Insurance Claim

The first place to start in examining how a claim works is to define the different players. When you are involved in a Charlotte car wreck and file a claim against the other person’s insurance you are called the claimant. The other person’s insurance is referred to as the liability carrier. The claim itself is referred to as the third party claim (commonly referred to as a personal injury claim). Your own insurance is referred to first party insurance. You can also interact with your own insurance via your uninsured motorist coverage (UM) or underinsured motorist coverage (UIM).

When a claim is reported to the liability carrier the first thing they will do is research coverage. If the policy was not active at the time of the accident they will not pay out on the claim. Many clients are surprised when this is brought up at the inital consultation considering the insurance information is listed in the standard North Carolina police report. The insurance information listed is tied to the license plate of the vehicle involved in the wreck. That information is stored by the NC DMV. When the police officer pulls up the DMV information on their computer it automatically populates with the insurance information. However, there is no way to ensure that the DMV’s information is up-to-date or correct. The only way to determine coverage is to speak with the carrier.

Insurance companies’ profits are determined by the amount of premiums they take in minus claims. As such, there is a large financial incentive to not paying out claims. A common way to disclaim coverage is to argue non-permissive use. Basically, this means that the owner of the vehicle did not give permission to the driver to use the vehicle, and as such, coverage should be denied. This is an affirmative defense which means the insurance company has the burden to prove this argument. Typically, our personal injury lawyers can defeat this argument especially if the owner of the vehicle did not report the vehicle stolen prior to the accident.

If coverage is active the carrier will next look to avoid paying based on liability. Liability deals with the negligence of their insured. The carrier will typically want to review the police report and speak with their insured before making a decision on liability. For more complex cases or those involving significant injury a liability determination can take a significant amount of time. For some cases the insurance company may bring in an engineer to reconstruct the accident to determine the negligence of their insured. If the carrier believes their insured is not negligent or that the plaintiff will have a hard time proving negligence they will deny the claim.

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One of the most common misunderstandings about insurance deals with the question of negligence. In North Carolina you do not sue an insurance company directly, you sue their insured. For example, let's assume you are involved in a Charlotte Car accident with a person named Bob. Let’s also assume that Bob is insured by Allstate Insurance and Allstate denies the claim. Many clients want to sue Allstate, however, in North Carolina you have to file suit against Bob, not Allstate. As such, you will have to convince a jury that Bob was negligent. Further, you are unable to introduce any evidence of liability insurance (Allstate) to the jury.

If the carrier believes there is enough evidence to prove negligence against their insured they will next look to any allegation of contributory negligence against the claimant. In North Carolina contributory negligence can serve as a complete bar to recovery. Many adjusters like to quote the 1% rule – “if the claimant is just 1% negligent they can’t recover anything.” This is a misstatement and misunderstanding of the law. However, if the carrier believes there is contributory negligence they will deny the claim. If they believe there is not enough evidence of contributory negligence the claim will be accepted.

While all this is going on the most important thing for the claimant to consider is their health. Failing to make their health a priority can have disastrous consequences both for their long term health as well as their claim. Our personal injury attorneys do not submit demands to the insurance company until our clients have finished treating. There are two reasons for this. First, there is no way to fully know the extent of your injuries until you have completed all of your treatment. Failure to know the full extent of your injuries may result in settling your claim for less than full value. Second, once a case is settled in North Carolina it can not be reopened. This is why we tell our clients to take their time regarding their treatment. The insurance carrier does not have the right to direct your treatment. Any attempt by the carrier to direct your treatment is a statutory violation and should be reported immediately.

Once the client has finished their treatment a demand package is created and forwarded to the liability carrier. The package includes all claims, allegations, medical history and monetary demand for settlement. The carrier upon receipt of the package will review the same and make an offer. One of the most important aspects of an experienced personal injury attorney is explaining to their clients how insurance companies determine the value of claims. Many times, the aspects of your case that you consider the least significant can have the most influence on the value of your case.

UIM Coverage - Underinsured Motorist Insurance

On a weekly basis one of our Charlotte personal attorneys speaks with an individual who was in a car accident with someone with a minimum limit policy. The minimum required limit of liability coverage in North Carolina is $30,000.00. In minor car accidents this may not be an issue. However, in accidents involving significant injuries $30,000.00 is not sufficient. All too often individuals try to save money on their insurance by not getting underinsured insurance coverage (UIM) coverage. Accidents can happen at any time. UIM coverage is protecting you from other drivers who may have minimum coverage.

