The Ultimate Guide to Insurance Claims

Sometimes accidents happen, no matter how careful you are. After a serious accident – from car crashes to slip and falls – victims face more than physical pain. They are often left with mounting medical bills, lost wages, and the uncertainty of how to move forward.

At the heart of every personal injury case is a critical mechanism designed to restore what has been lost: insurance. Essentially, insurance policies are designed to provide financial protection against losses and damages.

When it comes to accidents and injuries, 95% of cases are settled with the insurance company rather than going to court, so you need to be informed about the process.

This guide, produced by Bisnar Chase Personal Injury Attorneys, explores how insurance works to compensate injury victims, why the majority of claims never reach a courtroom, and how to navigate complex insurance claims with confidence.

A Quick-Read Guide to Accident Insurance Claims

In this guide, we will explore every aspect of insurance claims in great detail. Below, we start by providing a quick read detailing the absolute basics of the process and how it works for accident victims. Get a brief overview below, and read on for more detail and actionable advice.

How Insurance Works to Compensate Accident Victims

Insurance plays a foundational role in compensating injury victims by shifting the financial burden of an accident from the injured individual to the at-fault party’s insurance carrier.

Liability insurance policies are required by law in most states for drivers, property owners, and businesses. They provide coverage that is intended to pay for medical expenses, rehabilitation, lost income, property damage, and non-economic damages such as pain and suffering.

For accident victims, the insurance system can mean the difference between financial ruin and a path to recovery. An insurance claim can compensate you for losses related to an accident. But that process is rarely easy and straightforward.

Insurance policies contain dense language, coverage limits, and exclusions that can dramatically affect the amount of money that a victim might receive. Our firm has helped countless clients who believed that their claim would be resolved quickly and fairly, only to discover how difficult the process can be.

Why Most Personal Injury Claims are Actually Insurance Disputes

The truth is that most personal injury cases are not traditional lawsuits at all. They are insurance disputes.

Nationwide statistics in the U.S. consistently show that more than 95% of personal injury cases are resolved through negotiations with insurance adjusters, rather than jury verdicts in courtrooms.

When you are injured by someone else’s negligence, your legal team will typically file a claim directly with that party’s insurance company. The insurer will then investigate the accident, determine liability, evaluate damages, and make a settlement offer. Your legal team will negotiate on this offer to secure a fair amount.

These negotiations often occur entirely outside of court proceedings, before a lawsuit is ever filed. The claim becomes an insurance dispute because the insurance policy itself is the source of compensatory funds.

Adjusters are trained to question causation and liability, minimize injuries, and limit payouts to protect their company’s bottom line. Essentially, they want to show that their customer wasn’t entirely at fault and that your injuries are not as bad as reported, so that they can pay less in compensation.

For injured victims, this isn’t a legal battle against an individual. It’s an intimidating negotiation against a massive corporate entity with unlimited resources. Understanding this process is essential. Most clients come to us expecting a lawsuit. Instead, we can often use skillful advocacy at the claims stage to achieve the best results.

Common Misconceptions About Insurance Companies

There are some common misconceptions about how insurance companies behave. One of the most believed myths is that the insurance company is on your side. But these insurance carriers are for-profit businesses. They will work really hard to pay out as little as possible. Their adjusters are evaluated based on how they negotiate claims, not on how fairly they treat claimants.

Another widespread belief is that insurers will automatically pay out the full value once liability is established. But our experience shows otherwise. Insurers routinely make lowball offers, especially when the victim does not have legal representation. They hope that the claimant will accept a low offer out of desperation.

Many people also assume that it is simply standard procedure for an insurance company to request a recorded statement or an independent medical examination. But these tactics are often used to build a defense file that justifies reducing payment.

Insurance Claims vs. Lawsuits

It is important to understand the difference between an insurance claim and a lawsuit.

An insurance claim is an administrative process that depends on the terms of the policy. Under an insurance claim, your legal team will still submit a claim and handle negotiations. But no judge or jury is involved unless the claim fails.

By contrast, a lawsuit is an action filed in court. We file a lawsuit when the insurance company denies a claim, makes an unreasonably low offer, refuses to budge, or fails to respond within the required deadlines.

Pros and Cons

Filing a lawsuit triggers a long legal process involving discovery, depositions, and the possibility of trial. Insurers hate the uncertainty and expense of litigation, so the threat of a lawsuit can provide valuable leverage. However, lawsuits also carry risks for the plaintiff. They take longer, involve much higher costs, and carry the risk of an unfavorable verdict.

Most personal injury attorneys will start with aggressive settlement negotiations at the pre-litigation stage because this offers the fastest and least expensive path to resolution. But when the insurer refuses to act in good faith, effective law firms will escalate and use the court system as a powerful tool to enforce the rights the insurance policy was meant to protect.

We designed this in-depth guide to reveal everything you need to know about the role of insurance after an accident, including practical and actionable knowledge and advice.

It is based on our decades of courtroom and negotiation experience. At Bisnar Chase, we believe that informed clients become empowered clients.

Personal Injury Cases Involving Insurance

Personal injury cases occur when someone is injured due to another person’s or a company’s carelessness. In most of these cases, insurance pays for the victim’s medical bills, lost wages, and other costs. The insurance settlement comes from the at-fault party’s policy.

⇒ Motor Vehicle Accidents (car, truck, or motorcycle crashes)

These are injuries caused by another driver’s careless actions, such as speeding, distracted driving, or running a red light. The primary insurance used is the at-fault driver’s auto liability insurance (specifically, bodily injury liability coverage). This pays for the injured person’s medical costs and other damages. In some cases, uninsured or underinsured motorist coverage may also apply if the at-fault driver has little or no insurance.

⇒ Slip and Fall Accidents (premises liability)

These occur when someone slips, trips, or falls on unsafe property, such as a wet floor in a store, an icy sidewalk, or broken stairs. The property owner or business may be responsible if they did not keep the area safe. The insurance that usually applies is the owner’s homeowners’ insurance (for a private home) or commercial general liability insurance (for a business or store).

⇒ Dog Bites or Animal Attacks

These cases involve injuries from a dog or other animal that attacks or bites someone. The animal’s owner can be held responsible if they did not control the animal properly. The insurance that typically covers this is the owner’s homeowners’ insurance, which includes liability protection for injuries caused by their pet.

⇒ Product Liability Cases

These involve injuries caused by a defective or dangerous product, such as a faulty tool, unsafe toy, or malfunctioning appliance. The manufacturer, distributor, or seller can be responsible. The applicable insurance is the company’s product liability insurance, typically included in its general liability policy. It covers bodily injury claims from defective products.

⇒ Workplace Accidents

These are injuries that happen on the job, such as falls, equipment failures, or being struck by objects. Employers are required to carry workers’ compensation insurance, which covers medical care and lost wages regardless of who was at fault. In some cases, if a third party (not the employer) caused the injury, their liability insurance may also be involved.

Understanding which insurance applies helps you know where to file your claim. In every case, the responsible party’s insurance company reviews the claim and decides how much to pay. If you have questions about your specific situation, talking to a lawyer early can make the process clearer.

The Basic Structure of an Insurance Claim

It is very useful to know how the insurance claim process works. The following is an overview of a typical insurance claim.

