Insurance Claims Tips

Read these 22 Insurance Claims Tips tips to make your life smarter, better, faster and wiser. Each tip is approved by our Editors and created by expert writers so great we call them Gurus. LifeTips is the place to go when you need to know about Personal Injury tips and hundreds of other topics.

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I have an injury, but, it is not bad. Will an insurance company pay big money if I complain?

Use Your Judgment As to Whether You Should Report an Incident

Don't report an insignificant injury. It is a waste of an establishment's time, money, and effort. Unless required by law, such as an auto accident, a work accident, or an accident in which you injured yourself doing something you would reasonably be considered at fault for doing in a space that you abide in, don't try to blame someone else. There are many attorney commercials that lead you to believe free money is out there from insurance companies for any injury. They put the blame on the insurance company for not paying legally due monies, when, in fact, insurance companies have gone into bankruptcy paying legitimate claims. Insurance companies and Third Party Administrators (TPA's) hire trained professionals that settle legally owed claims for reasonable amounts, and do not get bonuses or benefits for settling claims for any less than the claim's value.

When Should I seek Medical Treatment?

Seeking Medical Help

If you are injured severely enough, immediately go to the local emergency room for treatment. However, do not incur expenses you normally would not incur out of anger because you think someone else should pay because you feel it was someone else's fault. If it is not an emergency, see your primary care physician or an urgent care facility if you feel the need. Be reasonable when seeking medical care. When it comes to evaluating and paying bills, claim examiners, adjusters, mediators, and juries will determine your reasonable medical treatment, as well.

Should I report an accident?

Failure to Report an Accident

Your immediate failure to report a personal injury accident of any nature can impede a full investigation into the causation of the accident, the surrounding circumstances, gathering of evidence, photographs of the scene, witnesses' names, and documentation of the extent of your injury. This may result in a denial of your claim altogether, and may limit your rights of recovery. Reporting an accident to the manager of a location, the police, or your workplace boss is vitally important for you to recover any compensation that you may be entitled to receive, as you may need to comply with OSHA regulations. In order not to jeopardize those statutory rights, do not fail to immediately report an accident.

When can I expect my medical bills to be paid?

Finishing Medical Treatment Prior to Settlement

Depending on the type of personal injury you have, you may have to finish treatment for your injury prior to settlement, if the company is going to settle on behalf of their insured. Coverage for injuries may fall under different types of policies, and some benefit types may be first party, meaning you are entitled to those benefits, after a review of the reasonableness of your treatment. Policies cover injuries where, when, and how they happen, and sometimes why they happen. You may also file claims under your health carrier. However, health insurers, some carriers have subrogation clauses stating if you collect a monetary settlement from another carrier, you must re-pay the health insurer. As to personal injury third party liability claims, you usually must finish treating for your injury prior to any liability settlement, and a release signed prior to any payout. If it is an auto accident and you are a passenger, you may collect benefits under either first party Medical Payments (MP) coverage for your medical expenses from the driver's policy, or become a claimant against the driver if the driver is at fault. On a premises claim, if there is no liability found on the part of an insured, a company may cover bills up to a certain amount under the same type of first-party MP coverage some companies carry for incidents occurring on their premises. The adjuster may pay your bills as expenses incur, but, do not expect a "general damages" (otherwise known as pain and suffering) settlement in addition.

I may have lost my ring, but, I want to report it to my personal carrier for reimbursement. Would this be a False Claim?

Reporting a False Claim

Reporting a false claim is against the law. You can be fined and jailed for it. It is called insurance fraud. As it costs everyone millions of dollars of annual premiums, insurance companies, authorities, and special investigation units have created networks and other systems to identify possible insurance fraud. Reporting a false or suspicious claim is not worth any monetary settlement you may receive. The consequence of being caught far outweigh any compensation.

How is a bad faith claim dealt with in court?

Dealing with a Bad Faith Claim in Court

If your case against an insurance company goes to court, you and your attorney have to be prepared for a hard fight. Your personal injury lawyer will be able to coach you and help you to find doctors and other professionals to attest to your claim, if needed. The insurance company must prove that you are not acting within your policy, thus causing the insurance company not to pay the claim in question. You must prove that the insurance company is not following their end of the policy you signed, and that they are acting in bad faith because of this.

What should I do if I think my claim was handled in bad faith?

How to Handle 'Bad Faith'

If you think your claim was denied for a reason other than those stated in your policy, or if you believe that your insurance company is trying to put off paying your claim, you have the right to question bad faith practices. Start by contacting the insurance company yourself and let them know you feel your claim was unfairly denied (or that you feel that you have been made to wait an inordinate amount of time). You can also confront the company if you feel they are trying to get out of paying you the full amount you are owed on a claim, such as with auto insurance. If contacting the insurance company yourself does not work, you will need to contact a lawyer to argue your case for you. Most often the lawyers who handle these types of cases are personal injury lawyers, and they are well versed in the laws dealing with insurance claim cases.


