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What Do I Need to Understand About Insurance Claims?

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Across the U.S., auto accidents injure approximately 50 million drivers each year. Therefore, car accident insurance claims are a fact of life for many Americans. It is crucial for you as a driver to familiarize yourself with the auto insurance claims process. That way, you will be prepared if and when you need to file a personal injury claim.

How do I make a health insurance claim?

How Do I Make a Health Insurance Claim?

If you get into an accident, you might need to make a health insurance claim. This can be a long and confusing process, so it is important to know what to expect. To make a claim, you will need to:

  • Collect any receipts: To file any claim, you will have to submit all the receipts associated with the incident. For most health insurance claims, this includes any receipts from health care providers. If you did not receive one at the time of the visit, you can call them and request a new copy. Be sure you have an itemized receipt, so your insurance can see which procedures or medication the medical provider charged you for.
  • Fill out a claim form: Next, you will need to request a claim form from your insurance and fill it out. The form will likely request more specific details about the incident and any medical attention you received. Fill the form out completely, with as many specific details as you can. Be sure to file insurance claims as soon as possible after the incident.
  • Send in the form: Once you have filled out the form and gathered all the necessary documents, you can send it to your insurance company. Always be sure to make a copy of the claim for your records.
  • Follow up: Insurance companies are notorious for taking extended periods of time to process claims. When you submit the form, try to contact your insurance company and ask for an estimated processing time. If you have not heard back after that period has elapsed, follow up with them. Do not afraid to be persistent.

How Do I Deal With My Insurance Company?

There are several things you should know well in advance of calling on your insurance company after an accident:

1. Do Not Expect a Fair or Comprehensive Offer Upfront

When you file an insurance claim over a car accident, the insurance adjuster will typically be more concerned with the interests of the company they represent rather than your interests as the claimant. Consequently, an insurance adjuster is likely to minimize the damage to keep the payout to a minimum.

2. Stand Your Ground in the Negotiation Process

It must be understood that insurance companies are under no obligation to treat claimants with promptness or fairness. These facts are most evident in cases where you file a personal injury claim on the insurance of a liable driver. Regardless of the extent of your injuries and losses, the first offer you receive is bound to be for a low amount.

3. Never Accept the First Settlement Offer

In the immediate aftermath of an accident, victims tend to have an immediate need for money to pay for repairs, medical expenses and personal loss. Knowing this, insurance companies typically make low settlement offers up front in hopes the claimant will accept the low amount and be on their way. Unfortunately, it is hard to initially determine just how much the expenses might pile up as repair bills, hospital costs and lost wages mount. Therefore, you should never accept the first offer from an insurance company.

4. Keep Records of Your Hospital Visits

Insurance companies will often attempt to downplay your injuries in an effort to low-ball a settlement offer. A common tactic is to insinuate exaggeration or outright insurance fraud on the part of the claimant. An insurance adjuster might also claim you have a pre-existing condition that accounts for your injuries. Therefore, you must keep a record of any hospital visits related to an injury — especially if you did not immediately go to an emergency room after the accident.

5. Don’t Sign Without an Attorney Present

Regardless of how decent a settlement might appear, the primary job of an insurance adjuster is to get you to agree with the insurance company’s version of the accident. As such, insurance adjusters will often try to lock claimants into limited settlements through a series of selective questions. To avoid this trap, do not sign your name on any papers or make recorded statements without the presence of a personal injury attorney.

6. Bring a Repair Estimate From Your Preferred Auto Shop

When it comes to vehicular repairs, you are not under any obligation to use the repair shop recommended by the insurer. In some cases, the auto shop in question will have a deal with the insurer and skimp on service by using cheap replacement parts. Choose an auto shop you know and trust and bring an estimate of the needed repairs when you file a claim.

7. Beware of Low Replacement Offers

In cases where a car is a considered a total loss — generally when the damages approximate 70 percent of the vehicle’s full value — an insurance company will most likely opt to issue you a check for a replacement vehicle of the same value. However, this “value” is often based on local prices and not the value listed in any of the authoritative auto guides such as Kelly Blue Book. Therefore, you should do your own research into the value of the vehicle and present your findings to the insurer. Moreover, if you get a low offer, consider hiring a third-party adjuster to do a second evaluation.