An accident occurs, and the victim sustains an injury.
The victim (or their legal representative) reports the accident to the necessary insurance company. In most cases, this will be the at-fault party’s insurer. In some cases, such as hit-and-runs or single-vehicle accidents, it might be the victim’s own insurer.
A demand letter will be sent to the insurance company requesting a certain dollar amount in compensation.
The insurance company will investigate the claim.
Accident victims will visit a medical professional, continue to undergo treatment as needed, and document their injuries as part of the process.
After investigating, insurers will decide who they believe is liable and to what degree.
The insurance company will make a settlement offer based on its investigation.
Negotiations will take place between the victim or their legal representative and the insurance company until the two sides can agree on a fair amount.
The claim is resolved with an acceptable settlement.

No Settlement

If the insurance company refuses to compromise or offer a sufficient amount:

The case progresses to litigation. This means that a lawsuit is filed with the courts. The insurance company will have its own team of defense attorneys representing it.
The case will progress to trial and may be resolved with a jury verdict. The two sides can also continue settlement discussions during litigation, and a settlement can be agreed upon at any time before the jury delivers its verdict.

An accident case that progresses to an insurance claim will typically follow these basic steps. But an experienced legal team can walk you through the likely steps specific to your case.

The Types of Insurance that Apply to Personal Injury Claims

In personal injury cases, insurance helps cover medical bills, lost wages, and other costs that arise when someone gets hurt.

Understanding the different types of insurance that can apply to injury claims is the key to determining where your claim will be directed.

Liability insurance pays when you are harmed by someone else. First-party coverage pays for your own injuries, no matter who caused them. In some cases, the different insurance policies may overlap. This section explains each type of insurance in simple terms.

Liability Insurance

Liability insurance protects the person or business that caused the injury. It covers the damages that they are legally required to pay to the injured victim. This is the most common insurance used in personal injury claims.

What liability insurance covers:

Bodily injury (medical bills, lost wages, pain and suffering).
Property damage to the other person’s belongings.
Legal defense costs if the case progresses to litigation.

Coverage stops at the policy’s dollar limit. It usually does not cover the insurance policy holder’s own injuries or punitive damages.

Common examples of different types of liability insurance:

Auto Liability Insurance: Drivers in California are required to have auto insurance. This pays for injuries or damage caused to others while driving.
Homeowners’ or Renters’ Liability Insurance: Covers injuries that happen on your property, such as a guest slipping and falling. It can also extend to cover some off-property accidents. For example, it often covers injuries caused by the policyholder’s pets in public places.
Commercial General Liability (CGL) insurance: This is a type of insurance used by businesses. It will typically cover injuries caused by business-related activities or occurring on business property.
Professional Liability Insurance: Many professionals carry malpractice insurance to protect them if their work harms others. For example, doctors, lawyers, accountants, and architects might all carry some form of professional malpractice insurance.
Product Liability Insurance: This type of insurance is carried by product manufacturers or retailers and can cover injuries caused by defective products that a company has made or sold.

First-Party Insurance Coverage

First-party insurance is coverage that you buy for yourself. After an accident, you can file a claim directly with your own insurance company for your losses. The result will always depend on the terms of your policy. But it will usually pay regardless of who was at fault.

Examples of First-Party Coverage:

Personal Injury Protection (PIP): Also known as “no-fault” insurance, PIP will pay for your medical bills, lost wages, and other costs after an accident. It is primarily used in car accidents, and typically covers you and your passengers. This insurance is required in some states, but it is optional in California.
Uninsured/Underinsured (UM/UIM) Coverage: UM/UIM is a clause included on your own auto insurance policy. It pays out for your injuries and damages if the other driver has no insurance, or the policy limits on their insurance are not high enough to cover your damages. UM/UIM is included as standard on your policy in California – you have to opt out to be excluded from it.
Medical Payments (MedPay): This is a type of insurance that solely covers medical bills for you and any passengers or related parties after an accident.

Third-Party Insurance Claims

When you hear the term “third-party insurance claim,” it means that you are filing a claim against someone else’s insurance. In this scenario, you are the third party (not the policyholder or the insurance company).

This is the most common way of getting paid out after an accident.

Examples of Third-Party Claims:

Another driver hits you, and you file a claim against their auto liability insurance.
You slip in a store and file a claim against the company’s commercial general liability policy.
A dangerous or defective product injures you, and you file a claim against the manufacturer’s product liability insurance.

Commercial and Corporate Insurance Policies

Businesses and commercial companies purchase specialized insurance policies to cover accidents or injuries related to their work. These are often required by law.

Commercial insurance coverage might include:

Commercial Auto Policy: An insurance policy that covers vehicles used for business purposes, such as company cars, trucks, or vans.
General Liability Policy: This acts as protection for businesses against bodily injury or property damage caused by their operations, premises, products, or services.
Umbrella Policies: An umbrella policy extends extra protection beyond normal policy limits. They kick in for large claims once the primary policy’s limits are reached, providing higher total coverage.
Workers’ Compensation Insurance: This covers medical bills and wages for employees injured on the job. These employees make a workers’ compensation claim. Once compensated by workers’ comp, they usually cannot sue the employer for more.
Employer Liability Coverage: This covers lawsuits filed by employees over work-related injuries or illnesses that go beyond standard workers’ comp claims. It protects employers from legal costs, settlements, and judgments.

Knowing these different types of insurance claims will help you understand what type of claim you will be pursuing. It can be complex and confusing, and your best bet is usually to gather any documentation and talk to a lawyer.

Policy Limits and Why They Matter

The policy limit is the maximum dollar amount that an insurance company can pay for a covered claim. These limits are stated in the policy coverage agreement. A policy limit could apply per person, per accident, or for the whole policy.

Once you hit the limit, the insurance company stops paying, even if you have ongoing costs.

Minimum Liability Requirements in California

California law requires drivers to carry liability insurance. The minimum amount allowed, since the law changed in 2025, is:

$30,000 for injury or death to one person.
$60,000 for injury or death to more than one person in a single accident.
$15,000 for property damage.

You might see this amount limit written as “30/60/15.”

How Policy Limits Impact Compensation After an Accident

After an accident, the at-fault driver’s insurance company pays for the injured person’s damages, but only up to the policy limit.

For example, if your medical bills, lost wages, and other damages total $50,000 and the at-fault driver’s limit is $30,000 per person, the insurance will pay no more than $30,000. You would need to find other ways to cover the remaining $20,000.

If your damages are lower than the limit, you may receive full compensation after the insurance company reviews the claim. Higher policy limits usually mean a better chance of getting paid for all your losses. Lower limits often leave injured people with unpaid bills.

Unfortunately, many people have the bare minimum insurance, because this carries lower premiums.

Situations Where Claims Exceed Policy Limits

In many instances, an accident victim’s damages will exceed the available insurance. Claims cost more when:

Injuries are serious and require hospital stays, surgery, physical therapy, or ongoing care.
Multiple people are hurt in the same accident, quickly pushing the total damages to the “per accident” limit.
The at-fault driver only carries the California minimum 30/60/15 coverage, which can be used up very quickly.
Lost wages or extensive property damage add to the total.

