Filing an Insurance Claim: What You Need to Know

It can be a stressful and chaotic time in your life if you ever find yourself injured in the wake of an accident. If you, or even worse, someone you love, is sidelined because of a long recovery period, this can have some serious repercussions for your life. Lengthy absences from school or work can jeopardize your ability to pay important bills, and long hospital stays can leave you with even bigger medical bills — even if you have medical coverage.

There are ways to help cope with such tumultuous times. If you were involved in an accident that wasn’t your fault, you can often make a claim against the party responsible for the conditions that contributed to your pain and suffering. This is usually the case whether you were injured a car accident, at the supermarket, or any other location or instance where you weren’t responsible for what happened to you. In fact, here’s what you need to know about filing an insurance claim in the wake of an injury.

Be Smart When it Comes to Your Claim

By design, insurance companies don’t want to pay out on any claim you may make. This is because they are for-profit businesses, and the best way to make money as an insurer is to take in as much money as possible from their customers and pay out as little as possible in compensation claims. As a result, you’ve got to take steps to outsmart insurance companies. Here are some excellent tips to accomplish this:

• Read Every Policy With Care: Whether you’re claiming against your insurance provider or you’re making a claim against someone else’s, make sure you get a copy of the relevant policy and go over it with a fine-toothed comb. Make sure you understand what the policy says — and what it doesn’t. Make use of a personal injury attorney if you need. This way you can discover what the policy covers and what it might not.
• Read the Consumer Bill of Rights. You’ve got rights as a consumer, and they’re enshrined in a document, known appropriately enough, as the Consumer Bill of Rights. Most insurers are required to include a copy of this with a policy, though you can also find the information in this Bill of Rights directly on the internet.
• Make — and Keep — Meticulous Notes: If you interact with an insurance company in any way, be sure to document the encounter. Keep track of dates and times, who you spoke with, their title, and what you spoke about. Ensure you have backup copies of all documents you might have submitted to these insurers to provide a strong paper trail in case there are any disputes. And, knowing insurers, there will be disputes.
• Always Follow Up: Whenever you do have an interaction with an insurance company over the phone, be sure to send an email or a letter as a follow-up. This extends that paper trail. Sending letters through Certified Mail might cost a few extra pennies, but creates even more paperwork to showcase your efforts.
• Ask for Specifics: If an insurer is settling your claim, ask it to point out the specific language in the policy that it’s basing its decision on. These policies are often open to interpretation, and an insurer will almost always decide to use a more conservative one when it comes to paying out on a legitimate claim.

Claims for Property Damage

Sometimes you get lucky — you end up in an accident where you or one of your loved ones isn’t hurt or injured. Yet even in these situations, there could be some serious property damage that needs to be rectified, and in instances such as this, you’ve got some unique challenges to overcome. Regardless, if you’ve had a vehicle that’s been totaled, or if you’ve suffered damage to other types of property such as your home or the items in it, you’re entitled to be compensated for any financial losses. In cases like these, keep the following in mind:

• Keep Your Receipts: If you pay out of pocket for any repairs done to your property, be sure to keep every receipt. In some cases, insurance policies that cover homes and vehicles sometimes require “reasonable temporary repairs” to be undertaken to prevent any further damage. These cost of these repairs is almost always covered. Be sure to document the extent of any damage thoroughly before repairing by taking plenty of pictures or even video.
• Hold Off on Permanent Repairs: If you make a claim, it’s a fair chance that the insurer will send a claims adjuster to survey the damage. This means you’ll have to hold off on permanent repairs until after the adjuster has had a chance to take a closer look. If possible or practical, try to be present when this occurs, as this provides you with opportunities to answer questions the adjuster has about the incident that led to the damage.
• Request a Full Explanation: If your adjuster offers to settle your claim, be sure to ask for a detailed explanation as to how the insurer came to their decision. For damage to a home, your offer should include a full list of everything that was damaged within the home, along with its depreciation and the value cost of a replacement. Ask your adjuster for their rationale for reaching these figures.
• Never Be Afraid to Negotiate: If it turns out you’re going to be out-of-pocket even after a settlement offer, bring your concerns to the claims adjuster. Provide documentation such as sales receipts that support a higher replacement cost. Make copies of these documents and present them to the adjuster as proof. Additionally, if contract work needs to be undertaken to repair your home or vehicle, have the contractor or mechanic discuss the issues directly with the adjuster as well.
• Replacement Receipts are Even More Important: When you replace items, keep your receipts for the adjuster as well. If the insurer paying the claim has replacement cost coverage, you’ll be required to demonstrate that you’ve spent your own money to replace the items before the insurer will reimburse you for your purchases.

Claims for Physical Injury

Often some of the most harrowing experiences, claims for personal injury can be the ones most fraught with fear and anxiety. In these cases, you often require the most help — especially if you’ve suffered greatly from the injury. It’s always recommended to seek aid from a qualified personal injury attorney in this case, as they can help you through the process and fight for your rights. There are other things to keep in mind as well, such as:

• Rely on Your Doctor: Make sure you have your doctor to provide the insurer with the details of your injury. This includes the extent of how hurt you are, what types of treatment you’ll need to undergo, and what your expected outcome is.
• Get Treatment Denials Reviewed: If an insurer denies you a treatment on the grounds of it not being “medically necessary”, you may be entitled to have an independent review organization take a look at this denial. Texas law sometimes requires insurers to participate in independent reviews, though many insurance companies voluntarily participate as well. For additional information, you can learn more from the Texas Department of Insurance.
• Think of Mediation: If your own insurance would normally cover your treatment but have received treatment through an out-of-network provider, turning to mediation might be an option to resolve your medical costs. Choosing mediation can help resolve issues without having to rely on settling the dispute in a court of law, which can be a long, drawn-out process that can put an even further strain on your health and your finances.