What is involved in the claims process?

The claims process can be quite confusing to one who has never been involved in a claim. The person who is injured likely has never had to deal with anything quite like this, and needs help. The insurance company for the party at blame often tries to offer a friendly face and answer questions, but the injured person should treat them like a rattlesnake. The other side’s insurance adjuster has his company’s interest at heart, and owes the injured victim no duty. Most people never realize this until it is too late, and are offered little or no money on meritorious claims. Most of the time they are completely lied to, and almost always are mislead.

Here is what is usually involved when a lawyer handles the file. A notice of claim letter is sent to the insurance adjuster and to those responsible for causing the injuries. At the same time, the lawyer gathers evidence to prove the case, both for liability and damages. To prove liability, the lawyer gathers evidence such as witness statements, photographs, police reports, government records, background information concerning the potential defendants, industry records, accident history, criminal histories, and other records. A Private Investigator helps with the investigation, especially with locating witnesses, and obtaining their recorded statements. The quicker the investigator can locate and take the statements, the better, because the insurance company sends a team of its own out into the field with the goal of influencing witnesses, and trying to persuade them to give partial or misleading statements, usually out of context. Again, the goal of the insurance company is to lower the value of the claim, and this almost always involves some degree of deception. If the insurance company can persuade one witness to slant the story, it may win the case for them. Therefore, the injured person’s investigator needs to get involved quickly in order to record and lock in a witnesses story so that the truth is preserved. A good lawyer will only use investigators who preserve the truth, and who will not try to deceive or mislead. That is because a good lawyer’s goal is to show he and his team are truthful and credible, unlike the opposing side. Juries side with the side that is most credible in my experience.

Next, the lawyer gathers information that shows the client (s)’ losses. This includes all medical and wage records to show the economic losses. Further, photographs and videos are gathered to show happy times when the client was not suffering from the injuries; then photographs and videos are used to document how the incident has harmed the client in everyday life and activities.

Experts are hired to help. This may include accident reconstructionists, engineers, and medical experts. Materials are forwarded to them to review. The expert shares and educates the lawyer about the strengths and weaknesses of the case. Reports are written.

Most larger claims require the filling of suit. Why? Because most insurance carriers want to get their lawyers involved to investigate and document the claim, and to shoot holes in the claim. They hire the best “hired guns” in the industry paying them several hundred thousand dollars or more. Many times they have paid lawyers on the other side of my law suits far in excess of a million dollars to defend the claims, especially when they know they are likely to lose a lot of money in court.

Once suit is filed, subpoenas and written questions are sent to the defense lawyers who have been hired by the insurance companies (or large corporations). They send out their own subpoenas and written questions to the victim’s lawyer. All of these questions and subpoenas are reviewed with the client, and truthful answers are obtained for relevant inquiries. Objections are lodged for the many irrelevant items sought. The Court must rule on the objections. Similarly, the court must hear motions that the victim’s lawyer files seeking to force the Defendant’s lawyers to produce the most basic information such as accident reports, statements and photographs. Most of the time, the insurance company is caught trying to hide the documents that hurt its case. (an oversight is what they claim).

Then depositions are taken. These are out of court statements taken with all lawyers involved in the case present. All lawyers ask questions, and the testimony can be used in court for many purposes, including impeaching witnesses who tell different versions of the truth.

The victim’s lawyer will meet to discuss what to expect with his client prior to deposition so the client is not mislead by the opposing lawyer’s questions, which are often deceptive. (keep in mind, the opposing lawyer is paid by the insurance company, and their goal is to do whatever is necessary to win, and not to learn the truth).

At some point, a case is mediated, and efforts are made to settle the case if possible. If it cannot be settled, the case is set for a jury trial. At trial, the client must appear. The jury will then decide the case, and a Judge will enter a judgment based on what the jury decides. Hopefully, the case is won. Whether it won, or lost, either side has a chance to appeal the case. The appellate court can uphold the verdict, reverse it, or send it back to the trial court for a new trial.

If the insurance company has lost, and has forced a client to go through the entire process above, it must pay the Judgment. (if the case has been won and upheld). Fewer than 5 % of cases go through the entire process outlined above. About 80% of cases are settled at some point along the way.

The better the lawyer, the better the chance of a meaningful settlement. Of all things involved in the claims process, the lawyer is by far the client’s best hope for a successful outcome. A bad lawyer guarantees a bad result, even with a good claim. A good lawyer gives the accident victim an excellent chance of a good outcome, if the claim is meritorious.


More General Personal Injury FAQ

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