In these cases, the insurance policy will pay out up to its limits, even if the injured person still has unpaid bills.

Options for injured victims may include using their own underinsured motorist coverage to cover the shortfall, checking whether the at-fault party has any additional insurance that may apply, or pursuing the at-fault party’s personal assets through a lawsuit.

Policy limits are extremely important in any personal injury case because they directly control how much money is available to fight for in compensation. Knowing these limits can help you understand what to expect from your case. If your claim involves an accident in California, a lawyer can review any policies to explore every possible way that your losses could be covered.

About Umbrella Insurance Policies

An umbrella policy is an additional insurance policy that provides extra liability coverage. It is taken out in addition to normal auto and home insurance.

When normal insurance policies reach their payout limits, umbrella policies kick in to extend the coverage. It is usually advisable for people with significant assets to protect them in the event of an accident.

What Umbrella Policies Cover

An umbrella insurance policy will cover liabilities beyond your regular auto and home insurance.

For example, if your home insurance covers up to $500,000, but the policyholder causes a major accident resulting in a $1 million judgment, the umbrella policy will cover the shortfall and prevent out-of-pocket payments.

Umbrella policies are typically only required for high-level incidents. This could include the policyholder being involved in a major accident, such as a multi-car pile-up, a fatal car crash, or a fatal accident in their home.

These policies are usually paid for by people with significant assets, parents of teenage drivers, or people with a pool at their home.

Umbrella coverage can protect savings, investments, property, and retirement accounts in the event of a lawsuit. These policies also typically provide broader liability coverage, including extending to some liabilities that standard policies may not cover.

How an Umbrella Policy Can Increase Compensation Potential

An umbrella policy can be vital for the policyholder because it can protect their assets in the event of a claim or lawsuit against them. But it can also be just as beneficial to the injured party seeking compensation.

In many cases, policy limits prevent victims from recovering enough compensation to cover all of their medical bills and other damages. But an umbrella policy can ensure that there is enough coverage to pay for everything.

This means that the right legal team will be able to claim for every aspect of your injury and recover the full compensation that you deserve.

Insurance Exclusions

An insurance exclusion is a specific item that is not covered under the insurance policy and will not qualify for compensation.

Some of the most common exclusions include:

⇒ Intentional Acts

Most insurance policies will deny coverage when the insured party deliberately causes damage or injury. This means that the policy will not cover any injuries or damages if the policyholder acted with intent to harm or damage, OR if the injury was a foreseeable consequence of the action. The key aspect here is the intention behind the action.

⇒ Business Use Exclusions

These are policy terms that can deny coverage for commercial activities. For example, an auto insurance policy might include a business-use exclusion. This means it would not cover damages caused while the vehicle was used for commercial deliveries or rideshare driving. The same can apply to property. You may need an additional policy or a policy add-on to cover commercial use.

⇒ Household Exclusions

Many policies have household exclusions. This means that the policyholder’s family members cannot claim for their injuries in an accident. For example, this type of clause could ensure that the insurer is not liable when a driver crashes into a relative or a relative is injured inside a home. This exclusion is designed to prevent insurance fraud by stopping scammers from staging or engineering accidents to collect insurance money.

⇒ Named Driver Exclusions

A named driver exclusion is a formal provision in an insurance policy stating that a specific person is not covered if they drive the car. It is typically used to exclude a high-risk driver from the policy, such as a newly licensed teenager, thereby lowering the insurance premium.

⇒ Natural Disaster Exclusions

Most standard home and commercial insurance policies will not cover damage caused by natural disasters, weather conditions, and “Acts of God.” For most of these scenarios, separate specific insurance policies are required. Injuries sustained could still be covered, but it depends on exactly how and why they occurred and whether those circumstances fall under the exclusion.

These are just some of the most common insurance exclusions. They provide a good example of why it is important to know the terms of your insurance policy.

Reporting an Accident to the Insurance Company

For many people, the only time they will communicate with an insurance company – either their own or someone else’s – is when they are reporting an accident or making a claim.

It is important to know how to go about this process to ensure your rights are protected and your claim is properly evaluated.

When to Report an Accident

After an accident, you should collect the insurance details of the at-fault party. When you are ready to do so, you should report the accident to your own insurer AND the at-fault party’s insurer.

There are two schools of thought. You can phone the insurance companies immediately, or you can delay that call until you have had your injuries and damages assessed.

Immediate Reporting vs. Delayed Reporting

There are pros and cons to both options. If you make the call immediately, you will get things moving faster. You can get the ball rolling on vehicle repairs, replacement vehicles, and compensation.

It is also easier to source certain evidence in the immediate aftermath, such as dash-cam and traffic-camera footage that is regularly stored or deleted.

However, there may be downsides in some situations. For example, you probably won’t know the full extent of your injuries straight after an accident. That can make it harder to receive full compensation for them.

You could also end up making a minor claim when the incident could have been handled privately, without risking a premium increase. (It should be noted that most insurance policies require all accidents to be reported as a contractual obligation, though that rule is not always observed in minor cases.)

Some insurers may also deliberately try to rush the process to pressure you into accepting a lower payout than you deserve, which can provide further incentive to slow things down until you get a second opinion.

The Bottom Line

The bottom line is that most insurance policies require you to report an accident promptly. That usually means within 24-72 hours after an accident.

Statistics show that claims reported after the 24-hour mark are 60% more likely to be investigated in depth by insurers and are more likely to be denied. Any delay may raise red flags over potential fraud or compromise the ability to fully investigate the accident.

With that said, it is often advisable to contact a lawyer to ensure the insurance company does not take advantage of you.

PRO TIP: The best option is often to report the accident to the insurance company within 24 hours of the accident. Do not give a recorded statement or provide more information than you have to. You can inform the insurers that your attorney will be in touch with further details.

Statutory Reporting Requirements

There is no legal time limit for reporting an accident to the insurance company. But you should report the incident within the timeframe outlined in your policy.

However, there is a statutory requirement to report the accident to the DMV within 10 days if it results in injury or death, or it causes property damage valued at greater than $1,000.

How to File an Insurance Claim

There are several important steps that you will need to take after an accident. The outline below is for auto accidents, but many of the steps also apply to other types of accidents. They include:

Call 911 and request a paramedic if anyone is hurt.
Contact the police and report the accident. They may or may not come to the scene. It will depend on the location and severity of the incident, as well as how busy they are. Always at least try to notify the police. If they do attend, request a copy of their report.
Take down the details of anyone involved in the accident. That includes all drivers and passengers involved. Obtain their names, addresses, and phone numbers.
Obtain the at-fault driver’s insurance details and take pictures of their driver’s license.
Take pictures of the license plates and vehicle identification numbers (VIN) of any vehicles involved.
Use your cell phone to take pictures of the damage, the accident scene, the position of the vehicles, tire marks on the road, or anything else you think might be relevant.
Start the insurance process and contact a lawyer.

Starting Your Insurance Claim

Most accident guides will tell you to contact the insurance company to start the claims process. But which insurance company, and what details do you need to provide? We have all of the information you need, right here.

