Insurance Claims and Settlements
Dealing with insurance claims can be confusing and sometimes, frustrating. The idea of insurance is straightforward: You pay money (policy premiums) for your insurance contract. In exchange, the insurance company agrees to make payments according to a published schedule if you incur a covered loss. However, in some cases, policyholders’ claims are denied or are not paid in full.
Hiring the right attorney on your side can help you navigate the insurance world and may improve your chances of obtaining the benefits you are legally entitled to under insurance and contract laws.
Insurance attorneys can help when issues arise with nearly any type of insurance policy. Insurance litigation may include issues or disputes about any of the following types of coverage:
- Auto. Claims frequently arise related to insurance on cars, trucks, motorcycles, and boats.
- Health. This coverage area includes issues related to traditional health insurance and related insurance fraud cases, as well as long-term care policies and disability income insurance.
- Life. People sometimes hire attorneys to help with life insurance claims or to advocate for them with the insurance company when policy issues arise.
- Homeowners/Renters. Property insurance disputes may involve damage or theft claims, or loss claims (for example, losses due to water leaks or flooding, or other disasters such as earthquake or fire, soot, smoke, ash, etc.)
- Commercial policies. This umbrella includes business interruption insurance, construction coverage, commercial general liability, product liability, business income, cybercrime policies, and more.
- Professional lines. Some insurance attorneys work with claims related to professional liability insurance, including errors and omissions (E&O) coverage (e.g., for medical malpractice, legal malpractice, etc.) and directors and officers (D&O) policies.
- Worker’s compensation. Benefits issues related to worker’s compensation matters are also fairly common, and are a regular practice area for many law firms.
Common Insurance Matters Handled by Insurance Law Attorneys
Some insurance attorneys specialize in one particular type of insurance law such as medical malpractice, legal malpractice, workers’ compensation, or insurance bad faith litigation. Other insurance lawyers are generalists, handling claims and lawsuits about a variety of different types of insurance products, including auto, health, commercial (business) insurance, professional liability, homeowners, renters, property and casualty insurance, etc. When hiring an attorney to help you, find out if the lawyer or firm routinely represents clients in similar types of insurance matters.
Regardless of the underlying insurance policy type, insurance claims and litigation attorneys may help clients with issues related to:
- General claims. Unfortunately, filing insurance claims is not always as simple or straightforward as it seems it should be. Insurance attorneys can help claimants with paperwork and supporting documentation.
- Underwriting matters. This category includes denial of coverage, or coverage is offered but at a substantial cost increase.
- Coverage issues. These include situations where the insurer states the policyholder’s loss is excluded or only partially-payable, or where the insurance company simply fails to adhere to contractual requirements.
- Policy interpretation. Insurance lawyers can help with situations where the insurance company and customer have different interpretations about the policy’s terms.
- Claims-handling problems. In some cases, the claims-handling process is flawed or made unnecessarily complex due to a series of missteps by the insurance company’s claims processors.
- Insurance bad faith litigation. Insurers in California have a duty to provide legal defense and to indemnify policyholders against lawsuits, when the claims involved in the suit would be covered under the insurance policy. Insurance litigation attorneys represent policyholders whose insurers fail to do so.
An insurance dispute may be a relatively simple, two-party issue between one insurance company and one policyholder. In other cases, attorneys work to help resolve complex issues involving multiple insurance companies and consumers. Some lawyers represent both insurers and insureds, while other focus their practices on one side or the other.
Why Hire an Insurance Attorney?
Hiring an insurance law attorney when you have an issue can help ease the stress of dealing with the insurance company. Attorneys and law firms that routinely handle insurance matters and lawsuits understand the language used in insurance policies and communications. This means insurance lawyers can more quickly identify potential problems that may not be readily apparent to individual consumers.
Hiring an attorney does not mean that you have to file a lawsuit against the insurance company or agent. In many cases, insurance lawyers serve in an advisory capacity, providing coverage counseling, advice for policyholders, claims assistance, and/or handling the entire pre-litigation phase for negotiating and settling insurance claims without formal litigation.
