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The Role of Insurance Companies in Personal Injury Claims and Lawsuits

worker woman accident on arm with green arm cast on blurred business office working space backgroundThey say accidents are just waiting to happen. That’s why insurance companies exist.

Injuries could be from a car crash, a slip and fall on someone else’s property, a workplace or medical mishap, or the result of a faulty product.

Many of those accidents will involve a personal injury.

If that injury meets thresholds established by Florida law, a personal injury claim can be filed. We provide an extensive personal injury education center that details Florida laws and the legal process for personal injury claims along with your rights and options.

Regardless of the circumstances, faults, and injuries, be aware that those personal injury claims will typically involve an insurance company seeking to quickly settle the claim.

It’s at this point that your rights, needs, and desires regarding your claim of a fair settlement for your injuries may collide with Florida rules and the insurance company’s interest to reduce the value of your compensation.

There may also be pressure to settle the claim without going into litigation where a more favorable settlement may be reached. Additionally, there may be pressure for you to settle without seeking the guidance of a personal injury attorney.

Keep in mind when dealing with an insurance company, you’re not just dealing with a claims adjuster working off of a settlement formula. Behind that individual is a team of attorneys tasked to fight your claim if it doesn’t favor their employer—the insurance company.

That’s why if you’re involved in a personal injury case, it’s smart to have someone who understands your legal rights by your side. An experienced personal injury attorney can help maximize your chances to reach a settlement, or verdict if going to court, that fairly compensates you for your injury.

Below, we’ll explore more about how insurance companies handle personal injury claims and best practices on how you should deal with them.

However, if you’re currently facing a personal injury issue, we’d like to offer you legal assistance. Please don’t hesitate to reach out to Fusco Law Group at (904) 567-3113 for a free consultation.

Understanding Insurance Companies and Personal Injury Claims

Insurance Policies that Cover Personal Injury Claims

Different types of policies handle personal injury coverages depending on the type of incident and where it took place.

Auto Insurance Injury Coverage:

Purchased by an auto owner, coverage typically covers:

  • Personal Injury protection
  • Uninsured Motorist
  • Underinsured Motorist

Injury coverage usually covers medical bills and related costs such as out of pocket expenses and lost wages.

Settlements typically will be based on a strict formula crafted by the insurance company and the minimum amount allowed by law.

Business and Homeowner’s Insurance:

When injured due to hazards on a property not owned by you, claims will be handled by a:

  • Business Liability Policy
  • Homeowner’s Insurance Policy

Since claims against businesses and homeowners may increase insurance premiums, these claims may be challenged by the property owner.

Worker’s Compensation Insurance:

A business with employees must provide worker’s comp coverage to help provide injured-on-the-job employees with access to financial and medical benefits.

While most worker comp claims are paid regardless of fault, claimants should understand that they typically give up rights to sue employers when accepting payment.

That means that injured employees give up rights to compensation for pain and suffering.

Medical Malpractice Insurance:

Doctors and hospitals in the U.S. must carry medical malpractice insurance.

Coverage typically handles medical negligence claims and medical product liabilities.

Since medical injury cases tend to be complicated and expensive, insurance companies that provide coverage and their employed attorneys will put up a significant battle to minimize the value of the injury.

How Insurance Companies Will Handle Your Personal Injury Claim

In many personal injury cases, claimants will deal with a claims adjuster.

After the insurance company is notified of the accident and resulting injuries, the claims adjuster will generally conduct the following steps:

  • Gather documentation (i.e., police reports, accident reports, business documentation, etc.)
  • Interview the insured party
  • Investigate the claimant for past personal injury claims, preexisting conditions, etc.
  • Reach out to the claimant to introduce themselves—and ask if it’s okay to record the conversation
  • Request documentation related to the claim from the claimant (i.e., medical bills, proof of earnings, tax returns, etc.)