In most cases, you will follow these steps:

⇒ Notify Your Insurance Company

Even in a no-fault accident, you should promptly notify your own insurance company. You can do this as soon as you want – even from the scene of the accident. There are several reasons for this. It is probably required by your policy terms, it will protect you if the at-fault driver disputes liability, and it will provide another avenue for compensation if the at-fault driver is uninsured or has low policy limits.

⇒ Contact an Attorney

Next, contact a personal injury lawyer. They will provide a free consultation and guidance on your next steps. Once you have signed with a lawyer on contingency, with no out-of-pocket costs, they will represent your interests with the at-fault party’s insurer.

If details were exchanged properly at the scene of the accident, the at-fault party will report the crash to their insurer, and the insurance company will contact you. At this point, you can refer them to your attorney or follow your attorney’s instructions.

If you are not contacted, you can initiate communication by following the instructions on the back of the at-fault party’s insurance card. Alternatively, you can provide that information to your legal team and let them handle it.

What Information Should You Provide the Insurers?

You can start by providing the basic details to the insurers. These can include:

The date and time of the accident.
As exact a location as possible.
A police report or incident number.

You should discuss it with your attorney before providing pictures of any injuries and damages, as well as contact details for any witnesses that you were able to collect.

It can be a difficult balance. You need to cooperate with the investigation without giving too much away.

What You Should NOT Say to the Insurance Company

There are some things that you can do or say to insurers that will jeopardize your claim.

Do not provide a recorded statement until you have discussed it with your attorney first. It is a common insurance tactic to collect a statement right after the accident and use it against the victim later.
Do not admit fault or speculate that you may have been partly to blame.
Don’t speculate about your injuries or downplay your pain. Injuries can evolve over time. You may think you came through an accident unscathed, only to develop pain once the shock has worn off.
Accepting an early settlement offer is a mistake. Insurers will often try to pressure victims into folding with a quick (but undervalued) cash offer.

Above all, you should communicate with your attorney and follow their instructions. Insurance companies have their own objectives, namely, to make money. They do not necessarily have your best interests in mind.

In contrast, your attorney is working for you. They will do everything possible to ensure you get the maximum possible compensation. The best law firms will have dealt with countless similar claims and know what information to provide to feed the investigation, and in what order.

The Insurance Company Investigation Process

After you file a personal injury claim, the insurance company starts an investigation. Their goal is to figure out who is at fault and how much they should pay for your injuries and losses.

The investigation process helps insurers to decide the value of your claim, or whether to deny it. The main person handling this process is the insurance adjuster.

The Role of Insurance Adjusters

Insurance adjusters work for the insurance company, not for any individual. They are not on your side; their job is to collect facts and recommend how much money (if any) their company should pay.

Adjusters review documents, talk to all parties involved, and sometimes visit the scene. They are looking for reasons to pay a lower amount or deny a claim outright, such as downplaying the severity of your injuries or looking for a potential share of the blame.

The insurance adjuster will evaluate liability by determining the cause of the accident and assigning blame. They may cast blame on multiple parties.
They will assess damages, mainly the economic damages, such as medical bills and property damage.
Of the potential damages, they will decide which elements are compensable.
They will respond to demand letters from the injured party’s lawyer and negotiate to determine whether a compromise can be reached.

The Evidence That Insurance Companies Review

Insurance adjusters will start their investigations by reviewing the evidence provided by the parties involved in the accident before delving into the accident in any way they can.

Essentially, they are reviewing much of the same evidence as the plaintiff’s attorney. This includes:

Police reports, which often include details about the accident and the parties involved, any citations, and the officer’s observations.
Photos and videos of the accident scene, vehicle damage, and any hazardous conditions (such as wet or slick surfaces).
Witness statements from people who saw the accident.
Medical records and bills to check your current injuries, the extent of your treatment, any prior medical conditions, and any gaps in treatment.
Repair estimates for damaged property.
Each party’s statements or descriptions of events.
Dash cam, traffic cam, or surveillance camera footage.
Social media posts that might show inconsistencies in injury reports.

The evidence that you provide is just a starting point for insurers. They won’t just take your word for it. Any inconsistencies in the evidence can hurt your claim, or even result in outright denial.

Independent Medical Examinations (IME)

If your injuries are disputed or the claim involves larger amounts, the insurance company may ask you to attend an independent medical examination, often referred to as an IME.

An IME is an exam conducted by a doctor who is chosen and paid by the insurance company. The doctor will review your medical records, including your full medical history, and examine your injuries.

The purpose is to get a second opinion on your injuries. The independent doctor will offer their professional opinion on your injuries. This will include whether they were caused by the accident, how serious they are, and what future treatment you might need.

Note that an IME is not truly independent, despite the name. The doctor works for the insurance side, and their reports are often used to argue that your injuries are not as bad as claimed or are unrelated to the accident. It is a good idea to consult with a lawyer before attending an independent medical examination.

Recorded Statements

Early in the process after an insurance claim, the adjuster will often ask for a recorded statement. This is a phone or in-person interview with the adjuster, during which they ask questions about the accident and your injuries. All of your answers will be recorded and become part of the claim file.

Adjusters use your answers to lock in your version of events early in the process. They can then look for any small inconsistencies between your story and any other evidence. This is one of the common tactics they use to reduce the value of your claim.

Seemingly simple or innocuous questions can later be used against you. You should always talk to an attorney before giving a recorded statement to the at-fault driver’s insurance company. Your own insurer might also require you to give a statement under the terms of your policy.

The investigation process can feel one-sided because the insurance company controls it. But having an experienced legal team will help you organize strong evidence and respond correctly to requests for IMEs or recorded statements. It is always best to get legal advice as soon as possible.

Determining Liability in Insurance Claims

Liability means legal responsibility for causing an accident or injury. In personal injury claims, the insurance company must determine who was at fault before agreeing to pay.

Determining liability is one of the most important steps in the claims process. If the insurance company finds the other party to be 100% at fault, your chances of getting fair compensation are much better. If they decide that you share some blame, your payment will be reduced.

How Insurance Adjusters Determine Liability

The job of determining liability falls on the insurance adjuster working on your claim. To do so, they investigate by judging the evidence and applying the rules of negligence. They are not neutral – their job is to protect their employer’s money. As such, they often look for ways to shift blame or minimize the claim.

The key factors that the adjusters will look at to determine liability include:

Police reports and any citations issued.
Photos and videos of the accident scene.
Examinations of the vehicles, including visible points of impact.
Witness statements.
The statements from the parties involved.
Physical evidence, such as skid marks, road conditions, or hazards.
Road layouts, traffic lights, and signage.
Traffic laws or safety rules that may have been broken.
Medical records to see if your injuries match the accident.

Adjusters review all of this information to decide the percentage of fault for each person involved.

Multiple Liable Parties

Sometimes, more than one person or commercial entity is responsible for an injury. Examples might include a multi-car crash, a slip-and-fall in which both a store and a cleaning company were negligent, or a defective product made by one company and sold by another.

In California, the rule of joint liability usually applies to economic damages, such as medical bills and lost wages. These are losses that can be quantified as a dollar amount. This means that any one of the at-fault parties can be held responsible for paying the full amount of those damages. You don’t have to chase every involved party for a share.

Non-economic damages work a little bit differently. These are more subjective damages, such as pain and suffering. For non-economic damages, each party is generally only responsible for their own percentage of fault.