Consulting a Lawyer Regarding Your Insurance

It is wise to consult a lawyer or an “insurance counselor” as opposed to an “insurance agent” to advise people as to what coverages are necessary and appropriate to the purchaser's needs. The reason to avoid relying on the advice of an insurance agent is that the agent is an employee of the insurance company. As with medical opinions, it is always good to get advice from an unbiased party when protecting yourself.


Common Mistakes When Purchasing Auto Insurance

Purchasing auto insurance for you and/or your family is no easy task, but an essential one. Here are some mistakes to avoid when purchasing an auto insurance coverage policy:

-Many people believe they have “full coverage”, but the term is misleading;
-People always ask for cheapest, or “best deal," but for literally a few extra dollars a month, they can buy better protection.

What sort of damages can be awarded in a bad faith insurance case?

Damages to be Won in a Bad Faith Insurance Claim

In a bad faith lawsuit, you can be awarded more than just your initial insurance claim amount. If your claim goes to court and the judge (or jury) decides that the insurance company did indeed act in bad faith by failing to pay a legitimate claim, by underpaying a legitimate claim or by unreasonably delaying payment, you may be awarded damages in excess of those that are just for breach of contract. You might also be awarded amounts for punitive damages as well.

Can bad faith insurance claims be settled out of court?

Out-Of-Court Bad Faith Claim Resolution

Many insurance companies are fearful of litigation, especially if it gets to the level of a court case. Public court cases can damage a company's reputation, so often they want to stay out of the spotlight as much as possible. Many lawyers in the insurance claim specialty area state on their websites that they are able to resolve these claims without having to go to court. Usually communication from an attorney will get the ball rolling and get your claim paid, if the insurance company is truly the party that is in the wrong.

What does it mean if a lawyer works on contingency?

Lawyers Who Work on a Contingency

There are a lot of lawyers who advertise "No Recovery, No Fee". This is called a contingent fee arrangement. These lawyers don't get paid unless they get you money, meaning unless you settle or they win your case in court and you are awarded monetary damages. If you lose, they get nothing. Many of these attorneys earn 33.3% of the award or settlement. In some cases, their percentage is higher if the case is tried or appealed. As the injured victim, this is good because you don't have to pay any fees up front. Often a lawyer will work to get a larger award so that they can get a larger amount of payment as well, as they are interdependent.

What kind of bad faith insurance practices occur with car insurance?

Bad Faith Insurance Practices in Automobile Insurance

The insurance area that is most accused of having bad faith practices is automobile insurance. If you're in an automobile accident, and suffer medical problems as a result, you should consult with a personal injury lawyer for information on handling your insurance claims. If your insurance company does not agree to pay all of your medical bills, or for all of the damage to your car, make sure you check over your policy carefully. If you have full coverage in these areas, the company might be committing an act of bad faith by trying to get you to take a lesser amount of money than the amount you're owed. In cases like this, it is advisable to obtain a reputable attorney to fight for your case so that you are paid correctly.

What are some different types of bad faith practices?

Different Types of Bad Faith Practices

There are numerous ways in which an insurance company can be considered to be acting in bad faith. Aside from not paying claims (and giving no relevant reason), they can do many things to hang up your claims. Insurance companies may take a very long time to process your claim while saying that they are doing research, or some other excuse. They can cancel your insurance policy because you issued a claim against it, and state they cancelled it for another reason. If the insurance company acts in a deceptive way, or avoids communication, it can also be considered as acting in bad faith. Often, even the hiring of an attorney as an advocate can cause the insurance company to treat you unfairly, as they may view this as a threat.

Will a Lawyer Help Me With My Claim?

Lawyers and the Claim Process

When the first claim report is a notice from an attorney, it will definitely impede the investigation of the claim. Immediate attorney representation after any accident type prolongs the investigative claim process. Accident causation, witnesses, incident reports, (if any) will have to be located, and the process may take months to complete, if your attorney cooperates with the investigation. The adjuster can only do so much with the cooperation from the insured. When you are the claimant, making a claim against the adjuster's insured, the adjuster has an obligation to believe his insured. However, he must now await the claimant to finish all medical treatment, obtain medical records to evaluate treatment, and possibly get to the point of deposing the claimant prior to trial, if they find no liability on their insured's part.