If it makes sense to do so, your insurance attorney can handle communications with the insurer on your behalf, advocating for your rights and interests. Sometimes, when a policy interpretation error is pointed out or when additional supporting facts and documents are provided to the insurance company, they are willing to reverse earlier decisions. In other situations, the insurer may be willing to mediate, arbitrate, or negotiate a settlement with a strong insurance attorney rather than litigating the matter in court.
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Personal Injury Claims and Settlements in California
Every day in California, numerous mistakes are made, accidents take place, and wrongful acts are committed. You could have been a pedestrian who was struck by a motorist at an intersection (pedestrian accident) or a victim of another motor vehicle accident. You could slip and fall (premises liability) on a wet floor as a consumer at the grocery store or fall off a ladder at a construction site (as a contract employee or otherwise). You could have visited your doctor, at which time the doctor misdiagnosed an illness (medical malpractice). In an entirely different situation involving no physical injury but mental and financial injury, and serious injury to your reputation (defamation), you could have lost clients because someone was upset and left a false Yelp review about your small business.
Whatever the personal injury may be, the point is this: in California, accidents and wrongful acts happen each and every day. It’s good to know that most personal injuries are compensable. And almost all qualifying injuries will be compensated through a personal injury claims process. Knowing a little bit about the claims process and what to expect can help you make sure you get fair and just compensation. Here’s what you should know for personal injuries suffered in the Los Angeles metro area.
What is a California Personal Injury Claim?
A personal injury claim––whether it’s in California or elsewhere––is a process to recover damages from a personal injury caused by another person’s or another entity’s (organization, company, etc.):
- Negligence;
- Carelessness or Gross Negligence;
- Recklessness;
- Intentional act; or
- An otherwise wrongful act.
A personal injury claim is typically a claim filed with an insurance company; it is not a lawsuit and does not involve the courts.
The claim process, however, can be just as convoluting as a lawsuit. There are many steps of the process that are not in any kind of chronological order.
There are also things to consider to make sure you optimize your chances of getting the best settlement possible in your unique situation.
The Process to File & Settle a Claim
The process of a personal injury claim can begin with something as simple as contacting the at-fault party’s or your own insurance company. Once that happens, the wheels are set into motion. A fact-finding stage begins, but from this point onward, the moving parts of the process will typically overlap, and you, your insurer, or your attorney will constantly be in contact with the other party. The main three moving parts include:
1. An investigation to uncover all the facts and circumstances of the accident or wrongdoing (e.g., determining coverage and liability on the case by contacting witnesses or reviewing photos and videos) and the injury, if any (e.g., obtaining medical records);
2. Documentation to keep track of evidence but to particularly maintain a database of ongoing mounting losses, which often occurs in the more serious of personal injuries; and
3. Negotiations between and among the claimant (the person seeking compensation), the claimant’s attorney or insurance company, and the at-fault party or the insurance company, which will include, among other things, demand letters explaining the loss you have suffered, the legal argument for your claim, and a demand amount––to note, more than one demand letter may be sent throughout the process, including pre-suit demand letters.
The personal injury claim process has an aim: to obtain the best possible settlement offer. For the insurance adjuster, reducing or denying the claim is the ultimate goal and best possible settlement for them while your goal is maximizing compensation, which is your best possible settlement. The process, therefore, may start with a high demand and low settlement offer. Through negotiations, the parties may meet somewhere in the middle. It takes skill, knowledge, and grit to negotiate with insurance adjusters––they use manipulation, intimidation, and other tactics to lower the settlement. You’ll need to fight fire with fire so that the final offer isn’t terribly watered down.
Of course, this isn’t everyone’s experience. Minor personal injury claims are pretty straightforward and quickly and fairly processed when it’s clear who the at-fault party was, the damages are complicated, and the insurance coverage is sufficient. If your personal injury isn’t straightforward, you’ll want to keep in mind some common do’s and don’ts to avoid making serious mistakes that’ll impact your ability to recover fair and just compensation.