In some cases, having multiple liable parties involved in an accident can increase the total money available because more insurance policies come into play. However, it can also complicate the issue of liability.

Comparative Negligence

California follows a pure comparative negligence system. This means that you can still recover money after an accident, even if you were partly at fault. However, your total compensation is reduced by your percentage of fault.

For example, if your damages total $100,000 and the insurance company says you were 25% at fault, they will only pay $75,000.

Insurance adjusters sometimes try to assign you a higher percentage of fault to reduce the payout. Factors such as not wearing a seatbelt, making unsafe maneuvers, or evidence that you looked at your phone while driving can be used to reduce your recovery.

Strong evidence from your legal team can be used to fight unfair fault percentages.

Disputed Liability Cases

In many claims, the insurance company disputes who was at fault or how much responsibility each person shares. They may argue that you caused or contributed to the accident, that the other driver was not negligent, or that there is not enough proof.

If there is no dispute, getting the compensation you deserve can be relatively straightforward. When liability is disputed, the claims process slows down. The insurance company may make a very low offer or deny the claim. In these situations, it often becomes necessary to conduct a more thorough investigation and gather more evidence.

Proving Liability

Lawyers often hire experts and produce accident reconstructions. If the insurance company digs in and refuses to accept liability, despite the evidence presented, a lawyer can file a lawsuit to resolve the dispute in court.

If your claim involves disputed liability, it is especially important to avoid giving a recorded statement to the at-fault party’s insurer without legal advice. An attorney can help build a clear case showing why the other party should be held responsible.

Understanding how liability is determined helps you see why insurance companies ask so many questions and request so much information. Good documentation and quick legal help can protect your right to fair compensation. If you are unsure about who is at fault in your accident, speaking with an attorney early can make a big difference.

Calculating Personal Injury Damages

When you hear people talk about damages, they are referring to the money awarded to an injured person or their family to compensate for losses caused by someone else’s negligence.

In personal injury claims, damages are divided into categories to cover both the financial costs and the personal impact of the injury.

Insurance companies and lawyers calculate the total value of a claim by adding up all the different types of damages. There is no single fixed formula; calculations depend on the facts of the case, the evidence, and California law.

Economic Damages

Economic damages are the actual, measurable financial losses caused by the injury. These are the easiest to calculate because they come with bills, pay stubs, and receipts.

Common economic damages include:

Past and future medical bills covering everything from hospital stays and surgeries to ongoing therapy and medication.
Lost wages and lost earning capacity. This is the money you would have earned but couldn’t because of the injury.
Property damage, such as the repair or replacement of your car or other belongings.
Other out-of-pocket costs. This could include the cost of transportation to medical appointments, home modifications, or replacement vehicle rental.

Insurance companies will review your medical records and bills to verify these amounts. Projected future economic damages often require expert testimony from doctors or other experts to estimate long-term costs.

Non-Economic Damages

Non-economic damages compensate for losses that are harder to measure in dollars. They cover the physical and emotional impact of an accident or injury.

Common examples include:

Pain and suffering (physical pain and discomfort)
Emotional distress (anxiety, depression, or fear resulting from the accident)
Compromised quality or enjoyment of life (the inability to do the activities and enjoy parts of life that you did pre-accident)
An impact on your relationships.

It can be hard for both sides to determine exactly how much these factors should be worth. Insurance companies sometimes use a multiplier system to provide an estimate for these damages.

They will take the economic damages and multiply them by a number (usually between 1.5 and 5), depending on the severity of the injuries. A higher multiplier is used for severe accidents and results.

Another method, used in some cases, is to assign a dollar amount based on the duration of the period of suffering.

Catastrophic Injury Damages

Catastrophic injuries are severe injuries that have a significant impact on the victim’s life. That could range from a bad fracture with a complicated recovery to more severe injuries. These could include spinal cord injuries, traumatic brain injuries, amputations, burns, and other debilitating conditions.

These cases usually result in much higher damages because they include:

Very high future medical and care costs. These can include dedicated nursing costs, assistive devices, and home modifications.
Significant loss of future earning capacity if the person is no longer able to work.
Higher non-economic damages due to the likely permanent impact on the victim’s quality of life.

Calculations of these damages often require experts, such as life care planners and economists, to produce long-term estimates. Settlements or verdicts in catastrophic injury cases can reach hundreds of thousands or millions of dollars.

Wrongful Death Damages

Wrongful death damages are claimed by the surviving family members of someone who has died due to another person’s negligence. These damages are designed to help the family recover financially and emotionally from their loss.

Economic damages in wrongful death cases typically include:

Funeral and burial expenses.
Lost financial support and future income that the deceased would have provided.
The loss of household services, such as childcare or home maintenance.

Non-economic damages cover the intangible losses from the death of a loved one, including the love, companionship, guidance, and affection that they would have provided. However, in California, families cannot recover damages for their own grief or sorrow in most wrongful death cases.

No matter what kind of case you have, calculating personal injury damages is complex. Insurance companies often start out with low offers. But strong evidence, clear medical records, and experienced legal representation can lead to better results.

Insurance Settlement Negotiations

Getting the compensation that you deserve from an insurance company can be quite a process. Most claims in California end with a settlement agreement rather than a trial, and are resolved through negotiations.

Settlement negotiations are the back-and-forth discussions between you or your lawyer and the at-fault party’s insurer. The goal is for both sides to agree on a fair amount without going to court.

This negotiation process often starts after you have finished most of your medical treatment. However, this is dependent on the individual case. Once you reach a point of maximum medical improvement, doctors can better estimate your future treatment needs, and experts can determine the associated costs.

Deciding a claim through negotiation gives both sides a chance to avoid the time, cost, and uncertainty of a lawsuit.

The Demand Letter

The negotiation process usually begins with a demand letter. This is a formal document prepared by your legal team and sent to the insurance company.

A good demand letter includes:

A clear description of how the accident happened and why the other party is responsible.
Details about your injuries and medical treatment.
Supporting evidence, such as medical records, bills, photos, police reports, and witness statements.
A calculation of your economic damages and non-economic damages, with a specific dollar amount that is being requested.

The demand letter acts as a starting point for talks. Insurance companies usually respond with a lower counteroffer. This back-and-forth continues, with both sides arguing their case over specific points, until both sides agree on a compromise number.

If they cannot reach a compromise and are too far apart, they might decide to stop negotiating and file a lawsuit.

Insurer Settlement Negotiation Strategies

Insurance adjusters use several common strategies during settlement negotiations. These include:

Low Initial Offers: They often start with an offer well below the value of the claim. This is often referred to as a lowball offer. This is a test of whether you will accept less money to get things wrapped up quickly, because you need the cash or feel pressured.
Questioning Your Damages: Adjusters may argue that some medical treatment was not needed, that your injuries are not as serious as claimed, or that they are pre-existing conditions caused by something other than the accident.
Delay Tactics: In some cases, they may take time to respond or request additional documents to slow the process down. They hope that you will get tired or need the money, and accept less to force a quicker resolution.
Disputing Liability: Even after the investigation, they may say you share some blame for the accident, which reduces the amount you would receive.