The claims adjuster will then determine a settlement value that includes such factors as:

  • Percentage of the fault of all parties
  • Credibility of claimant
  • Pre-existing medical conditions
  • Damages based on calculating medical bills and lost earnings
  • Potential damages based on pain and suffering (based on software calculations)
  • Chances of winning if the case goes to trial
  • Potential amount a jury would award for injury to the claimant

The settlement value determined by the claims adjustor might not be what is first offered to the claimant.

In many cases, insurance companies will make an offer that’s a substantial percentage below the actual value.

Recommendations if You’re Seeking Personal Injury Compensation

Get Legal Guidance from a Personal Injury Attorney from the Start

When dealing with an insurance company for a personal injury claim, it’s not just the claims adjuster you’re talking to about your injury. You’re also facing an army of company lawyers skilled at investigations, settlement offers, and lawsuits.

It’s to your advantage to have an experienced personal injury attorney who will know how to:

  • Talk with the claims adjustor
  • Evaluate settlement offers
  • Advise on whether to accept the offer or pursue litigation for a fair compensation for your injuries

When Speaking with Insurance Company Don’t Agree to Be Recorded

When the claims adjustor contacts you, they’ll typically ask to record your statement. Statements made during any phone call with the insurance company may impact your settlement.

Understand that you are not legally obligated to have your statement recorded.

Having a personal injury attorney with you during a phone call with an insurance company may help keep statements from damaging your claim.

Keep All Conversations with Insurance Companies Relevant to the Claim

Claims adjusters will typically keep the phone call with claimants friendly. Conversations may include topics about family members, friends, coworkers, other items not pertinent to the case. They may also include past medical conditions they’ve uncovered in their investigation.

While you might deem these topics as irrelevant, to the insurance company, the information could help minimize the value of your claim.

Keep your conversation strictly relevant to the case. This is another reason it’s smart to have an attorney by your side when speaking with the insurance company.

Don’t Release Medical Records until Advised by Your Attorney

If provided prematurely for the insurance company’s investigation, medical records could impact your settlement amount. Wait until your treatment is nearing completion and your attorney says it okay to release the records.

Don’t Settle Quickly

It’s in the insurance company’s interest to settle a personal injury claim quickly. While you might be impressed by the amount of the settlement offered, keep in mind the following:

  • Offer might not be the full settlement value for your injury
  • Extent of your injuries might not be apparent until later resulting in more medical expenses, lost wages, and poor quality of life issues

Get the Legal Help You Need

Settling a personal injury case can be tedious, complicated, and confusing. An experienced personal injury attorney can help you understand the process, your rights, and how to avoid costly mistakes.

Insurance companies have attorneys protecting their interests, you should have similar legal representation by your side. Our Personal Injury Attorneys can provide the help you need.

Contact the Fusco Law Group: (904) 567-3113 for a free consultation.

Frequently Asked Questions Insurance Companies and Personal Injury Cases

What is the difference between a Personal Injury Claim and Personal Injury Lawsuit?

A personal injury claim is made against an auto insurance policy, property owner’s insurance policy, or professional liability insurance policy when an injured party seeks compensation due to injuries they feel were the fault of the insured.

A claim will result in an investigation from the insurance company that may lead to a settlement offered by the insurance company.

A personal injury lawsuit is typically filed by an attorney of the claimant if a fair settlement cannot be reached with the insurance company.

When Should a Personal Injury Lawsuit be Filed?

A couple of factors may determine when it is time to file a lawsuit for a personal injury.

Settlement cannot be reached: If the claimant does not agree to a settlement offer or the insurance company denies a settlement, then a lawsuit might be the best option for the claimant.

Statute of Limitations: In many states, the timeframe to file a lawsuit in a personal injury case may be subject to a deadline. If the personal injury claim is past the statute of limitations, then so does the opportunity to seek compensation in court.

If you have been injured contact the Fusco Law Group: (904) 567-3113 for a free consultation.