Third-party claims involve three different parties that become connected through an accident or incident. The trio is usually an insured individual, insurance company, and another individual. This means that a third-party claim is made by someone who isn’t the owner of a policy in the insurance company. Liability claims are the most common forms of third-party claims where it’s necessary to prove that the other party was at fault and caused you harm. Most of these claims involve accidents in workplaces or on the road. While the circumstances leading to the accident are always different there are a few standard steps that must be taken in order to ensure that you’re getting what you deserve. Sometimes when the fault isn’t clearly known, a first-party and third-party claims are needed. Here is a summary regarding the course of third-party claims and their importance.
Contacting the Insurance Company
Reaching out to the insurance company within 24 hours of an accident is vital to any third-party claim, but the question is, which one? Whether it’s a personal injury at work, in an automobile accident, or at any building, you need to assess whether you were the one at fault or not, after receiving medical attention. If you’re not at fault, then you’ll need to contact the insurance company of the individual or establishment with all the required information regarding the accident and the extent of your injuries. The said insurance company would then commence an investigation into your claim to verify and assess the damages. You’ll normally be asked for documentation like photos or videos of the scene, names of witnesses, or more specific information about the accident. Usually, the insurance company would require you to submit an independent medical examination by a doctor of their choice. If the injuries are sustained from a building accident or an automobile, a thorough inspection of the property is done by the insurance company.
Denial and Appeal
After the investigation is done, the insurance company either calculates the value of your claim or denies it. This is often the troublesome part as sometimes the claim is undervalued or denied entirely even though it is quite legit. The experienced legal team at https://www.stewartlawoffices.net/workers-compensation-lawyer/third-party-claims/ claim that recovery for damages isn’t automatic and you may need to fight for it. If the claim is denied or you find its value lower than you had in mind, you’ll need to appeal to the insurance company. Appeals require extra-detailed accounts of the accident, evidence, and further verification. The reasons for a claim to be denied are sometimes more technical, like not submitting the claim within the specified timeframe or not submitting an independent medical examination of the insurance company. It’s important to know that some insurance companies have different appeal processes and it’s advisable to get familiar with the insurance policy. It’s recommended to consult a seasoned attorney to help you through the denial and appeal process.
Calculating medical and owed wages isn’t very hard as the numbers are easily identified. Most of the difficulty lies in being able to value a traumatic or painful experience in numeric terms. There are some mathematical formulas that insurance companies use to come up with a value for such non-monetary losses. An analyst usually compiles all the medical expenses accrued and multiplies it by a number depending on the severity of the injury. Light or mild injury multiplies the total medical expenses by 1.5 or 2 times to give a value to special or non-monetary damage. The more severe an injury is, the higher the number the total medical expenses are multiplied by; it can even reach 10 in extreme cases. Lost wages are simply added after all the medical and special damage expenses are calculated. A higher settlement can be obtained through negotiating with the insurance company after it provides the value of the settlement.
A lot of people aren’t fully aware that they’re able to pursue their employer for compensation outside the worker’s compensation legal framework since it doesn’t provide complete compensation for lost wages, traumatic experiences, and injuries. You may sometimes need the expertise of an insurance attorney to help you prove that the accident happened due to negligence or reckless behavior from the employer or colleague, whether it’s intentional or not. Work-related negligence claims can be at different work environments like construction sites, industrial venues, or offices.
It’s important to be familiar with third-party claims as knowing the process beforehand would make your claim smoother and less confusing. Some legal offices offer free legal consultation to help you determine the next course of action which is pretty helpful when things start getting a little too complicated.