These tactics are all normal. Insurance companies train their adjusters to protect the company’s money. Staying patient, responding with strong evidence, and having experienced legal experts handling this process can help you push back effectively.

Settlement Timelines

How long this negotiation phase takes will vary from case to case.

Simple cases with clear fault and minor injuries may settle within a few months.
Cases with ongoing treatment or moderate injuries often take 6-12 months, or longer.
Complex claims with serious injuries, disputed fault, or multiple parties are likely to take over a year, and can extend to several years in serious cases.

After the demand letter is sent, the insurance company usually has 15 days to acknowledge its receipt under California law. They have 40 days to accept or deny the demand.

However, they will sometimes ask for extensions to investigate the claim. It often takes up to 90 days, and you should enter this process expecting negotiations to last weeks or months.

(California Code 2695.5 and 2695.7)

Once both sides agree on a settlement amount, you will sign a release form, and the insurance company will issue a check. The law moves slowly, and even these final steps after an agreement is struck can take weeks or months.

Other Important Points

Settlement negotiations are a normal and expected part of most personal injury claims. It can be frustrating, but understanding the process helps you stay patient and realistic.

Do Not Rush: It is usually best to wait until you reach maximum medical improvement before settling. Accepting money too early can prevent you from getting paid the money that you deserve for future medical needs.
Get Everything in Writing: When you reach an agreement, make sure all of the terms are clearly written down before signing anything.
Attorney Involvement: The negotiating period is hard. Adjusters are trained to do this and have experience in handling negotiations day in, day out. Working with lawyers and pre-litigation experts can be vital to a successful outcome.

If the insurance company refuses to make a reasonable offer, your lawyer may recommend filing a lawsuit to put more pressure on them

If you have questions about your claim or the offers you are receiving, it is always best to speak with a trusted law firm first.

Bad Faith Insurance Practices

Bad-faith insurance practices occur when an insurance company acts unfairly, dishonestly, or unreasonably in handling a claim.

In California, every insurance policy includes an implied duty of good faith and fair dealing. This means that the insurance company has a responsibility to investigate claims properly, respond to claims on time, and pay what is owed under the policy without unreasonable delays, denials, or lowball offers.

But there are plenty of examples of that not happening. When the insurance company acts unreasonably and puts its own financial interests ahead of the injured person’s rights, it is considered bad faith.

It is important to note that either your own insurance party or someone else’s insurer can act in bad faith toward you.

Examples of Common Bad-Faith Insurance Practices

Some of the most common bad faith insurance practices include:

Unreasonable Claim Denial: Denying a legitimate claim without a valid reason or without conducting a proper investigation. The company must have a fair basis for saying no.
Failure to Investigate Properly: Not thoroughly reviewing the facts, evidence, or medical records before deciding on the claim. They must look for reasons to pay out on a valid claim, not just search for ways to deny it.
Unreasonable Delays: Taking too long to respond to a claim, investigate it, or make a decision without a good reason. Delays can cause financial hardship for injured people who need money for medical bills, lost wages, or vehicle repair.
Lowball Settlement Offers: Offering a settlement amount that is far below the real value of the claim. This tactic pressures people who need money quickly to accept less than they deserve.
Misrepresenting Policy Terms: Giving false or misleading information about what the policy covers, twisting the meaning of exclusions, or hiding benefits that should apply to your claim.
Failure to Communicate: Ignoring calls, letters, or requests for information, or failing to keep you updated about the status of your claim in a timely manner.
Unnecessary or Repeated Document Demands: Asking for the same records or demanding excessive paperwork that is not truly needed in order to slow the process down.
Failing to Settle when Liability is Clear: Refusing to make a reasonable settlement offer even when it is obvious that the insured party is at fault and the damages are well documented.
Using Unfair Tactics to Undervalue the Claim: Disputing your injuries without good evidence, ignoring reports from your doctors, or pressuring you to accept a quick, cheap settlement before you finish treatment.

Counteracting Bad-Faith Tactics

Some of these bad-faith tactics are more likely than others. It is common for adjusters to stretch the limits of what is allowed by lowballing and dragging out the process.

It is much less common for them to deliberately mislead you or refuse to do their due diligence during the investigation.

If you believe the insurance company is acting in bad faith, it can seriously harm your ability to get fair compensation. You should document everything, including dates of communications and copies of letters and emails.

Truly bad faith conduct is rare. But if it can be proven, it can even lead to a separate legal claim against the insurance company for additional damages.

The best way to counteract these tactics and protect your rights is to work with an experienced law firm. They will know what to expect from the process, how long things should take, when things don’t feel right, and when to step up the pressure.

The Role of a Personal Injury Attorney

Dealing with an insurance claim after an injury can be stressful and confusing. But a personal injury law firm can act as your advocate and guide you through the entire process.

Their job is to protect your rights, handle communications with the insurance company, and work to get you the full compensation you deserve.

Having a lawyer often leads to significantly higher settlements because they understand how insurance companies operate and how to build a strong case.

How Attorneys and Pre-Litigation Experts Strengthen Insurance Claims

When you choose a law firm, your case will be handled by an attorney or a pre-litigation expert. The pre-lit team works specifically on cases during the initial claims process and will consult with the attorneys as required.

If a settlement cannot be reached and a case enters litigation, the attorneys will take charge. A skilled and experienced legal team will strengthen your claim in several important ways.

How Your Lawyer Will Help:

Handle All Communication with the Insurance Company: The attorney or pre-lit team deals directly with the adjuster, so you do not have to deal with requests or respond to pressure tactics on your own.
Investigate the Case Thoroughly: They gather evidence, interview witnesses, obtain police and medical reports, and preserve evidence before it disappears. This is used to build a file that supports the claim.
Work with Experts: Attorneys often bring in experts to strengthen the claim. These may include:
- Accident reconstruction experts to demonstrate how the accident happened.
- Medical experts to explain the extent and cause of the injuries.
- Financial experts to calculate future costs and damages.
- Life care experts for serious injuries that require long-term care.
Calculate the Full Value of Your Claim: They properly value both economic damages (medical bills, lost wages, etc.) and non-economic damages (pain and suffering), using proven methods and supporting evidence to ensure no money is left on the table.
Prepare and Send a Strong Demand Letter: A well-written demand package with organized medical records, bills, evidence, and expert opinions puts pressure on the insurance company to make a fair offer. It is important to start on the right foot.
Negotiate Aggressively: Attorneys know common insurance tactics and can push back effectively against low offers, delays, and unfair blame.

Having professional help early usually results in better compensation and less stress for the injured person.

Litigation When Insurance Refuses a Fair Settlement

If the insurance company continues to deny the claim, makes unreasonably low offers, or acts in bad faith, your attorney may recommend filing a lawsuit. This step is called litigation, and is best handled by an experienced lawyer. During litigation:

A formal complaint is filed with the courts against the at-fault party.
The discovery process begins, where both sides must exchange evidence, answer written questions, and give depositions under oath.
Your attorney can use the court system to obtain important documents and testimony.
Negotiations can continue over a settlement as both parties prepare for trial. The threat of going to trial often motivates the insurance company to up their offer.
If there is still no settlement agreement, your attorney will argue your case in court at a jury trial, fighting for a favorable verdict.

