How Does the Insurance Claims Process Work?

In many accident situations, people who suffer injuries and those with property damage must file an insurance claim to receive compensation for their losses. While individual insurance company claims processes may vary slightly, the general process works the same. We’ve compiled a basic guide to how the claims process works after an accident.

Purchasing an Insurance Policy

To secure compensation from insurance, you or another party needs to own a valid policy. In states such as West Virginia, all drivers must carry a minimum amount of liability and uninsured motorist coverage. For other types of accidents, you may need to file a claim against a homeowner’s insurance policy, a business liability policy, or another form of insurance. If the party liable for the incident does not carry insurance or does not carry enough insurance, the injured individual(s) may choose to take legal action.

Steps in the Insurance Claims Process

After an accident, always exchange insurance information with those involved. In the days after the incident, the claims process often involves the following steps:

  1. To protect the right to file a claim, those involved in an accident must first notify an insurance company of the incident. During the claims process you may file:
    1. Third party claims. If someone else was responsible for property damage or injury, contact the party’s insurance company to begin the claims process.
    2. First party claims. Always contact your own insurer to let them know of the incident, even if you don’t believe you were at fault. Without reasonable notification, an insurance company can deny your request.
      In many cases, accident claimants contact their own insurance providers and their insurance provider will contact a third party provider if someone else was responsible. To file the claim, you may need to provide preliminary information about the incident, including the location, the time, and what happened. Avoid speculation during the initial process.
  2. After you file the initial claim, an insurance adjuster will take over the process. He or she will investigate your claim and make a determination about liability, the extent of your injuries, and your eligibility for benefits under the terms of the policy.

    A claims adjuster may require:
  • Police reports and accident reports
  • Witness accounts
  • Photographic evidence
  • An independent medical evaluation
  • Property damage evidence
  • Medical bills and records

    Do not agree to an initial settlement offer; do not lie to an insurance representative; and do not sign any medical authorizations. Provide only the information that the adjuster requires to make a decision.

  1. After the claims adjuster approves your claim and makes a settlement offer, take some time to consider the amount. You may want to partner with a West Virginia personal injury lawyer to determine the true value of your claim and negotiate for fair compensation. If you do not partner with an attorney, make sure the settlement covers your full medical needs now and into the future.
  2. Denials and Appeals. An insurance adjuster may deny your claim. If you receive a denial notice, you can file an appeal. Look at the terms of the policy to determine the company’s appeal process. If you did not involve an attorney prior to the appeals process, consider doing so. An attorney can help you build a stronger case and/or hold bad faith insurers liable for unethical practices.

Your Rights During the Claims Process

Throughout the claims process, you have the right to fully understand your policy and the benefits under your policy. If you file a claim against a liable third party, you may also have the right to understand the insured’s liability coverage. Companies that fail to respond adequately to policy limit requests may face bad faith claims.

If you have any questions about the process or your case, consider reaching out to an attorney at Tiano O’Dell, PLLC for a free case evaluation. Insurers often play games to reduce their total payouts, and our personal injury attorneys work through these types of claims on a regular basis. Our insights may help you secure full and fair compensation.