The Basics of Insurance Claims After an Accident

Filing an insurance claim from your insurance provider is one of the first things that you do after being injured due to accident. An insurance claim permits you to get compensation for the medical expenses, lost wages, or suffering or injury as a result from an accident. Learn more about insurance claims procedure, how insurance companies compute the value of the claim, and the differences between the first party and third party.

First Party Claims and Third Party Claims

Here are the two forms of insurance claims: the first party claims and the third party claims. First party claim refers to filing of claims with your own insurance company while the third party claim is filing your claim with the insurance provider of the other person or business. Most of the insurance holders have coverage for third parties who are injured due injury sustained as a result of their actions.

The type of insurance claim that you will file lies on who is at fault in the accident, the kind of accident that happened, and the degree of your insurance coverage. As a sample, if you have caused an accident while driving your car, you may file a first party claim with your automobile insurance provider but when you are hit by another car while crossing the street or when you were involved in an accident while being a passenger in a vehicle, then you can file a third party claim with the driver’s automobile insurance provider. However, if you were injured while shopping in a store or having your dinner at a restaurant, you can file a third party claim with the insurance company of the business.

Insurance Claims Procedure

If you were in automobile accident at home or in a building, or while visiting your business, you should report the accident to the insurance provider within 24 hours of the incident. If you were proven not to be at fault for the accident, then contact the insurance provider of the business or the owner of the building, or the at-fault driver. You may need to give an account or the basic information about the cause of the accident and the degree of your injuries.

Then, the insurance company will conduct an investigation of your claim. You may be requested to provide pictures of the accident scenes, names of any witness, or detailed account of the accident. Aside from this information, you may have to submit to independent medical examination by the selected doctor of the insurance provider. When the injury is caused by a building condition, the claims adjuster may conduct an inspection of the property.

After computing the value of your claim, the insurance provider will issue a settlement check. However, when your claim is denied, or if you think the amount of the settlement in insufficient, you may appeal to the insurance provider. This appeal may ask you to submit more examinations or more information and evidence regarding the accident.

Denial of the Claim and Appeals

Your insurance claim may be denied for several reasons. For instance, you have waited for awhile to file your claim or you may have failed submit to an independent medical examination. Another reason can be that the type of accident you were involved in was not covered by your insurance plan.

No matter what your case may be, you will receive a notice from your insurance provider when your claim is denied. It is up to you to appeal the denial of the claim. The appeals procedure may vary from company to another company, so you should review your policy in question to determine your next steps. if you have some inquiries about the appeals processor if your appeal is denied, then it may be time for you to find and contact an experienced lawyer who help you in filing your insurance claims or in your appeals.

Computing the Value of Insurance Claims

Medical expenses and lost wages are often times are cut and it is hard to put a dollar amount on the suffering an individual experiences after sustaining an injury due to accident. Insurance companies designed damages formulas to compute the value of the injured person for these non-monetary losses.

The insurance claims analyst will sum up all your medical expenses. When the injuries are not very severe, the total amount is normally multiplied by 1.5 or 2 to determine the amount of your “special damages.” But if the injuries are serious, the total amount may be multiplied by 5 or up to 10, if the injuries are extremely devastating. When the special damages amount is determined already, then the analyst will add your lost wages to get the amount of your settlement. You may usually negotiate with the insurance provider to get the higher settlement.

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