THE CLAIM PROCESS

Logic would seem to dictate that the less severe the injury, the simpler it should be to resolve your Personal Injury Claim. However, that is not always the case. There seems to be a perverted sense of "logic" that is running ramped among insurance companies. All too many insurance companies are refusing to be fair in settling Personal Injury Claims, knowing full well that consumers will have to seek a qualified attorney to collect what is rightfully due. The operative word there is "qualified" attorney. Believe it or not, this approach actually works out to the best advantage of the insurance companies on either the short term or the long term basis (or both). The reasoning behind this aggravating approach to adjusting will be discussed in greater detail below. For now, suffice it to say, the insurance company is probably not going to bend over backwards trying to be fair with you. Therefore, what you are about to learn will be invaluable in your efforts to understand and deal with insurance companies when you have a Personal Injury Claim.

Everyone's Rights and Obligations

You have the obligation to prove who is responsible for your personal injury. Because this is a "comparative negligence" state, YOU also have to prove that YOU were NOT guilty of any negligence that may have contributed to you having sustained a personal injury. Then YOU have the obligation to "mitigate" (minimize) your damages and YOU have to prove your damages. Are you beginning to see a pattern here?

Here are a few questions that could arise:

1. What constitutes "comparative negligence"?
2. How is negligence apportioned?
3. What is "reasonable mitigation"?
4. What constitutes proof of my damages?

These details and subtleties will not be discussed here. If any of these questions become a part of your claim, call us at 800.718.4658 .

If liability is clear (other party struck you from the rear while you were legally stopped in traffic AND there is a police report to verify these circumstances AND the other driver was cited AND you received no citation AND you were wearing your seat belt at the time of the accident) . . . if your injuries were obvious at the accident scene AND the police accident report notes that you were injured . . . if the insurance company for the other party quickly commits to paying for your damaged vehicle AND puts you into a rental vehicle at no cost to you AND acknowledges they may have to pay you for any reduction in resale value of your vehicle after it has been repaired . . . if the adjuster advises you of the insurance policy coverage limits up-front . . . if those limits are sufficient to cover your expected damages (vehicle damage + diminished resale + rental car costs + medical expenses + lost wages + projected future medical expenses + "pain & sufferance" compensation with NO expected residual disability) . . . then you will still need our law firm . After all, some Personal Injury Claims actually are simple and some insurance companies will actually step-up, treat you with respect and pay what they owe. However, if your situation does not meet ALL of the criteria specified above, we suggest you consider talking with an Attorney .

Now that we have discussed your obligations, listen to the obligations of the insurance company. This part is simple. Once you have proven their insured is 100% liable for you damages and you have proven your damages, then the other party's insurance company has an obligation to protect the interests of THEIR INSURED by paying for your damages. Did you notice that? THE OTHER PARTY'S INSURANCE COMPANY HAS NO OBLIGATION TO YOU! Their obligation is to their own insured.

You can see the "perverted logic" that occasionally seems to be an underlying factor when consumers are involved in dealings with the other party's insurance company. That perverted logic manifests itself when the other party's insurance company is rude and indifferent to you . . . almost as though they are trying to drive you to an attorney. Well guess what . . . THEY ARE!  First of all, if you take this abuse you will wind up settling cheap and the insurance company saves money. If you go to an unqualified attorney, there is a better than average chance they will be able to force a cheap settlement on you through that attorney. Again, the insurance company saves money. If you get a qualified attorney, such as the Law Offices of Nadrich & Cohen, LLP, they will have to pay full value to settle your claim. Even then, there is benefit for the insurance company AND the insurance industry in general. Every couple of years the insurance industry tries to push some type of Insurance Reform Bill through the Legislature. When they do, they point out how many consumers hire attorneys to help them resolve their claims and it is these "greedy" attorneys that are driving up the cost of auto insurance. The insurance industry points their collective finger at personal injury attorneys as being the reason why insurance companies keep raising their auto insurance premium rates. Have you ever noticed that when you are pointing your finger (your index finger) at somebody else . . . you have at least three (3) more fingers pointing right back at YOU! Well, the same rule holds true when insurance companies try to blame rising auto insurance premiums on personal injury attorneys.

When insurance industry lobbyists fund campaigns, vacations and employment opportunities, they can usually find legislators with attentive EARS! Then, when the insurance industry tells their story, Bills start getting submitted to the Legislature. That's when consumers, YOU and I, have a problem! When the insurance industry is pushing for Insurance Reform Legislation, you can bet they're not doing it to benefit consumers.