When there is no attorney involvement when the accident is first reported, the investigation of the accident and the personal injury is expedited, as a direct line of communication is open between adjuster and injured claimant. However, the minute the adjuster receives the attorney's notice of representation, the adjuster can no longer speak to the represented party directly in regard to property damage or bodily injury. An attorney's advertised claims of intimidated claim adjusters forking over more money due to his involvement are baseless. Read the fine print in the attorney's paperwork prior to hiring one. Speak to the adjuster if you are working with one if you have concerns. Then, you can make an informed decision as to whether you should get a lawyer. In different states, there are statutes of limitations in which to file claims, and to preserve these statutes, an attorney must file a complaint. Served a summons, the defendant, the adjuster's insured, will notify his insurance carrier, and the adjuster will have notice of your claim, if he does not already. Therefore, you may want to consult a lawyer if your claim has been with the adjuster for a while, or if it has been about a year since the injury happened, and the claim process has not been initiated.

What are the different bad faith insurance laws in effect?

Differing Bad Faith Insurance Laws

There is no single law that governs how insurance companies are required to behave. In 1945, the McCarran-Ferguson Act (Federal) was approved by Congress to essentially disallow any regulation of the insurance industry on a federal level. The states themselves have individual insurance watch-groups and agencies that oversee the practices of insurance companies within their state, but these do vary state to state. Generally, these "unfair insurance practices acts" outlaw all of the things deemed to be in "bad faith", such as neglecting to pay a claim, non-communication and delay of claim payment. You can search the web or local library for your specific state's laws.

Are all claim denials in bad faith?

Not All Claim Denials are in "Bad Faith"

If your insurance company denies your claim, it does not automatically mean that they are acting in bad faith. There are many valid reasons to deny a claim, such as insufficient information, incorrect information or the fact that your coverage might not cover that sort of claim (for example, not all homeowners policies cover flood damage). If your claim is denied, contact your insurance carrier and ask them to explain to you the reasons why. You can also read over your policy carefully to make sure you understand what your duties as a policyholder are, and what the responsibilities of the insurance company are. Then, if you believe that the denial was in bad faith, you will need to take further action against the company.


Most Popular Forms of Insurance Available (2006)

Auto insurance is required in most states, which naturally makes it the most popular. There are many states that have “no-fault” laws, which require your own auto policy to provide for payment of medical bills and/or lost wages and/or household essential services resulting from auto related injuries.

Under the medical provisions of certain "no-fault" policies, an insurance company may be required to pay nursing care services provided by non-professionals such as family members and friends for seriously injured accident victims.

Following auto insurance, the most important and also most popular coverages are medical, followed by life, home, and disability insurance.

Because of our aging society, long-term care is becoming incresingly more popular. It should be noted that long-term care may be a deductible item provided to business owners and employees and spouses.

Where can I find a lawyer to handle my bad faith claim?

Finding a Lawyer to Handle Your Insurance Claim

If you find that communication directly with your insurance handler is not working, you will need to find a competent lawyer who can handle your case. There are many lawyers within the arena of personal injury law who specialize in dealing with insurance companies and bad faith claims. A good way to find a lawyer is by searching online search engines, or asking for referrals from friends, coworkers and family members. Often you can find local lawyers who have websites detailing their areas of expertise. As is the case with any online search, be wary on all of these sites and do you research through interviews and estimates before signing with an attorney to handle your case.

What does the term "good faith" mean in insurance?

"Good Faith" in Relation to Insurance

When you sign up for any type of insurance, the insurance company enters into an agreement with you. In that agreement, the insurance company states that it will pay any claims that you submit provided they fall under your insurance policy, and that you are not trying to commit fraud against it. When an insurance company acts in "good faith", it completes all the agreed upon acts (such as paying claims) that were in the policy that was created. The company responds to your communication in a timely manner, and does not reject or delay your claims for false reasons. In short, it does all that was promised in the policy you signed.


What is "No-Fault" State?

The following states are "no fault" states. The laws regarding protection under these states are varying, so it is imperative to check with an attorney regarding your rights:
-New Jersey
-New York
-North Dakots

Why does it take so long for my Personal Injury Claim to be Settled?

"Insurance Companies Don't Want to Pay You" is a Myth

Ads from attorneys claiming trained insurance adjusters do not pay or pay as little as possible on claims is ludicrous. Also ludicrous is the fact that when attorneys get involved, the claim process moves faster, and claims have an inflated value. They do not. The only inflated value is the cost that the claimant must pay the attorney, which is supposedly thought to be paid by the insurance company. Cases where claimants are left holding the bag, after trials found no compensable damages and/or liability, are ones which are not advertised. An inflated claim costs the insurance company money, the company that purchased the policy money, and ultimately, the consumer pays through increased prices. Therefore, everything is inflated when insurance adjusters pay "large cash settlements" that are unwarranted. The reality is, no insurance adjuster pays a "large cash settlement".

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