Auto injury claims get complicated
Damaging your car in an auto accident is stressful enough, but getting
hurt is worse. Not only do you suffer, but unlike vehicles, your body can't be
repaired with original parts nor can you be replaced. This makes injury claims
arising from an accident a different beast from damage claims.
an injury claim is involved, [the claims process] gets more complicated,"
says John Eager, senior director of claims services with the National Association
of Independent Insurers (NAII), based in Des Plaines, Ill.
because if the other party is at fault, you will most likely have to file a claim
with the other party's insurer, which is duty-bound to protect the interests of
its insured -- not you. This is a truly adversarial relationship, and in most
cases you may best be served by hiring legal counsel.
if you have a no-fault policy or personal injury protection, you will file your
initial claim with your own insurer.
"In a no-fault
situation, you will file with your carrier, who will make you whole (pay your
expenses) and the other person will go back to their carrier," says Daniel
Kummer, director of auto insurance for the NAII. "In a lot of states, there's
still room for tort remedies."
For instance, even in
a no-fault state, you may be able to sue the other carrier to compensate for certain
permanent injuries, pain and suffering or other issues if the other party is at
fault. You will also file with your own insurance carrier if the other party is
uninsured and you carry coverage against uninsured drivers.
like your insurance carrier stands in place of the carrier that does not exist
or the person that has no insurance," says John Eager of NAII.
You will be covered up to the limits in your policy, and you may
have the right to seek compensation directly from the person who hit you.
You may also file an uninsured motorist claim with your carrier
in the case of a "phantom vehicle," where you might be hit or run
off the road by a vehicle that speeds away and is never identified, Eager adds.
In all other cases when the other driver is at fault, you will
file with the other party's carrier. Obligated to represent the other party's
interests, the other carrier will do everything it can to keep the settlement
as low as possible, says J.D. Howard, co-founder of the Insurance Consumer Advocate
Network, based in Branson West, Mo.
You have the obligation to prove your damages and mitigate them.
This means you must not exaggerate your claim and keep the expenses as low as
possible without compromising your recovery.
For example, Howard says, "If you have an injury that would
normally take you two to three days off work to heal, you can't retire or go
on disability for six months."
If you live in a "comparative negligence" state, you
also have to prove that you were not guilty of any negligence that may have
contributed to the injury.
"To begin with, you have the obligation to prove who is responsible
for your personal injury," says Howard.
In addition to the five elements of proof that stem directly from
an accident -- your statements, the other party's statements, the police report,
witnesses and physical evidence -- medical treatment received and doctors' diagnoses
are added to the mix of proof that you've suffered an injury from the accident.
Proof of who is at fault will likely be based solely on the initial five elements.
Howard counsels consumers to get a personal-injury attorney in
all but the simplest injury claims if the other party is found to be negligent.
He says simple claims would be cases when it's clear the other party was 100
percent at fault, the police report notes that you were injured and the other
party's insurer makes quick commitments to put you in a rental car and pay your
vehicle damage, and the other party's coverage limits are sufficient to cover
your expected damages.
-- Posted: Sept. 23, 2003