How Insurance Companies Settle Personal Injury Claims

The Insurance Claim File

When an insurance company is notified of an accident, the first step it takes is to set up a claim file, and assign a claim number to that file. The file is then sent to an adjuster.

The adjuster is responsible for monitoring the claim and has substantial authority in making a settlement on both the property damage and the bodily injury part of the claim. In auto accident cases, some insurance companies may have one adjuster handle the bodily injury claim and another handle the property damage claim.

Personal Injury Insurance Claims

If you have been injured as a result of an automobile accident, a slip and fall accident, or another person's negligence, you have the right to receive compensation. The amount of money that is paid varies from case to case. Each personal injury case is evaluated on its own set of facts. If you have further questions after reading this article, the Law Offices of John J. LaCava provides free consultations and evaluations in all personal injury cases.

How Long Should my Case Take?

Most bodily injury claims are not settled or resolved until all medical treatment has been completed and the extent of the injury, including any permanency rating, is known and documented. This means that each case is different, depending on how long you are in treatment.

What Is the Amount of a Settlement Based On?

In a settlement you should receive compensation for

  1. Out of pocket medical expenses and future expenses
  2. Loss of earnings for time lost from work
  3. Lost future earnings, and
  4. An additional amount of money based on your injuries for pain and suffering, and the effect that the injury will likely have on your quality of life now and in the future.

What Do Insurance Companies Look At?

When insurance companies value a bodily injury, the three most important considerations are: the type of the injury (brain injury, neck injury, back injury, etc.), the amount and type of medical treatment, and the permanency of the injury. In any accident case, it is important to get prompt medical attention for any injuries received. If you are referred to physical therapy, or chiropractic treatment, it is important to keep all appointments. Insurance companies take into account the number of physical therapy or chiropractic treatments, and the amount of all medical bills.

The permanency of any injury is a very important factor. Your treating physician will give an opinion as to whether your bodily injury is likely to be permanent in nature. It usually takes a minimum of six months before a doctor can determine whether a particular injury will result in a permanent impairment. A doctor usually will use published guideline in rendering such a opinion, such as the American Medical Association's Guide to the Evaluation of Permanent Impairment. This book lists various types of injuries, and provides estimates of impairments to specific body parts. For example, a disk herniation in the neck (cervical herniation) with radiculopathy (radiating pain) would provide a permanent partial disability rating of approximately 11% of the whole person according to the Guidelines.

Paying Medical Bills From Auto Accidents

  • If you have purchased Medical Payments Coverage as part of your automobile insurance policy to pay for medical bills following an auto accident, you should submit your accident related medical bills to your auto insurance carrier. Check your insurance policy to see if you have this optional coverage.
  • Be aware that medical payments coverage is no longer mandatory in Connecticut, you must request this coverage. It is optional. Some HMO's and health insurance plans will not pay for medical treatment resulting from an automobile accident until you provide a letter from your auto insurance company that you do not have medical payment coverage.
  • If you have health insurance, you should pay your medical bills using your own medical insurance, rather than waiting for the at fault party to pay. Any out-of-pocket copays or deductibles should be included in the settlement.

What to Do If The Person Who Hit You Has No Insurance --Uninsured Motorists Coverage

  • If the person who caused the accident does not have insurance or does not have enough liability insurance, you may make a claim under the uninsured motorists/underinsured motorists (UM/UIM) provision of your own insurance policy. You may also make a claim against your own insurance company if you were injured by a "hit and run" driver.
  • Your own insurance company will then "stand in the shoes" of the other driver and insurance company. The law requires that every automobile insurance policy sold in Connecticut must include Uninsured and Underinsured Motorist Protection, but the amount of coverage may vary according to what limits of insurance you purchased.

Statute of Limitations and Other Deadlines

  • In general, victims of accidents occurring in Connecticut due to negligent conduct have two (2) years from the date of injury to bring a claim. If the conduct involved is intentional, victims have three (3) years. Determining the appropriate limitations period may depend on the specific facts of the case, and you should consult a lawyer to confirm the correct date.
  • If a highway defect is the cause of the accident, or if a government entity (city, town or the State) is involved, other notices may have to be filed within a very short period of time (in some cases within 90 days), and you should consult an attorney as soon as possible.
  • The time period in which an Uninsured or Underinsured Motorists claim may be brought against your insurance company is contained in the policy provisions, but in Connecticut it may not be less than three years from the date of the accident for most cases. Some policies require arbitration, and others require that notice or a lawsuit be filed within specified time periods.