Do’s & Don’ts of Filing a Personal Injury Claim in California
Making a mistake in the personal injury claim process can be the difference between fair compensation and no compensation. Your health and finances are dependent on you getting it done right. Here are some things you should do to ensure you’re protected:
- Do get medical attention. Immediate medical attention will link the accident or wrongdoing to the injury. If the injury doesn’t materialize until hours or days later, you still need to get medical attention; you can’t wait to file a claim in the hopes you’ll get money to seek the care you need.
- Do follow your care plan exactly as prescribed. Your doctor may order tests, rest, and/or medicine. The doctor may also tell you when you can go back to work and when you can’t. Whatever it is, follow your doctor’s orders. Not only will failure to listen and adhere to the care plan delay recovery, it can also result in a reduced or denied settlement offer.
- Do get a police report. If it was a car accident or some other type of wrongdoing and the police were involved, get a report, especially if you were not at fault. This report will have valuable information, like the police’s perspective of what happened, names of witnesses, photos, and other necessary pieces of evidence or indications of evidence.
- Do keep a journal. If you have serious injuries specifically, a journal can go a long way to document how life has changed for you and how much physical pain and emotional stress you have experienced. This may help you optimize non-economic damages.
There are also things you shouldn’t do when filing a claim, and these include the following:
- Don’t admit fault. This is the first thing you should NOT do. Never admit fault after an accident, whether it’s to the other party, the police, a doctor, or a friend. You may feel bad or guilty the accident occurred, but that guilt does not mean you were at fault or contributed to the accident in any way.
- Don’t contact the insurance company without being represented by a lawyer. For straightforward accidents, you can go ahead and contact your insurance company, but for more serious cases, get legal advice first. You may change your statement without even knowing it. If you do, that little detail can matter in terms of compensation, and it’ll be to your detriment.
- Don’t provide a statement to the at-fault party’s insurance company. Though you are required to cooperate with your own insurance company, you are under no such obligation with the at-fault party’s insurance company. It can get your statement through your own insurance company. The same is true here: if you give another statement and there’s a discrepancy, then that can be twisted and used against you.
- Don’t sign anything. This is particularly important with release forms, whether for property damage or for your bodily injuries. You shouldn’t sign one until medical treatment is completed. And always speak to an attorney first.
- Don’t go on social media. Posting information about your accident or injury or just about anything else can be manipulated in a way that doesn’t support your claim. It may be tempting to share with friends and family, but it can also be very risky.
- Don’t let the statute of limitations expire. Some adjusters like to keep prolonging negotiations so that the statute of limitations expires and you can no longer file a lawsuit. Don’t let that happen because once it does, the insurance adjuster can use that as leverage. Most personal injury cases in California have a two-year deadline. The clock starts ticking on the date of the accident and expires two years from that date. Some statutes of limitations are shorter or longer, so contacting an experienced personal injury lawyer in Los Angeles will be critical.
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What is a Personal Injury Settlement?
A settlement is the end-goal of a personal injury claim process. The settlement is the amount of compensation the insurance company or at-fault party offers and you accept. The full amount, however, will likely not go straight to you. There may be legal fees, other costs (e.g., payments to obtain reports or expert opinions, if needed) and possible medical liens that must be paid first. Here’s what you need to know about settlements.
The Settlement Process
Most personal injury claims end with a settlement. The final amount will depend on:
- The facts and circumstances of how the accident happened;
- The extent and nature of your injuries and losses;
- The strength of the evidence and the persistence of you or your personal injury attorney.
Once there is an agreement on the settlement amount, the following steps may be taken:
A. Negotiate and Sign the Release. Releases typically release the insurance company of an obligation to make additional payments and require the claimant to give up the right to sue the insurance company or insured driver at a later date. Sometimes, you may have to sign a release before a witnessing person or a notary public. Once the release is properly signed, it should be returned to the insurance company immediately to prevent delays.
