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Understanding the Personal Injury Insurance Claim in NC

Apr 3, 2017 - Personal Injury by

personal injury lawyer in Charlotte NC

Have you been in a car wreck and sustained personal injuries?  Or have you ever been in a grocery store and slipped, hurting yourself?  It is likely something has happened to you, and that’s why you are reading this article. You want to be compensated for the full worth of all economic and non-economic damages you endured and, for many of you, will continue to endure.  So now what?   You might think the first thing to do is contact either your insurance company, or the insurance company for the at-fault party, and let them handle everything. Think again.  And read on.

The claim process has great potential to be long, tedious and time-consuming.  It requires skill and knowledge of the process and the laws, which many non-lawyers do not have.  Plus, insurance companies, even your own, want to minimize the amount of money they offer to you. Oftentimes that offer does not come close to the actual amount you are rightfully owed, but most non-lawyers don’t know how to navigate the system so that it works for us and not against us.  

Fortunately, an experienced personal injury attorney does have that kind of skill and knowledge.  The first thing you want to do after a personal injury is contact an experienced attorney if you want to make sure you have someone representing your interests, and your interests alone.  An attorney can guide you through the process, ensuring that it goes smoothly and ends in your benefit.  For you to gain an idea of what the process is and the depth of what is involved, the following provides a small snapshot of it.

Types of Claims

There are two types of claims: (1) first party; and (2) third party claims. 

  1. First party claims are filed if you are the person at fault, or if you have uninsured motorist coverage or underinsured motorist coverage.  In such cases, you file a claim with your insurance company.  
  2. Third party claims are claims if another person or entity is at fault. In such cases, you file a claim with that person’s or that entity’s insurance company. 

In some cases both types of claims may be filed.  

Claims Process

When a claim is made, a number of things start to happen both on the insurance side and your side, which generally includes the following:

  1. The insurance company assigns a claim number and a claims adjuster to your case.
  2. The insurance company opens an investigation.  
  3. Your insurance company may request a recorded statement.  In many instances this may need to be done as you have a duty to cooperate with your insurer.  Keep in mind this statement becomes part of the investigation.  It is important to be honest yet careful with what and how you say it. For these reasons, it is typically best to refrain from giving a recorded statement without first consulting with an attorney.

The other party’s insurance company may also request a statement.  Keep in mind that you are not obligated to give them a statement.  In fact, you should not do so; they can use it against you.  

4. Your insurance company may request medical and work authorization forms.  Again, it is highly advisable to consult with an attorney before providing any type of authorization forms as insurers often seek limits of authorization well beyond that which you are required to give.

The other party’s insurance company may also request you sign a medical authorization for release forms. You are also not required to do so, and in fact, if you do it may work against you.  Insurance may be given access to all of your medical records and sensitive information.  They may look for something they can use against you.  

5. You and your attorney submit a demand package.  

Your attorney will work with you to collect evidence and document all bills, costs, pain and suffering, loss of enjoyment, and any other factor that will be used to evaluate your claim.

6. The insurance company reviews evidence to determine fault and connect it to the proximate cause of the accident and injuries. 

7. The insurance company extends an offer to settle your claim.  This often kicks off subsequent rounds of negotiation which will ultimately allow you to make the informed decision about whether or not to settle your claim before filing a lawsuit.  

Tips to Better Your Odds

To increase your chance of success, the following are generally true:

  • Be honest; do not get caught in a lie.
  • Read your policy and know what it says.
  • Notify your insurance company in a timely manner.
  • Have proof for all your claims.
  • Be aggressive and follow-up with the insurance company.
  • Consult an attorney for guidance.

As you can see, the claims process can be stressful and many claimants who try to do it themselves end up giving in to the pressure of the insurance company.  If you truly want what you deserve, you need the skills and knowledge of a qualified North Carolina personal injury attorney, and we, at Brown, Moore & Associates PLLC, are here to help you find one.