IT IS IMPORTANT THAT YOU KNOW HOW YOUR PERSONAL INJURY CASE IS HANDLED BY THE INSURANCE COMPANIES
By reading this page, you will gather valuable information about the role an insurance company plays when you make a claim for personal injuries. There are different duties and responsibilities that an insurance company has depending on the type of insurance coverage.
DISCLAIMER: This page is provided for informational purposes only. Every case is different and you must not substitute this information for competent legal advice. Rather, the information is intended to highlight the benefits of hiring an attorney who can best protect your rights.
Liability insurance provides coverage for the damages that a person may be legally liable to pay to another person as a result of an accident. The insurance company will usually investigate the claim and pay any damages it deems proper. Likewise, the insurance company maintains complete and exclusive control over the handling of the claim. The insurance company will also hire an attorney to defend the responsible party should a lawsuit be filed.
Example: You have a car accident with another vehicle. You claim the accident is the other driver’s fault. The other driver’s insurance company will investigate the claim by reviewing all the pertinent facts, police report, medical records and bills, and photographs. If the insurance company determines that their driver was at fault for the accident, it may choose to offer you a settlement for your losses (car repairs, medical bills, lost wages, pain and suffering, etc.).
It is important to know that liability insurance represents and protects the liable party. The liability insurance purchased by the other driver is just that – it is their insurance and not yours. Likewise, the insurance company only has a duty to protect and defend their insured.
If you are unable to settle your claim with the insurance company, then you would have to file a lawsuit against the other driver. The law does not permit you to sue the insurance company directly. If you choose to file a lawsuit, then the other driver’s insurance company will hire a lawyer to defend the other driver against your claim.
To add insult to injury, should the case proceed to a trial, you would not be allowed to mention to the jury that the other driver has liability insurance, nor can you tell the jury anything about your prior dealings with the insurance company. In effect, the company you believed should be helping you is, in fact, protecting the other driver.
This is how liability insurance works: It protects the other party for his/her liability. THE INSURANCE COMPANIES HAVE EXPERIENCED PEOPLE WORKING FOR THEM – AND YOU SHOULD TOO!!!
Most claims, however, are settled without the need for a lawsuit or a trial. But understand that any settlement with the insurance company is for the benefit of the liable driver in obtaining a full and final release of your claims.
UNINSURED and UNDER-INSURED MOTORIST COVERAGE
1. UNINSURED MOTORIST COVERAGE.
Unfortunately, not everyone carries liability insurance as they are legally required to do. If you have the misfortune of having an accident with someone who is uninsured, then your uninsured motorist coverage will cover the damages that the uninsured driver would be legally liable for. Your insurance company will investigate the claim and make a determination of whether the uninsured driver is at fault, and how much he/she would be legally liable to pay for your losses.
2. UNDER-INSURED MOTORIST COVERAGE.
With this type of coverage, the other driver has liability insurance, but the insurance is insufficient to cover all the damages you sustained. Now, you can file a claim with your insurance for the damages in excess of what the other driver’s liability insurance was unable to cover.
Under each of these circumstances, your insurance company now takes on the role of the other person’s insurance company. The difference, however, is that you are now the protected party since this is coverage that you purchased for your own protection.
3. PERSONAL INJURY PROTECTION (PIP)
Personal Injury Protection (“PIP”) is insurance you purchase to cover medical expenses and lost wages you incur as a result of an accident. The benefit is that this coverage is payable to you regardless of fault in the accident.
Another added benefit is that PIP is recoverable regardless of anything you may collect from the other person’s liability insurance. Furthermore, you do not have to reimburse your insurance for PIP benefits if you collect from the liability insurance company. The only time your automobile insurance company gets credit for any PIP benefits paid is when your claim is for additional uninsured or under-insured motorist benefits.
4. HEALTH INSURANCE
Health insurance is separate and apart from automobile insurance. If you are injured in an accident, especially if the injuries are severe, it is always beneficial to use your health insurance. This way, you get the medical treatment you need without relying on the other person’s liability insurance.
If you happen to collect a settlement from the liability insurance company, then your health insurance company may have a right of reimbursement for the medical bills it paid. However, their reimbursement right is usually much less than the amount of medical bills actually incurred, and might be further negotiated to an even lesser amount. The net effect is that you are usually better off reimbursing your health insurance company than paying the medical bills directly out of any settlement.