Expert Guidance on the Best Path for Your Case

Most cases still settle during litigation and never reach an actual trial. However, being prepared to go to court gives your attorney stronger leverage during negotiations.

A personal injury law firm will evaluate your case, explain your options clearly, and decide the best time to file a lawsuit if necessary. They also ensure important deadlines are met so you do not lose your right to compensation.

In short, while you can handle a simple claim on your own, having an experienced personal injury lawyer on your side usually leads to better results. This is especially important when injuries are serious, liability is disputed, or the insurance company is being difficult. If you have been injured, speaking with a lawyer for a free consultation is usually the smartest first step.

Special Insurance Issues in Personal Injury Cases

Not all accident and injury claims are straightforward. Below are some of the slightly less common issues and aspects of the system that you may encounter in certain claims.

Each of these issues, rules, and policies can significantly impact how much money you ultimately receive. They can reduce your final payout or create extra steps and deadlines.

Uninsured and Underinsured Drivers

Not all drivers carry the insurance that is legally required of them. In other cases, they may have the legal minimum, which might not be enough to cover the damage caused by an accident. This can really complicate the claims process.

However, victims can often use UM/UIM insurance to pick up the shortfall.

UM/UIM is a part of your own insurance policy. It is optional, so you will need to check whether it is included in your policy terms. But in most cases, it is automatically applied, meaning that you must opt out if you don’t want it. However, we strongly advise all drivers to have UM/UIM.

Uninsured Motorist (UM): When the at-fault driver has no insurance coverage, the only way to claim basic insurance from them is to target their assets in a lawsuit. But this is tricky, and often not worth the time and expense. But you can make a claim against the UM part of our own policy.
Underinsured Motorist (UIM): The underinsured motorist portion of your policy can fill in the gaps to compensate you if the at-fault party doesn’t have the policy limits to cover your damages. Again, the money is coming from your own insurance company.

Subrogation and Medical Liens

Medical liens and subrogation are important terms to understand when it comes to insurance payouts.

Subrogation is the right of an insurance company or other payer to take reimbursement from your settlement for money that they have already paid toward your medical bills or other benefits.

For example, if your insurer has paid out an initial sum to help you get started on your treatment, they can recoup that money from your settlement.

Similarly, a medical lien is a legal claim against your settlement money that requires you to repay certain parties before you keep the rest of the money.

These mechanisms mean that even if you win a settlement, some of the money may need to go to other parties to cover services already paid for. This can reduce the amount you end up with, but legal professionals often negotiate to lower these amounts.

Examples of these systems in action:

Health Insurance Liens/Subrogation: If your health insurer paid for accident-related treatment, they may have a right to be repaid from your settlement. Many policies include subrogation clauses that allow them to recover the costs they incurred.
Medicare Liens: Medicare is a federal health insurance program and has the right to recover payments for injury-related care. You must notify Medicare and repay them from the settlement.
Medi-Cal Liens: Medi-Cal is a form of low-cost healthcare coverage for people on low incomes. Medi-Cal can place a lien on your settlement to recover the cost of medical services paid. Repayment is often required before the settlement is finalized.
Workers’ Compensation Insurers: If you received workers’ comp benefits for a work-related injury, the workers’ comp insurer will usually place a lien against any third-party settlement to recover what they paid.

These issues all impact victims by reducing their final checks. But an attorney can sometimes negotiate reductions and ensure payments are made in the proper order.

Government Claims

The claims process changes when the at-fault party in an accident case is a government entity. This could include a city, a county, a state agency, or a public employee. Examples include accidents involving government vehicles, public transport crashes, or instances of dangerous public property.

In these scenarios, you have to follow special rules under the California Government Claims Act.

In most cases, you must file a written government claim with the public entity within six months of the accident. This is much shorter than the usual two-year statute of limitations.

The claim must include specific details about the incident, your injuries, and the amount that you are seeking. If the government entity fails to respond or rejects the claim, you can then file a lawsuit, but this process also carries strict deadlines.

If you miss the 6-month claims deadline, you usually lose the right to sue the government entity. These cases need faster action than standard claims, but your best bet is still to contact an attorney as soon as you can.

Multiple Insurance Policies

Some accidents involve more than one insurance policy that may cover your damages. In some cases, these policies can overlap or be held by different parties, and this can complicate the entire process.

The available insurance could include:

Liability insurance owned by the at-fault party.
Multiple policies if more than one party shares blame – for instance, in a car accident involving several vehicles.
Your own insurance policy – most likely UM/UIM contingencies.
Commercial policies.
Layered coverage, where primary insurance pays first, supplemented by an umbrella policy after primary policy limits are reached.
Corporate defendants and employer liability.

In cases where more than one policy applies, there might be a stacking effect, where various policies are targeted to increase the available coverage.

In California, stacking is allowed in some situations, but restricted or prohibited in others. This can help injury victims by increasing the available money and fully covering their losses, even when one policy’s limits are too low.

However, it also adds a layer of complexity to negotiations, coordination between insurers, and determining who pays what. It often requires careful legal review to maximize recovery. The right lawyer will help you navigate these issues and fight for the maximum amount that you could potentially recover.

Understanding Insurance Policies: Glossary

The following is a glossary of some of the key terms that you should understand regarding insurance claims:

⇒ Bad Faith

When an insurance company acts unfairly or dishonestly by delaying, denying, or knowingly undervaluing a valid claim.

⇒ Catastrophic Injury

A serious injury with long-term impacts. This could range from a complicated fracture that eventually heals to permanent spinal cord damage.

⇒ Comparative Negligence

Comparative negligence is a law in California that allows you to recover compensation even if you are partly at fault, but reduces your compensation by the percentage of fault you share.

⇒ Coverage Limits

The maximum amount of money that the insurance company will pay for a particular covered claim.

⇒ Damages

The money that an injured person can recover to compensate them for losses caused by an accident. Damages are split into economic and non-economic categories.

⇒ Deductible

The deductible is the amount of money you must pay out of pocket for a covered loss before the insurance coverage kicks in and starts paying its share.

⇒ Demand Letter

The demand letter is a formal letter, usually written by a legal professional, sent to the insurance company. It will detail the accident, the injuries, any supporting evidence, and the amount of money being requested to settle the claim.

⇒ Economic Damages

Measurable financial losses linked to the accident, such as medical bills, lost wages, and property damage.

⇒ Employer Liability Coverage

Insurance that protects employers from lawsuits by employees for work-related injuries that fall outside of workers’ compensation benefits.

⇒ Endorsements

A written change or addition to the insurance policy that alters the coverage in some way. It might add or remove something from the coverage, or change an existing clause. This is also sometimes referred to as a rider.

⇒ Exclusions

These are specific situations, conditions, or events that the insurance company will not cover, specified under the policy terms.

⇒ First-Party Insurance

Insurance coverage that you buy for yourself that pays for your own injuries and losses.

⇒ General Liability Policies

Business insurance that covers bodily injury and property damage claims arising from the company’s operations, products, or premises.

⇒ Government Claim

A formal written notice that must be filed with the at-fault government agency within six months of the accident.

⇒ Independent Medical Examination

An examination by a doctor who was chosen and paid for by the insurance company to evaluate your injuries and provide a second opinion.

