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Overview of the Insurance Claims Settlement Process

calculator-385506_640 An accident is by definition a traumatic and sometimes life altering the experience. The reality is that the ramifications of an accident extend far beyond the event itself. One of the initial tasks that you necessarily must undertake following an incident of this nature is filing a claim with an insurance company. The filing of an insurance claim is a crucial task. You must make certain that it is undertaken in a timely and proper manner. Therefore, you need to understand the essentials associated with filing pursuing an insurance claim.

Understanding the Difference Between First Party and Third Party Insurance Claims

In the aftermath of an accident, there are two different types of insurance claims which you potentially may face pursuing. These are known as first party and third party claims. A first party claim is filed with your own insurance company. You would file a claim with your own insurance carrier in a situation in which you were at fault. For example, if you rear-end another motor vehicle, you likely will be considered to be at fault and you will need to file a claim with your insurance company. In the alternative, a third party claim is filed with another insurance carrier. In the case of a third party claim, it is pursued with the insurance company of the person or entity you believe was negligent and responsible for the injuries you sustained because of the incident in question. For example, if you are a pedestrian and were hit by a car in the crosswalk, you are likely to file a third party claim with the driver’s insurance company. By way of another example, if you slipped and fell in a grocery store, you would file an insurance claim with the store’s carrier.

Overview of the Insurance Claims Process

Insurance policies set forth specific parameters regarding when a claim must be filed in the aftermath of an incident giving rise to injuries or even property damage. Generally speaking, if you sustain injuries as the result of an accident, you must report the incident to the appropriate insurance company within a 24 hour time period. There can be exceptions to the rule. However, you must take care to comply with the reporting requirements. 24 Hours reporting is based on your contract & apply only to your insurance company. On the liability side is the only limitation 3 years since your accident to file it in court. This includes incidents involving automobiles, injuries sustained at home or at a place or business. If you do not believe you were at fault, you should contact the other party’s insurance carrier within this time period if at all possible. This underscores the need to obtain insurance and other essential information from the other party when you are injured or when an incident occurs. Keep in mind that even if you do not believe you are at fault for an accident, you also need to report it to your own insurance company within the same time period. The possibility exists that for one reason or another the other party’s insurance may not provide compensation. In such a case, you will need to seek recovery or compensation from your own insurance carrier. When you make a report to an insurance company, you will need to provide basic information about the incident in question. This will include information about how the incident occurred and the type and extent of injuries that you sustained. Once the initial report is filed with an insurance company, the carrier will commence an investigation of your claim. You are likely to be asked to provide additional information during the investigatory process. For example, you may be asked to provide the names and contact information for witnesses to the event and any photographs or videos you may have made. An insurance carrier is also likely to have you obtain an independent medical evaluation pertaining to the extent and nature of your injuries. The insurance company will select the doctor who will undertake this evaluation of you. Ultimately, the insurance company will make a determination as to whether or not it will compensate you for the claim. In addition, the carrier will determine the amount of compensation it is willing to provide to you.

A Denied Claim and the Appeals Process

Insurance companies do deny claims with significant regularity. They deny claims for a variety of reasons. Common reasons for denial include a failure to file a claim in a timely manner or a failure to provide the carrier information requested during the investigation of the claim. No matter the reason or reasons for the denial, you have the ability to appeal the decisions. Procedures for an appeal do vary from one insurance company to another. Therefore, you must make certain that you are familiar with a particular company’s protocol for appeal. You must make certain that you file the appeal within the timeframe established by the insurance company.

Calculating Compensation Following an Accident

The amount of compensation paid on a claim for injuries arising from an accident is determined on a case by case basis. The amount paid for lost wages and medical expenses can be easier to determine. Calculating pain and suffering are more complex. Insurance companies commonly utilize a formula to compute compensation for pain and suffering. For example, if the injuries are not too significant, the insurance company may compute pain and suffering an amount equal to 1.5 times the total pain in medical expenses. If the injuries are more substantial, the insurance company may compute pain and suffering at a rate 5 or even 10 times greater than the total of medical expenses.




  • Everyone has slipped and fallen at some point – it’s just a fact of life. Sometimes, it happens because of mere distraction or lack of attention. But other times, it’s due to negligence of others. Contact Boyko & Associates to find out how you can get compensated for your injury.



  • Everyone has slipped and fallen at some point – it’s just a fact of life. Sometimes, it happens because of mere distraction or lack of attention. But other times, it’s due to negligence of others. Contact Boyko & Associates to find out how you can get compensated for your injury.
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BOYKO & ASSOCIATES
2021 Nostrand Ave
Brookyn NY 11210

Tel.: (917)-687-6829
Fax.: (718)-434-8953
alex.debar@boyko-law.com
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