The recorded statement: Most insurance companies have now gone to the practice of having their adjusters tape record their phone conversations with you. By rights, the adjuster should let you know when your conversation is being recorded. There are multiple reasons for recording these conversations:

1. The Adjuster needs to make a record of the facts related to how the loss occurred. This will become a permanent part of their claim file. You will be asked to provide self-identifying information, such as your full name, date-of-birth, place of birth, Driver's License # and Social Security #. With this information, the insurance company will probably order a C.L.U.E. (Claims Loss Underwriting Experience) Report and/or an Index Report. The C.L.U.E. Report will tell the insurance company of any claims you may have submitted to your own insurance company(s) in the past. The Index Report will reveal any prior claims you may have submitted for a Personal Injury Claim. The insurance company wants to know about your prior insurance claims experiences which could impugn your honesty.
   
   
2. By asking key questions about the circumstances of the loss, you may admit to something that would allow the insurance company to either deny your claim or substantially reduce the benefits you receive.
   
   
3. The insurance company will want you to be as detailed as possible in the recorded statement. Months later, when your memory may have faded, you may be called upon to once again answer the same set of questions. If you do not answer these questions exactly as you did in the recorded statement, the insurance company may try to make you look dishonest.

It is simply not practical to assume you will be able to avoid providing a statement to the insurance company. If you are dealing with your own insurance company, your cooperation is required by the policy. If you are dealing with the other party's insurance company, the Rules of Civil Procedure give them the right to interview and Examine you.

Since you are probably not going to be able to avoid giving a statement, the next best thing is to be prepared for the statement. If you are dealing with the other party's insurance company, as with a Personal Injury Claim, we bly suggest to provide your statement in the company of (and with the guidance of) your own attorney. If you are providing your statement without counsel, we suggest you review the following guidelines:

1. Answer the questions asked as briefly as possible without going into extemporaneous detail.
2. Unless you are 100% sure of the exactness of your answer, qualify you answer(s) with terms like "about", "approximately", or "as best as I can recall", etc. Or, if you do not know the answer to a questions . . . simply say so!
3. Avoid being specific as it relates to speed, time and distance. It is a simple matter of mathematics to take two of these factors and calculate the third. If you are specific in any of these two factors and you are wrong, then a wrong conclusion could be reached which could work against you. If your insurance claim involves a "significant loss" - CONTACT US BEFORE GIVING A STATEMENT !

The Wage and Medical Authorization: If you have a Personal Injury Claim pending with either the other party's insurance company or your own insurance company (Uninsured Motorist, Underinsured Motorist or Med-Pay Coverage), you will probably be asked to sign a "Wage and Medical Authorization" form. As nobody is supposed to be able to access your medical and/or employment records without your permission, it seems reasonable to sign this form. WARNING: By signing this form, you are usually allowing the insurance company to go on a "fishing expedition" in search of any reason to not pay all or any part of your claim. If your claim is with your own insurance company you have an "obligation to cooperate", as specified in your Insurance Policy Contract. Do not sign it - contact us .  It is usually to provide an authorization with limitations as to scope of access. We know how to limit this authorization, so as to protect your rights and limit what records your insurance company can access. If your claim is against the other party's insurance company, you have no obligation to provide a wage and medical authorization to them. You will have to provide them with legitimate information upon which they can base their evaluation of your Personal Injury Claim. However, by having that information come through our law firm, you are able to address any potential problems before they can be distorted and used against you. It is always best to be able to work with the insurance company. It is never prudent to surrender control of your claim to the insurance company.

It is usually in your best interests if you have your own Auto Insurance Collision Coverage cover the repairs and/or total loss settlement of your damaged vehicle. We say this for two (2) primary reasons:

1. In the event your vehicle is a Total Loss, your own policy provides you the right to challenge the settlement proposed by your insurance company in a timely and cost effective manner. This procedure is outlined in the Appraisal Clause of your own policy. In most states, your auto insurance premiums can not be increased for claims which do not involve your own negligence, so you don't have to worry about preserving your future auto insurance premium rates.
2. If your vehicle damage is economically reparable, the other insurance company may well pay you for that expense with a draft (or check) which includes "release" verbiage.

Insurance companies in general seem to like saving money by requiring the repair shop to use either used parts or after-market parts (non-factory imitation [non-OEM] parts). While the insurance company does have the right to use LKQ Parts (Like Kind & Quality), there are reasonable limitations to that right. Contact us if you have a problem.

If your vehicle is rendered inoperable because of the accident, your first concern (after the health and well- being of you and your passengers) will probably be finding substitute transportation. Unfortunately, most insurance companies are not going to step up immediately and put you into a rental vehicle. You will probably have to use your own credit card to secure a rental vehicle until such time as the other party's insurance company decides to accept responsibility for this expense.