8. Don’t Be Ignored

If an insurance company appears to delay matters or ignores you outright, hire an attorney to handle the communication aspects of your claim. Insurance companies sometimes ignore claimants, especially after a first settlement offer has been rejected. The idea here is that most claimants will eventually give up if their calls are not returned.

9. Do Not Sign Any Paperwork You Do Not Understand

Insurance companies will often hide the fact that, should you agree to their terms, you would be signing away your rights to further damage claims. Such information is often confusingly worded in the fine print of insurance documents. Have an attorney present at the time of any signing to ensure a full understanding on your part of the terms in question.

What Should I Tell My Insurance Company?

Knowing how to communicate with your insurance company, including what to share and what not to, is hugely important. Here is what to know:

1. Share Only Basic Facts in Conversation and Save Details for the Written Demand

Refrain from giving any full statement about the accident during your initial conversation with an insurance agent. Some agents will try to get claimants to agree to certain “facts” in preparation for low settlement offers. Keep your initial statements limited to the basic “who, when, where” details about the location and nature of the accident and the parties involved. Save the more detailed account for when you make your written demand for compensation.

2. Limit the Amount of Personal Information You Share

Always remember that your interactions with an insurance agent concern your damage claims and nothing more. Do not share any personal information about yourself beyond your full name, address and contact information. You are under no obligation to provide details of your work history, occupation, work hours or monthly income.

3. Do Not Share Details About Your Injuries

In the immediate aftermath of an accident, you might not know the full extent of your injuries. Moreover, you might forget certain details. Therefore, do not share injury details during this initial conversation. If you do, the adjuster might low-ball you based on incomplete information.

4. Set Restrictions on Your Interactions

Some adjusters will try to get claimants to settle quickly during the second or third call, if not the first. Make it clear you will not be sharing extensive details or making claims over the phone with an insurance adjuster. In the meantime, gather all the details and have your injuries and losses properly assessed. Some of this information will take time to fully materialize, but you will need as much information as possible to file a complete damages claim.

5. Do Not Admit Guilt

If you are the liable party in the accident, do not reveal that information upfront with your insurance agent. The company will make that determination once they have all the facts of the accident.

6. Identify the Agent With Whom You Speak

When you initially talk to an insurance agent, write down the agent’s name, address and contact information. Also, be sure to get the name of the insurance company they represent.

How Do I Prepare for the Insurance Claims Process?

The next part of this journey involves the preparation of the insurance claim itself. Here is a look at how to proceed:

1. Contact the Police

Before you even talk to an insurance agent, report your accident to the police. Give the police full details of how the accident happened and where it occurred. In the event of anything serious, a police report will be filed. Ask the officer with whom you speak for a police report number. Keep this information on hand for when you file an insurance claim.

2. Gather as Much Proof as Possible

Once you file your claim, you will need to provide as much information as you can gather to prove the full extent of your injuries, damages and financial losses. Proof can come in the form of hospital bills, medicine receipts, auto-repair estimates and pay stubs from work weeks prior to the period where you were sidelined due to injuries sustained in the accident.

3. Keep Up-To-Date on Your Premium Payments

To ensure you have coverage when you need it, stay on top of your premiums — whether you pay in monthly installments or annual lump sums. In the event of financial hardship, speak with your insurer about a possible grace period pending sufficient cash flow. Depending on your contract, a policy may be suspended after 14 days of non-payment and outright cancelled after 30 days. Some policies recommence once you catch up with your payments.

Do I Still Have a Claim If My Health Insurance Paid My Medical Bills?

When an insurance claim settlement is reached, injury-related medical expenses will be covered. This includes both upcoming expenses as well as any hospital bills you have already handled. In the event that you have already used your medical insurance to cover some of your injury-related expenses, your medical insurer might put a lien on a portion of the damages settlement.