B. Issuance of the Settlement Check. The insurance company will send the check to your attorney if you have hired one.
C. Process Lien Payments and Other Fees. The attorney will review the check and then process it. Before payment is made to you, all outstanding legal fees and medical liens must be paid as well as all other legal and medical costs.
D. Review Invoice Detail. The attorney will keep you updated, and allow you to review the details of the fees and costs. If you disagree with any of these fees and costs, the amounts you dispute can be held in a trust account until an agreement is reached. All other payments can go out.
E. Receive your Settlement Check. If you agree with the details of distribution, the attorney will issue you a check.
There’s always a sense of relief once the check is in hand and bills are paid. It’s at this time you can give recovery your full attention and move on.
Five Things to Know When Settling a Personal Injury Claim in Los Angeles
Settling a personal injury claim is key to quick recovery of damages. Here are five things you’ll want to know about personal injury settlements.
1. A personal injury settlement typically requires proof of four key elements. Most of the time, a personal injury case is a result of negligent act or omission to act. You must be able to show that there was a duty owed to you, the duty was breached, the breach caused an injury, and the injury resulted in damages. If your claim is weak on any of these points, there is a great chance the insurance company will use it as an opportunity to fight hard to minimize or deny your claim. It can be a daunting task to collect evidence, document everything, and relay that information in a way that connects the necessary dots.
2. Victims who retain a personal injury lawyer recover more statistically. Personal injury lawyers are trained and highly capable. Through years of experience, they gain useful insight on how to work with and against insurance companies. They also know how best to advocate your rights and interests. They aren’t emotionally attached and are not suffering financially, so they can pursue your case with clarity, purpose, and commitment. That said, even though some percentage of your settlement should be shared with your attorney, you will eventually benefit more since the settlement amounts with involvement of an attorney are statistically higher than those without an attorney. So, there’s a balance you must consider wisely.
3. Contacting a lawyer sooner than later benefits you. It’s always the case: the sooner you do something, the better it is for you. The sooner an attorney is retained, the sooner he or she can begin collecting evidence before it disappears, analyzing the data, researching legal doctrines and precedent, and communicating with the insurance company. Remember, too, there’s a clock ticking, so you really don’t have time to sit around and think about what to do. You need to take action before it’s too late.
4. There are no upfront fees to start a personal injury claim. If you are worried about money––and most people are who have suffered an unexpected and traumatic personal injury––be at ease that retaining a lawyer doesn’t mean you have to have money in the bank today. Most personal injury attorneys in Los Angeles work on a contingency fee basis. This means they take a percentage of the settlement offer after they obtain money for your matter. It also means they get nothing if there’s no settlement, if you decide not to file a lawsuit, or if you lose at court.
5. If the settlement isn’t what you think is fair, there’s always a second option: a lawsuit. You don’t have to settle. You can move forward with a lawsuit. This is definitely something for which you must consider the pros and cons, and it’s best done by consulting with your attorney. What you think is fair may not be logical or remotely possible. You’ll need someone with experience to help you see what’s in your best interests. If you do opt to sue, just keep in mind, too, that the negotiations for a settlement will continue and that, according to the Bureau of Justice Statistics:
a) More than 90% of personal injury lawsuits settle before trial.
b) When tort cases went to trial, plaintiffs were more likely to win before a judge (bench trial) as opposed to a jury trial.
c) Plaintiffs, however, prevail less frequently when they go to trial if their case is medical malpractice (only 37% in favor of the plaintiff) or product liability (34%) as opposed to motor vehicle accident cases going to trial (57% in favor of the plaintiff).
d) Medical malpractice and product liability cases––though having a lower success rate––have the “highest estimated median damage awards.” For product liability cases, this amount is found to be around $350,000.
Retain a Strategic Personal Injury Attorney in Los Angeles
A personal injury lawyer in Los Angeles can accurately and timely guide you through the personal injury claims process. Contact us today so that we can help you find a smart, strategic personal injury attorney who will strongly advocate your best interests before an insurance adjuster and make sure you get fair and just compensation.