Hopefully you will have Rental Reimbursement Coverage on your own auto insurance policy which will be available to you as a backup to what the other party's insurance company is going to try to pay you.  The other party's insurance company is going to try to limit what they reimburse you in daily rental charges and will refuse to reimburse you any CDW (Collision Damage Waiver) expense you may have incurred. It would not be unusual for the other party's insurance adjuster to tell you "We only pay $15.00 per day (or some other arbitrary amount) for daily rental charges and we do not pay CDW at all". That is so wrong and yet is so common. The insurance industry as a whole probably saves billions of dollars annually with this one abusive adjusting technique. By case law precedence, you are entitled to be reimbursed for reasonable costs incurred in renting a temporary substitute vehicle that is comparable to your damaged vehicle . If your damaged vehicle is a Buick Park Avenue, you should not be reimbursed based upon the cost to rent a Geo Metro. Yet, there will be insurance companies that will attempt to resolve your rental reimbursement claim based upon their own ridiculous standards. The other party's insurance company will also attempt to deny reimbursement for CDW charges, saying that your own Collision Coverage should transfer to the rental vehicle. Often times this is true, which makes denial of coverage a non-issue. However, when your Collision Coverage does not transfer, or when you do not have Collision Coverage on your own vehicle, this denial of coverage needs to be challenged. You should not have to assume a financial risk greater than that of driving your own vehicle. If you accept less than full reimbursement for all costs incurred in renting a temporary substitute vehicle, you can submit your un-reimbursed expenses to your own insurance company for add'l reimbursement under your own Rental Reimbursement coverage. However, if the other party's insurance company is not going to reimburse you fully for your rental expenses, you should consider this as a sample of how you are going to be treated on the rest of your claim and you should immediately contact our office. You should consider your treatment on your Rental Vehicle Claim as an early warning of how you are going to be treated later on.

Once you have cleared the hurdles of proving liability and proving your injuries, you must then prove those injuries kept you from earning your living and for how long. A statement from a knowledgeable attending physician is usually sufficient to document your inability to work and for what period of time. If you can provide such documentation to the other party's insurance adjuster, you would then be entitled to reimbursement of your lost wages. You would then have to prove how much income you have lost. A statement from your employer could do the job. However, if you are self-employed, you will be required to submit documentation much the same as you would if you were applying for a loan. You are owed reimbursement of your net income (after taxes). Under IRS code, the monies you receive from the insurance company are classified as an indemnification and are not subject to income tax. This is very tough without a qualified lawyer representing you.

If your injuries include internal injuries, broken bones, head injuries and/or cosmetic reconstruction, you will need to be treated by mainstream physicians such as MD's or osteopaths that are specialists in their respective disciplines. However, once your injuries have been isolated to soft tissue strain, we suggest you consider chiropractic or physical therapy by a registered physical therapist under the supervision of your attending M.D. or D.O. We have seen wonders achieved by chiropractic and/or physical therapy in relieving pain, rebuilding strength and restoring range of motion. The unfortunate part about receiving chiropractic treatment without mainstream supervision is that most insurance companies will not give full weight to the treatment charges when they attempt to calculate your pain & suffering settlement.

In the selection of a medical provider, expertise and results should always be your primary consideration. However, there is also a secondary consideration. When it comes time to resolve your claim for personal injury, you will want your health care provider to be able to compose a narrative (a "medical legal") about your injury and treatment that will leave no room for challenge by the insurance company. Just as your treatment is critical to your physical well being, a good medical legal is critical to your post-treatment financial well being.

Another important aspect of selecting a health care provider is that provider's willingness to await payment until your claim is settled. Health care providers who regularly work with accident victims are used to awaiting payment.

Of all the E-mail we receive from consumers, the overwhelming majority are asking "What is my claim worth?". As you can see by what you have read above, there is no easy or standard answer. The major portion of most Personal Injury Claims has to do with the Pain and Suffering Settlement, which is directly related to the type of injury, the medical expenses incurred, the add'l medical expenses projected, the extent of your recovery, and the physical pain and suffering that is directly related thereto. There is also the credibility of your injury and the expenses incurred to address those injuries. To be perfectly blunt, there is no way we can be specific in answering these questions over the Internet. We do know from experience that our law firm recovers for our clients the most money for pain and suffering. By retaining our Personal Injury Law firm you will avoid the mistakes, pitfalls and stress of having to deal with the insurance company yourself.

In this page we have attempted to make you aware of what you may be facing if you are involved in a Personal Injury Claim. We want you to contact us if you have any questions.