While a health-insured injured party can file a claim on the liable party’s insurance to cover medical costs, the victim’s health insurer can file a lien on a portion of the settlement. For example, if your injuries and losses amount to $40,000 and the liable party’s insurer awards you $80,000, your health insurance company could file a lien on the balance of that amount on the grounds that the company, not you, paid for your last round of medical expenses.

Will Insurance Cover Any Part of My Injury?

How, and to what extent, your insurance company covers your injuries depends upon several factors:

1. The Two Types of Damages

Compensation for personal injury falls into two categories: general damages and special damages. General damages refer to the subjective aspects of the post-accident condition, such as physical pain, personal trauma, reduced quality of life, depression, loss of a loved one, disfigurement and other personal consequences of an accident. Special damages refer to the measurable losses that can result from an accident, such as loss of income, loss of employment, medical expenses, property damage, auto repairs and anything else that involves a specific dollar amount.

2. Settlement Money for Pain and Suffering

If the injuries that you sustain in an accident result in pain and suffering, you can get money as part of a settlement to compensate for the discomfort and difficulty that the pain inflicts on your life. The portion of your settlement that covers pain and suffering will depend on the severity of the accident and injuries.

3. Insurance Claims Versus Lawsuits

When you have been injured in an accident and the other party is liable, you could pursue compensation through the court system. However, if you sue that party, your ability to collect on the amount awarded could depend on whether the plaintiff even has sufficient assets. Moreover, a court case could take years to resolve and you would not be guaranteed a favorable ruling. To avoid defense costs and the protracted complications of a lawsuit, the insurer will generally prefer to offer a settlement.

4. How a Settlement Is Reached

In the wake of an injury, there are basically two ways to get compensation for your injuries and losses aside from filing a lawsuit: file an insurance claim with the liable party’s insurer or file a claim on your own policy. In the latter case, your insurance provider could easily seek reimbursement from the insurer of the liable party. Either way, the insurance company that handles the claim will be intent on getting you to agree to a settlement that will release the company as well as the other party from further liability.

5. No Minimum to an Insurance Settlement

Insurance settlements have no minimum or maximum amounts. The amount you receive in a settlement could hinge on numerous factors, such as the extent of your pain and loss, your persistence with the claim — alternately, the persistence of the other party — and the facts surrounding the accident and whether you or the other party was responsible.

6. Rejecting a Settlement Offer

Under no circumstances are you required to accept a settlement offer. If you feel the offer is too low, discuss the matter with your attorney. In most cases, a rejected offer leads to continued negotiations. At this point, the claimant will usually present a counteroffer in the form of a demand letter that tells his/her side of the story. This is where you would go into detail outlining the severity of your damages and state the dollar amount that you would ultimately accept.

7. Collecting a Personal Injury Settlement

When a settlement is reached in a personal injury claim, the insurance company will usually write you a check in the stipulated amount. Once you sign a release on this settlement, the other parties will be absolved of further liabilities.

8. Taxation of Settlement Money

Money issued in a personal injury settlement is not taxable. However, if you have already claimed a tax deduction on the same medical expenses that have now been compensated by your reward, you will need to report this money as “other income.” Also, any portion of your settlement above the amount intended to cover your medical expenses will be taxable.

Where Do I Turn for Insurance Consultation?

Understanding your insurance does not have to be a complicated task. If you can keep good records, fill out the forms reliably and consistently follow up, you will have no problem filing your next claim.

When it comes to auto accidents in Pennsylvania, fatality rates are low but injury figures are relatively high. In 2019, one in 57 drivers was involved in an accident. Of the state’s roughly 12.8 million residents, 80,612 sustained accident-related injuries. As such, the auto insurance claims process is a fact of life for many PA residents.

With assistance from KBG Injury Law, you can successfully navigate your insurance claims and avoid the headache of dealing with insurance companies.

To request a free consultation on your personal injury claim, contact the offices of KBG Injury Law today.

During this challenging time, our attorneys are advocating more than ever. While our physical offices are closed, we are all working remotely to ensure you still get the Results You Deserve. To all of our current clients, you can connect with us the same way you always do via email, phone, fax or text. To all of our prospective clients, the best way to get in touch with us is by using our contact form or by calling (800) 509-1011