Working Up a Claim
Working up a claim involves several steps:
- First, we start gathering evidence proving that the other party is responsible for your injuries/damages. For example, we often ask to see your accident report associated with the auto-collision since the investigating officer will often assign fault to the responsible driver. We may need to contact and interview witnesses to the collision while it is still fresh in their minds, including the investigating officer.
- Second, we contact the responsible party and identify the insurance coverages that are available. This can be more complicated than it seems. For example, you may have slipped and fallen at a local restaurant. This restaurant may be a franchise and thus is owned by an independent company that is only identifiable by property tax records (and not by the sign). We will find the maximum amount of insurance coverage available to cover your claim. If your claim involves an automobile collision, we determine whether you have underinsured/uninsured motorist coverage (commonly known as "UM coverage").
- Third, our client must complete his or her medical treatment and reach maximum medical recovery before we can pursue settlement. This is often the most difficult part of any claim. Most injured people are first recommended to pursue conservative treatment, such as physical therapy. When this type of treatment does not get rid of the pain and symptoms, the doctor may recommend injections or more intrusive procedures. Again, if these types of treatments fail, your doctor may ultimately recommend surgery. Generally speaking, a claim that results in surgery is worth more than a claim that does not result in surgery. We, therefore, must wait until your medical treatment is 100% complete before pursuing settlement.
- Fourth, once our client completes all medical treatment, we begin to compile the medical evidence. This means we gather all of your medical records and bills (using your signed HIPAA form). This often means that we will need to speak to your medical providers and get their opinions on how the injury occurred, the treatment of this injury, and what are the long-term effects of such an injury. We also need to contact “before-and-after” witnesses who will tell us how your life has changed since being injured. These include family, friends, and even co-workers.
- Fifth, we then compile and present a demand package to the adverse party and his or her insurer. We then negotiate with a claims adjuster to get to the top offer on the claim. This is the part of working up the claim that requires us to really look at your medical bills. If you have health insurance, we need to determine if this insurance has an enforceable subrogation right against your claim. If you don’t have insurance, we call all of your providers to find out what you potentially owe and again negotiate down the amount owed. We also research and look for med-pay coverage and whether there are any medical liens against your claim.
If we are unable to settle during this time period and if it makes financial sense, we will file suit on your claim at your direction.
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