rule out or treat serious injury anyway but, additionally, the hospital will create medical records useful to the case and insurance companies will expect an injured party to seek medical treatment.

2. Follow the Doctor’s Orders
The second key to a fair settlement it to follow the doctor’s orders for follow up, testing or therapeutic care. This is good advice for the sake of your health but it can also help to convince insurance companies that you were indeed seriously injured.

3. Hire a Personal Injury Lawyer
The third key to getting a fair settlement is to seek out and hire an experienced personal injury attorney. Statistically, you are going to get a fifty percent higher payout if you hire a lawyer then if you submit the claim yourself.

4. Understand Your Insurance Coverage
The fourth key to a fair settlement is to review and understand your own insurance coverage. Even though you can expect the negligent party’s insurance company to pay for the settlement, your own insurance policy may have coverage that adds to your total payout, without an increase in your premiums.

How to Negotiate with your Insurance Company

Once your demand letter and supporting documents have been turned in to the insurance company, you will need to understand how to navigate through the negotiation process. You can expect to make a few phone calls with a claims insurance adjuster.

The first step is the phone negotiation. Expect a discussion about the strengths and weaknesses of your insurance claim and an initial offer to settle the claim. The amount offered will be lower than what you requested in your demand letter. You will be expected to counter with a figure in between the two and so on until you reach an agreement.

You may then receive a “reservation of rights” letter from the insurance company which will inform you that the company is investigating your claim but that it reserves the right not to pay you anything if it turns out that the accident is not covered under the policy. The purpose of the letter is to protect the insurance company from a claim that the company’s insurance policy covers your accident just because it began settlement negotiations with you.

Have a settlement amount in mind. Your demand letter should have included a request for a specific settlement amount but you will want to have a minimum settlement in mind for negotiating purposes. Keep this amount to yourself but be prepared to be flexible if the adjuster makes valid points that weaken or strengthen your case.

Don’t jump at the first offer. The initial offer may be so low that you can’t even work with it and may be the adjuster’s test to see if you have done the research to know what your case is worth. If the offer is reasonable but too low then you should make a counter-offer and continue negotiating until you reach a fair compromise.

Always request justification for a low offer. If the initial offer made to you is so low it is clearly a negotiating tactic rather than a serious offer you should request reasons for the low amount. Take notes on all the points and write a response letter to address each point. If the adjuster has made legitimate points than it is reasonable to lower your demand accordingly. The next time you speak with the adjuster, begin by asking for a response to your reply letter and plan for the adjuster to now make a reasonable offer from which to start the negotiation process.

It can be helpful to emphasize dramatic or emotional experiences and results of the injury. Even though there is no way to put a dollar value on emotional factors, they can be powerful tools in getting an insurance company to settle a claim.
Promptly Put the Settlement in Writing. When a settlement agreement is reached, write a brief letter to the insurance agency outlining the amount for which you settled, what injuries or damages the settlement covers, and the date by which you expect to receive settlement documents from the insurance company.

If you suffered a personal injury at the hands of a negligent party then you may be eligible for a settlement. If you think you have a legitimate legal claim for a personal injury incurred in an accident, contact the experienced personal injury attorneys at Tario & Associates, P.S.. We are here to help!