We counsel all of our clients to examine their automobile insurance policy, specifically UIM. UIM coverage applies when your injuries exceed the liability policy of the at fault parties insurance. North Carolina follows the set off rule, which gives the UIM a credit for any money paid by the liability carrier. For example, consider an individual with a $100,000.00 UIM policy and a case worth $130,000.00. If the liability carrier pays $30,000.00 the UIM carrier only has to pay $70,000.00. This differs from SC where in the same situation the UIM carrier would have to pay the entire $100,000.00.

Getting your insurance company to pay UIM is another issue. The relationship with your insurance company when you try to get your UIM becomes adversarial. Further, there are statutory requirements which must be followed or you void your coverage. This is why our attorneys suggest that our clients don’t speak with any insurance company, including theirs, following an accident. The other advantage of UIM coverage is the ability to arbitrate against your own carrier. When you are dealing with liability insurance your only option, if you can not settle your case, is filing a lawsuit and having a jury trial. However, when going against your own carrier you can arbitrate your case. Arbitration is a more informal process which takes place in the plaintiff’s office. Arbitration is heard by a panel of three arbitrators, one of whom is selected by the plaintiffs attorney. The decision is binding on both parties. While every case is different, arbitration is typically faster and more efficient that third party litigation.

Insurance companies typically want to avoid arbitration if possible. This can be used as leverage during negotiations. Because of this carriers look to disclaim coverage if possible. Carriers need to confirm to NC Rate Bureau policies. If their policy fails to conform it is void and reverts to the standard policy. Policies must also contain the language found in NCGS section 20. If it fails to conform it is void and the statutory language is written in.

UM Coverage - Uninsured Motorist Insurance

After being involved in a car wreck many people turn to their own insurance for help. While this is reasonable considering all of the overly heartwarming commercials on TV, it is also a mistake. This article will examine the interaction between the injured party and their own insurance.

It is easiest to start this explanation by redefining the relationship between you and your insurance company. Insurance is nothing more than a contract. You pay company X money each month to perform certain services upon demand, i.e. a claim. However, the relationship can become adversarial quickly considering that company X’s profits go down upon paying out on a claim.

Assuming a claim has been denied by the liability carrier for lack of coverage the only way to get compensation for your injuries is through your own uninsured motorist coverage, “UM”. UM coverage must be offered to North Carolina policy holders since NC is a mandatory insurance state. The only way to not get UM coverage is to specifically sign a waiver disclaiming coverage. We counsel all of our clients to get as much UM coverage as they can afford considering there are a large number of individuals driving without insurance.

When a UM claim is filed your carrier steps into the shoes of the other driver and acts like their insurance company. This is why it is advisable not to speak with your insurance company. Anything you said to your carrier could be used against you at this time.

You insurance company is free to use any of the defenses available to the at fault party, including contributory negligence. Many times clients seek our counsel after their own insurance company has denied their case based on their original statement. Sometimes the statement can be fatal to their case. You have no legal obligation to speak with your insurance company following an accident. The NC policy does require that you cooperate with your carrier but cooperation is not defined in the policy.

There are a multitude of ways your carrier, especially the ones you see on TV all of the time, will attempt to take advantage of you. For example, your carrier will not explain that the NC statutes set the deductible rates under UM. For instance, if you used your collision coverage following an accident you may have paid your deductible, lets assume it was $1,000.00. However, if the claim is moved under UM the most the property damage deductible can be is $100.00. AS such, your carrier is required to refund you $900.00. Many times the carrier will “fail” to let their customers know this and our office will have to demand the money be refunded.

One of the most important attributes of a UM claim is the ability to arbitrate it. If you are unable to agree with your carrier on the value of the claim you can demand arbitration. Arbitration, unlike a jury trial, is an informal process which would take place in our office. You can think of an arbitration as a very simplified trial without a judge or jury. We present our case to a panel of arbitrators who render a binding decision on the value of your case. Our attorneys take the time to explain arbitration and how it can be used to maximize the value of your claim.

Speak to a Charlotte, NC Car Accident Lawyer Today

Call (704) 714-1450 to make an appointment to speak with a Charlotte car accident lawyer or stop by the office during regular business hours. We understand that the last thing you need to do at this time is miss a doctor’s appointment or more time from work. We will schedule an appointment that fits your needs. There is no fee for the initial consultation. Whether you call, come in the office or request a home visit you will speak directly with a personal injury attorney who can answer your questions.