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You Can Do It: Handling Your Own Claim

by Joseph Matthews
Copyright © 1992 Nolo Press

Despite what the insurance industry and lawyers would like you to think, settling an injury claim with an insurance company is usually quite simple. Most claims involve no more than a few short letters and phone calls with an insurance adjuster who has no legal training. You don't need to know technical language or complex legal rules. Your right to be compensated usually depends on nothing more than common sense ideas of who was careful and who wasn't.

You can often best handle a claim yourself. You know better than anyone else--insurance adjuster or attorney--how an accident happened. You were there, they weren't. And you know what injuries you suffered and what your physical condition and other circumstances have been since.

The amount of fair compensation in any given case does not come out of a crystal ball that only lawyers and insurance companies know how to read. Rather, a number of simple factors--type of accident, injuries, medical costs--go into figuring how much any claim is "worth." The amount an insurance company will be willing to pay usually falls into a fairly narrow range, whether or not a lawyer handles your claim for you.

Except in serious or complicated cases, a lawyer can usually gain for you only an extra 10% to 25%, if anything, above what you can obtain for yourself once you understand the process. But the lawyer will also take 33% to 40% of your recovery as a fee--and in addition charge you for "costs" that seem to appear out of thin air and can quickly run into hundreds of dollars. Subtract the lawyer's fees and costs from the extra amount of the settlement a lawyer might get, and you'll see how you can actually do better on your own.

When you might need a lawyer

Sometimes, the skills of an experienced personal injury lawyer--or at least the threat to an insurance company that such a lawyer may present--are worth the money you must pay that lawyer to represent you. You may need a lawyer because of complex legal rules involved in your claim, or because your injuries are quite serious and so the potential amount of your compensation might vary greatly, or simply because an insurance company refuses to settle the matter with you in good faith.

There are no hard and fast rules about whether or not you need to hire a lawyer. Much of the decision has to do with how you feel things are going as you attempt to settle your claim on your own. At some point, you may feel overwhelmed--too much work, some obscure legal rule the insurance company throws at you. Or you may be stonewalled by an insurance adjuster who blusters that the company does not have to honor your claim at all or who offers you only a piddling amount to settle it. In these situations, you may at least want to consult an attorney for advice, and perhaps have him or her take over handling the claim.

A few types of injuries and accidents almost certainly require that you consult a lawyer.

Long-Term or Permanently Disabling Injuries

Some accidents result in injuries that significantly affect your physical capabilities or appearance for a long time--over six months--or even permanently. Figuring out how much such a serious injury is worth sometimes can be a difficult business and may require some assistance from an experienced lawyer to get the most out of the claim.

Severe Injuries

The amount of your accident compensation is mostly determined by how severe your injuries were. And the severity of your injuries is measured by the amount of your medical bills, the type of your injury and the length of time it takes for you to recover. Once the amount of your potential compensation gets high, it may be worth the expense to have a lawyer handle your claim and make sure you receive compensation at the highest end of the range.

Medical Malpractice

If you have suffered an injury or illness due to careless, unprofessional or incompetent treatment at the hands of a doctor, nurse, hospital, clinic, laboratory or other medical provider, both the medical questions and the legal rules involved are complex. They almost certainly require that you hire a lawyer experienced in medical malpractice cases.

Toxic Exposure

In the increasingly chemical world, we sometimes become ill because of exposure to chemicals in the air, soil or water, in products or in food. Claims based on such exposure are difficult to prove, however, and often require complex scientific data. And because the chemical and other industries have erected a huge wall to protect themselves from legal exposure while they continue to expose us to potentially harmful chemicals, the required evidence is very hard to come by. Get expert help.

When an Insurance Company Refuses to Pay

In some instances, regardless of the nature of your injury or the amount of your medical bills and lost income, you will want to hire a lawyer because an insurance company or government agency simply refuses to make any fair settlement offer at all. In these cases, something--what the lawyer can get minus the fee charged to get it--is better than nothing.

Side Bar--What Kinds of Claims Can You Handle Yourself?

  • Automobile, cycle or pedestrian accidents.
  • Slip or trip and fall accidents.
  • Home accidents.
  • Accidents with defective products.

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The selected articles originally appeared in the Nolo News and are Copyright © Nolo Press 1996 and reproduced here with permission. If you find them of value, we encourage you to visit Nolo Press at their web site http://www.nolo.com. If you wish to post them on-line or otherwise distribute them, first read Nolo's copyright policy.

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