Personal Injury Insurance

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 What Is a Personal Injury Claim?

A plaintiff in a personal injury lawsuit claims they have suffered a mental, physical, or both injury due to the defendant’s act or inaction. A court may award the plaintiff money damages for personal injury.

A personal injury claim may also lead to criminal charges in some cases. For example, a defendant may face a civil lawsuit for assault and a criminal assault and battery charge.

What Kind of Injury Does a Personal Injury Claim Involve?

Personal injuries damage either the plaintiff’s physical or emotional health. Emotional pain and suffering are two types of mental injuries.

Organs, limbs, and other body parts can be physically injured. A plaintiff’s injury may not manifest itself immediately and may occur over time.

A personal injury claim may arise from a variety of events or accidents, including:

Accidents can occur in a variety of ways. An individual may find it useful to examine accident statistics to be better prepared and prevent accidents before they occur.

What Does Personal Injury Protection Insurance Cover?

In the event of an auto accident, your personal injury protection (PIP) insurance can help you and your injured passengers cover medical expenses. It doesn’t matter who was at fault for the accident.

Even if you don’t drive, you’re covered by this policy. You may be able to get compensation for your injuries if you’re hit by a car while walking.

Medical Expenses
In addition to covering your medical bills and those of your passengers, PIP coverage may even help cover your health insurance deductible.

Work Loss
If you are injured in an accident and are unable to work, your PIP coverage might be able to assist. You can also take advantage of this benefit if you’re self-employed and need to hire temporary workers.

Funeral Expenses
After a car accident, your PIP coverage may help pay for the funeral, burial, or cremation costs.

Survivors’ Loss
Your PIP insurance can replace your lost income if you pass away in an auto accident.

Essential Services
PIP insurance can also cover services you would perform if you weren’t injured, such as childcare and housekeeping.

What Is Not Covered by PIP Insurance?

Personal injury protection insurance won’t cover:

  • Damage to property
  • Injuries to other drivers in a collision
  • Injuries caused by an accident while you were committing a crime, such as fleeing from the police
  • Accidents in which you received payment for driving

Why Would a Lawyer Sue the Victim’s Insurance Company?

Insurance often plays a significant role in personal injury litigation.

An insured pays an insurance premium to protect themselves from liability costs in the event of an accident. In the event of an accident, the insurance company will cover at least a portion of the costs. Most drivers, property owners, and business owners buy insurance to protect themselves from liability. Consequently, an insurance company is often responsible for compensating the injured party.

Insurance companies are motivated by the bottom line to make money, not to compensate injured parties fairly. They are experts at manipulating the law to reduce the amount they have to pay. Insurance companies will not hesitate to pressure injured people into settling their cases prematurely for less than they deserve.

What Is the Typical Process an Insurance Company Uses to Evaluate a Claim?

The process of evaluating a claim may differ from insurance company to insurance company.

The simplest formula involves coverage, liability, and damages:

  1. If the claim is covered, it will be determined by the insurance company: Most insurance companies will first try to find a way out of paying the claim. In most cases, the first step is determining if the accident is covered by insurance. For example, an insurance company that provides automobile insurance may not cover a pedestrian accident.
  2. The insurance company will determine who is responsible for the accident: An insurance company’s view of how much it is obliged to pay will often affect whether it should contact the other injured party about payment. At this point, lawsuits are filed to determine who is responsible for the accident.
  3. The insurance company will determine a dollar amount: Among the factors an insurance company considers when deciding whether to pay the insured are medical expenses, liability, and property damage. As a result, this amount will usually be less than the insured expected since the insurance company will charge the lowest price possible for each injury. For example, an insurance company might only pay $1,000 for a medical bill. If the insured signs the agreement for $1,000, but the medical bill turns out to be $5,000, then the insured is expected and legally obligated to pay the remaining $4,000.

How Would an Insurance Company Behave if Faced With a Lawsuit?

An insurance company’s primary goal at the time of litigation is to reduce the amount it must pay to the injured party. By shifting the responsibility back onto the injured party or a third party, an insurance company tries to minimize the insured’s liability. Also, insurance companies may attempt to settle a case for significantly less than it might be worth if it went to trial.

Should I Use My Insurance Company’s Lawyers If the Other Party Is Suing Me?

You can make this decision based on your own preferences. Be aware, however, that any lawyers from the insurance company will be working for them and not for you. As many states, like Texas, forbid parties from suing the other party’s insurance company, the other party has no choice but to sue the other person involved in the accident.

Insurance companies in these states protect their clients as part of the policy agreement. Insurance lawyers often leave the actual parties responsible for paying any fees that exceed the policy limit. The fees could easily exceed the policy limit depending on how severe the accident is. Therefore, it would be prudent to use your own lawyers rather than those provided by the insurance company.

What to Watch for When Making PIP Claims

Often, insurance companies are criticized for being much better at selling insurance policies and collecting premiums than paying claims. If your claim grows larger, you may face these reasons for not paying PIP benefits:

  • Your doctor’s fees are too high: They are not “ordinary and customary.”
  • You are receiving too much treatment: It is not “reasonable and necessary.”

Your insurance company may ask you to be examined by a doctor of their choice at some point. An Independent Medical Examination is usually an attempt by your insurer to get a medical justification for limiting or terminating your benefits.

What Should I Do If the Insurance Company Calls or Contacts Me?

Don’t give the insurance company any details about your accident or your injuries, don’t sign anything, and avoid the urge to settle quickly – you may not know what your claim is worth yet. Later in the process, you or your lawyer may need to provide more specific information about the accident. In the initial contact with an insurance company, you should only provide basic information such as your name and address.

Do I Need a Lawyer?

Insurance companies work for themselves, not for the people they insure, despite the charming advertisements on television. The insurance industry has an army of attorneys dedicated to finding contract loopholes. A personal injury attorney will protect your rights and ensure you get the maximum amount your policy is worth.

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