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Settling a Personal Injury Claim with an Insurance Company

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Settling a Personal Injury Claim with an Insurance Company

Most personal injury claims never reach a jury. Instead, the insurance company and the at-fault party usually settle the case. This helps them with the unpredictability of jury verdicts.

A settlement means the insurer and the at-fault party agree to pay you compensation. In exchange, you release your legal claims against them. You dismiss any lawsuits you have filed, and everyone moves forward.

Here are the steps involved in settling a personal injury claim with an insurance company and the benefits of settlement over litigation.

Personal Injury Claims in Florida

Personal injury claims come from tort law. In tort law, if someone injures you through negligence or other misconduct, they must pay compensation to cover damages related to the injury. This core concept of tort law applies whether you get injured due to a defective product, an intentional assault, or a car accident.

The facts you need to prove to win your case depend on the nature of your claim. A claim against a doctor for medical malpractice requires you to prove different elements than a claim against a medical device manufacturer for a defective implant.

If you win your case, the at-fault party is liable to you for your damages. This means the liable party must pay compensation to cover all of your losses, including those without a price tag, like physical pain and mental anguish.

The Role of the Insurance Company

A liability insurance policy is a contract between the insurer and the policyholder. Under this contract, the insurer agrees to pay for liabilities within the policy that fall on the policyholder.

Suppose that a doctor has a medical malpractice policy. If the doctor commits a medical error and injures you, the doctor becomes liable for your losses. The medical malpractice insurer must pay you for the doctor’s liability up to the policy limits.

So if the doctor’s error costs you $100,000 and the policy covers $750,000 in liability, the insurer must pay you $100,000. But if the doctor’s error costs you $1 million, the insurer only needs to pay $750,000 to you, and the doctor becomes personally liable for the remaining $250,000.

Insurance Adjustment of Personal Injury Claims

Since the insurer must pay claims against their policyholders, the insurer usually takes a central role in personal injury cases

You usually begin your case by submitting an insurance claim to the at-fault party’s insurer with evidence supporting your claim. The insurer assigns the claim to an adjuster. The adjuster must investigate the claim and determine whether the claim falls within the scope of the insurance policy. 

Some of the steps the adjuster might take include:

  • Review evidence relating to your accident, such as witness statements and police reports
  • Read your medical records
  • Interview the policyholder

The adjuster may also ask to speak to you. Generally speaking, you should decline to speak with the adjuster unless your lawyer sits in on the call. Claim adjusters can use anything you say to deny or reduce your claim.

The adjuster uses this information to form a picture of what happened and more importantly, the policyholder’s potential liability for your injuries. Based on this analysis, the adjuster then determines the insurer’s exposure.

Negotiating a Settlement of Your Claim

If your evidence shows that the policyholder bears liability for your injuries, the insurer will try to settle the claim. Florida law requires insurers to make a good-faith effort to investigate and settle claims where the injured person has proven liability.

The first offer from the insurer will probably be low. In some cases, the insurer offers a settlement that does not even cover your documented expenses. For example, if you had $30,000 in medical bills for your injury, an insurer might offer $16,000 to settle the claim.

Under Florida law, the insurer must provide an explanation for its settlement offer. The explanation will include the reasons why the insurer denied or reduced your claim. 

The insurer might give reasons for a low offer, such as:

  • You were partly to blame for your injuries
  • You failed to document your losses
  • Your medical treatment was unnecessary
  • Your injuries preexisted the accident

Since the offer will likely undervalue your case, you and your lawyer will send a counteroffer to the insurer and try to get more. This counteroffer will usually include additional documents and arguments to overcome the adjuster’s grounds.

Filing a Lawsuit

You can negotiate endlessly with the adjuster, but at some point, you may need to nudge the adjuster to increase the settlement offer. One option you can explore with your injury lawyer is filing a lawsuit against the at-fault party.

Since the insurer has a legal obligation to pay the at-fault party’s liabilities, the insurer will participate in the lawsuit. The lawyer will continue to negotiate with the insurer to settle your claim.

Even when you file a lawsuit, your case will probably not go to a jury. Lawsuits cost money, and insurers do not like spending money on litigation if they cannot win. But lawsuits do give you several ways to pressure the insurer.

Your lawyer can use the discovery process for interviewing the at-fault party and any witnesses of your accident. Your lawyer can also get access to documents possessed by the at-fault party. For example, if you were injured by a defective product, you might find out about other people injured by the same product or internal memos discussing the dangers of the product.

A lawsuit also raises the possibility that a sympathetic jury could give you a large jury award. Juries rarely sympathize with insurance companies, and the insurer might prefer to settle with you instead of sending the case to a jury.

Contact a Miami Personal Injury Lawyer for Help Settling Your Claim

Settling a case will require negotiation and compromise. Before you start your case, you and your lawyer will analyze the value of your claim. This will tell you when you have received a fair offer. To discuss the settlement you can seek for your injury claim, contact Shaked Law Personal Injury Lawyer for a free consultation. Call us at (305) 937-0191.