1.Car accidents and Bodily Injury Claims
When you are injured in a car accident and the person at fault is either the driver of the other vehicle or, if you are a passenger, the driver of the car in which you are riding, you may file a bodily injury claim with that driver’s insurance company.
The person who handles your claim is called a claims adjuster, and he or she will want to take a recorded statement from you regarding the facts of the accident, the damage to the vehicles, and in what way you were injured. Please keep in mind that it is the adjuster’s job to have you minimize your car accident claim so the insurance company doesn’t have to pay out a lot of money to settle it. If you have more than a very minor injury, you may want to speak to a lawyer first so you avoid saying or signing the wrong thing and hurting your chances of getting the settlement you deserve to make you “whole” again. Without an attorney, be prepared to answer on your own, questions such as:
• What injuries do you have?
• Did you leave the scene of the accident in an ambulance?
• What medical treatment have you received?
• What medical providers have treated you?
• What was the doctor’s diagnosis?
• Are you still being treated?
• Do you have a history of injury to the same body parts?
• When was the last time prior to the accident that you were treated for pain to these body parts?
• Do you have any residual pain or injuries?
• How much were your medical bills?
Whether you deal with the adjuster on your own, or with the assistance of a car accident lawyer, in addition to the above questions, here is what to expect. You will be asked to supply sufficient documentation to support your claim. This may include a request to sign a medical authorization, allowing the insurance company to obtain your medical records and bills from your treating healthcare providers. You will be asked for proof of lost wages or lost income. If you are self-employed, this may include your income tax records for the previous year or more. Documentation supporting other expenses you may be claiming will be requested, as well, such as receipts for travel to medical appointments, cancelled checks to pay a housekeeper if you couldn’t take care of your home yourself, etc. Then you or your attorney will have to negotiate a settlement.
Note that bodily injury claims may have a dollar limit or strict rules regarding when you can and cannot sue in some states where they have only “no-fault” auto insurance policies. Most states are “fault-based” and if the party you are filing a claim against was partially or totally at fault for the accident, you should get a fair settlement or you are allowed to sue. In a no-fault state, however, you file your injury claim not with the responsible party’s insurance company, but with a special coverage on your own policy called Personal Injury Protection (PIP). You may still sue the responsible party, but only if there were serious injuries or death. Other rules may apply, as well.
2.Car Accidents in a Choice State
If you live in the District of Columbia, or the states of Kentucky, New Jersey, or Pennsylvania, you live in one of the very few areas of the country where drivers actually have a choice of what kind of car insurance they may purchase. In these states and Washington, D.C., you may choose either a “Tort” policy or a “No-Fault” policy for your vehicle. If you have been injured in a car accident, which type of policy the parties have will determine how your bodily injury claim may be handled. (See articles on Bodily Injury and Bodily Injury in a No-Fault State.)
A “Tort” policy follows the same bodily injury insurance claims procedures as in “Fault” states. Regarding a car accident, a tort is a wrongful act that renders the negligent driver liable to the injured party for damages. A tort policy, therefore, is one that provides the insured with coverage if someone is injured and files a car accident claim against the insured’s policy. Unlike no-fault where everyone is covered under their own policy, with a tort or fault-based system, the negligent party’s insurance pays the damages of those who are injured and not responsible for the accident. In general, there are few limitations on suing the responsible party.
If you choose a “No-Fault” policy in one of the Choice States, there is coverage under the policy called Personal Injury Protection, or PIP, just like the “no-fault” only states. If you are injured and someone else is at fault, your medical and some other expenses will be covered by your own PIP coverage up to your policy limits. Just like with the no-fault only states, there are some differences in coverage depending on the state. In Kentucky, for example, basic PIP coverage is $10,000 combined for medical expenses, loss of income or services, and funeral expenses. You forfeit your right to sue the other driver for the cost of your medical treatment, and non-economic damages (e.g. pain and suffering), unless: the injury involves a broken bone, permanent disfigurement, medical expenses over $1,000, permanent injury or death. The law also allows Kentucky auto insurance companies to sell you back the right to sue (even though you carry PIP) for an increase in your premium.
In New Jersey, the no-fault policy may include much higher PIP limits than in many other states, of $250,000 per person, per accident, unless a lower limit is selected for a lesser premium. However, New Jersey’s no-fault policies include up to $250,000 coverage for permanent or significant injury as defined in the policy regardless of the limit selected. This is your own coverage, without suing the negligent party.
Pennsylvania offers both a tort policy and a limited tort policy, rather than “no-fault”. Under the tort policy, you have an unlimited right to sue. Under the limited tort scheme, you can sue for direct expenses, but not for non-economic damages (like "pain and suffering") unless your injuries are very serious. Purchasing a policy under the limited tort system reduces your premium. Due to the complexity of the system, if you are injured by a negligent driver, it would probably be best to consult with an attorney.
Under the no-fault system in Washington, D.C., you can purchase personal injury protection (PIP) coverage for you and your passengers. This policy is any combination of coverages for medical expenses, loss of income, and funeral expenses. You may still be able to sue the negligent party if the injury qualifies under one of the many exceptions to the no-fault rules there. Consult an attorney to learn about what those exceptions are and how they work.
In general, if you are in a choice state, because the laws are still in flux with regard to the no-fault and limited tort policies offered, it is always best to contact an attorney well versed in insurance law and personal injury cases to assist you with your claim.