How To Settle An Insurance Claim Without A Lawyer

Are you pondering how to settle an insurance claim without a lawyer ? If you can’t secure a personal injury attorney, you can handle the insurance claim privately.

Nevertheless, it’s crucial to understand your three options for self-representation in court before proceeding.

Only after determining the best option for your situation should you carefully follow the subsequent steps for settling an insurance claim without legal representation.

If you successfully settle your case, the insurance adjuster will provide you with a Release.

This document “releases” the insurance company and their insured party from any future claims of injuries related to the accident.

In simpler terms, you can’t accept the money, realize your injuries are more severe than initially thought, and then request additional compensation.

Once you sign the Release, the settlement is final.

How To Settle An Insurance Claim Without A Lawyer

How to Settle an Insurance Claim Without a Lawyer:

1: Identify your legal issue and determine the cause of action it falls under.

  • Start by understanding your legal issue and categorize it under the appropriate cause of action.
  • A cause of action arises when there’s evidence of a legally recognized wrong, and all necessary elements of the wrongdoing could potentially be met.
  • Most personal injury cases are based on a “negligence” cause of action.
  • Other causes of action in personal injury claims include loss of consortium and negligent infliction of emotional distress.

 2: Familiarize yourself with the elements of your cause of action.

  • In a negligence cause of action, the following elements must be present:
    1. The defendant owed a duty of care to the plaintiff.
    2. The defendant breached that duty of care to the plaintiff.
    3. The defendant’s breach of duty actually or proximately caused harm.
    4. Damages were incurred.
  • Negligence is the combination of elements (1) and (2), but merely demonstrating negligence doesn’t establish a cause of action.
  • It’s crucial to prove all four elements of negligence beyond a preponderance of the evidence.
  • Notably, negligence claims don’t consider “could have’s” as damages.
  • Only present, actual bodily injuries resulting from the incident qualify as damages for the negligence cause of action.

 3: Gather Insurance Information, Call for a Claim Number, and Draft a Letter

  • Depending on the type of incident (e.g., car accident, slip-and-fall), collect the alleged wrong-doer’s insurance details.
  • After obtaining this information, contact the insurance carrier to report the accident, acquire their claim number, and obtain the adjuster’s contact information.
  • For accidents involving Pennsylvania government entities, report the incident within 6 months.
  • When corresponding with an insurance adjuster, always include your claim number in the subject line.

3.1: For Motor Vehicle Accidents Only…

  • In the case of a motor vehicle accident, also contact your own car insurance to set up your Personal Injury Protection (PIP) benefits.
  • PIP benefits are mandatory for motor vehicle accidents in Pennsylvania and cover the initial $5,000 of your medical bills.
  • Setting up PIP benefits is crucial as they don’t have a lien on any recovery, unlike health insurance.
  • Your PIP adjuster will provide you with a claim number to share with your medical providers.

 4: Properly Address Your Injuries

  • Treat your injuries appropriately, avoiding exaggeration, which is unethical and detectable by physicians.
  • Injured individuals often endure significant pain but refrain from complaining or seeking proper treatment.
  • Failure to treat injuries adequately can be detrimental during trial when inconsistencies between medical records and daily routines emerge.
  • Follow your doctor’s recommendations for treatment and consult with them about your progress.
  • If still in significant pain, discuss alternative treatment options such as injections or surgery.

 5: Ensure Doctors Establish a Link between Your Injury and the Incident

  • For soft tissue injuries, seek treatment at a rehabilitation center.
  • These centers maintain comprehensive medical records crucial for your case.
  • Physicians at these centers provide thorough care and issue narrative reports.
  • These reports summarize your treatment, confirm diagnoses, and establish if injuries are “causally related to the incident within a reasonable degree of medical certainty,” a critical legal requirement.

 6: Collect Medical Records and Bills

  • After completing your treatment, request medical records from your providers, even if it involves outsourcing.
  • Gather all outstanding medical bills.
  • Know your outstanding bills, as you’ll be responsible for reimbursing your health insurance if you win your case.
  • PIP benefits don’t require reimbursement.
  • If in a motor vehicle accident, contact your PIP adjuster for a PIP Log to track payments.
  • If PIP benefits are exhausted, inform your health insurance about the personal injury claim.

 7: Determine the Value of Your Case

  • Case value depends on treatment duration, treatment invasiveness, treatment consistency, work loss, disfigurement, and prior injuries.
  • Soft tissue injuries treated through physical therapy typically yield $1,500 to $2,000 per month for pain and suffering.

 8: Draft and Send a Demand Package

  • Once you have all medical records and know outstanding bills, compose a “demand letter” to the defense insurance adjuster.
  • In the letter, professionally detail the accident, specify the insured’s negligence, summarize your treatment, list your diagnoses, and enclose medical records and bills.
  • Include proof of other expenses related to the incident and any work loss if applicable.
  • If in a motor vehicle accident, demonstrate that you are Full Tort, allowing you to sue for pain and suffering, even for minor injuries.

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