⇒ Joint and Several Liability

A rule that applies when multiple parties are at fault for an accident. It allows an injured person to recover the full amount of economic damages from a single one of the responsible parties.

⇒ Liability Insurance

Insurance that pays for injuries or damage that you or your business cause to others. This is the main source of payment in most personal injury claims.

⇒ Maximum Medical Improvement

The point in your medical treatment when doctors determine that your condition has stabilized and is not expected to worsen or improve further with additional treatment.

⇒ Medical Lien

A legal claim placed against a personal injury settlement that allows health care providers and insurers to recoup money from the settlement to cover bills that have already been paid. It typically allows victims to receive necessary medical care without paying out of pocket, while ensuring that medical providers are later repaid from the settlement.

⇒ Non-Economic Damages

Compensation for subjective losses, such as pain and suffering, emotional distress, and loss of enjoyment of life.

⇒ Policy limits

The maximum amount of money that an insurance policy will pay out for a covered loss. Policy limits can apply to the entire policy or to a specific type of coverage and depend on the policy’s terms.

⇒ Premium

This is the amount of money you must pay the insurance company to keep your policy active. Most people pay monthly premiums to make it more affordable.

⇒ Recorded Statement

A recorded interview conducted by an insurance adjuster where the victim answers questions about the accident and their injuries. Anything said is entered into an official record.

⇒ Subrogation

The legal right of an insurance company or benefit provider to be reimbursed from a personal injury settlement for payments made on behalf of the injured party.

⇒ Third-Party Claim

A claim filed against someone else’s insurance policy because they caused your injury. The claimant is the “third party” to the policy.

⇒ Umbrella Policies

Extra liability insurance that provides additional coverage beyond the limits of your regular policies for large claims.

⇒ Workers’ Compensation Insurance

Insurance that pays medical bills and lost wages for employees injured on the job, regardless of fault.

⇒ Wrongful Death Damages

This is compensation that is paid to surviving family members when a loved one dies due to someone else’s negligence.

This glossary covers some of the most important terms used in personal injury insurance claims. If you come across any other unfamiliar terms in your policy or claim documents, feel free to ask your legal team for clarification.

Frequently Asked Questions About Insurance Claims

If you need quick answers to specific questions, you’ve come to the right place. Most of these questions are answered in greater detail throughout this guide. But this FAQ section lets you quickly find the answers you need.

⇒ What should I do immediately after an accident?

Seek medical attention as soon as possible, even if your injuries seem minor. Document the scene as well as the circumstances allow, taking photos and collecting witness details if possible. File a police report if required and request a copy of the report. Contact your own insurance company promptly, but avoid giving a detailed statement to the at-fault driver’s insurer until you have legal advice.

⇒ How do I start the insurance claim process?

Notify the at-fault driver’s insurance company in writing. Provide basic information about the accident, but do not accept fault or discuss your injuries in detail. Many people hire a lawyer at this stage to handle communications and properly file the claim.

⇒ Should I give a recorded statement to the insurance company?

It is usually best to speak with a law firm before giving a recorded statement to the at-fault insurer. Everything you say is recorded and can be used throughout the process to reduce or deny your claim. Your own insurance company may require limited cooperation.

⇒ What documents should I collect for my claim?

Gather police reports, medical records and bills, proof of lost wages, photos of your injuries and property damage, and witness statements. Keep a log of all medical appointments and how the injury affects your daily life. Compile anything that can show a timeline proving the impact an accident has had on your life and health.

⇒ How long do insurance claims usually take?

Simple claims with minor injuries may settle in 3-6 months. More serious cases often take 6-18 months or longer. The timeline depends on how long your treatment lasts and whether liability is disputed.

⇒ When should I hire a personal injury attorney?

Hire a lawyer as early as possible, especially if injuries are moderate to serious, liability is unclear, or the insurance company is delaying or pushing back on your claim. An attorney can handle communications, and their involvement often results in much higher settlements.

⇒ What if my medical bills exceed the policy limits?

The insurance company will only pay out up to the policy limit. This is a cap on the money available. You may need to use your own underinsured motorist coverage, explore umbrella policies, or pursue the at-fault person’s personal assets through a lawsuit. An attorney can help identify all available sources of compensation.

⇒ What is maximum medical improvement (MMI), and when does it matter?

MMI is the point in the process when your condition has stabilized and is not expected to worsen or improve further. It is best to wait until you reach MMI before settling, so you know your future medical needs and can include all relevant details in your claim.

⇒ Should I accept the insurance company’s first settlement offer?

Usually no. Initial offers are often much lower than the true value of your claim. This is a common tactic used by insurance companies to minimize payments. Review any offer with a lawyer and respond with a strong counteroffer supported by evidence.

⇒ What if the other driver has no insurance or insufficient coverage?

File a claim under your own uninsured or underinsured motorist coverage. This is a branch of your personal insurance policy. If that is not enough, you may need to sue the at-fault driver directly. A lawsuit can target compensation through their personal assets. Act quickly because time limits apply.

⇒ What should I do if the insurance company requests an Independent Medical Examination (IME)?

Contact a lawyer before agreeing to an exam. It may be called “independent,” but IME doctors work at the request of the insurance company. Their report may be used to undervalue your injuries. If your attorney agrees to an examination, bring all of your medical records and discuss any injuries that are bothering you.

⇒ How do medical liens and subrogation affect my settlement?

Health insurers, Medicare, Medi-Cal, or workers’ compensation may claim part of your settlement to cover any initial payments that they made for your treatment. This reduces the final amount that you keep. However, a lawyer can sometimes negotiate to reduce these liens.

⇒ What if the insurance company disputes who was at fault?

Provide strong evidence, such as police reports, witness statements, and photos, to support your account. If they still refuse to accept liability, your attorney may recommend filing a lawsuit. Do not accept partial blame without legal advice.

⇒ How long do I have to file a claim or a lawsuit?

Insurance claims should be filed sooner rather than later. If your attorney escalates the case, you must observe strict deadlines. In California, you generally have two years from the date of the accident to file a lawsuit. Government claims must be filed within six months. Missing these deadlines usually means you lose your right to compensation.

⇒ What happens if the at-fault party works for the government?

You must file a special government claim within six months of the accident. When the government is involved, the process has stricter rules and shorter deadlines. It is highly recommended to have a lawyer handle government claims.

⇒ When do you need to escalate and pursue a lawsuit rather than an insurance claim?

You can file a lawsuit if the insurance company denies a valid claim, makes very low offers, refuses to compromise, or delays unreasonably. Most cases still settle during the lawsuit process before ever reaching trial.

⇒ What if I still have pain after my claim is settled?

Once you accept a settlement and sign a release, you usually cannot reopen the claim for future medical costs. This is why it is important not to settle too early, before you know the full effects of the accident and understand your long-term needs.

⇒ Can the insurance company cancel my policy if I file a claim?

No, they generally cannot cancel your policy simply for filing a legitimate claim. However, filing claims over time may affect your future premiums.

This FAQ focuses on practical steps that you can take after an accident. Every case is different. If you have concerns about your situation, consult with a personal injury attorney for personalized advice.

Key Statistics About Insurance Claims and Injury Cases

Understanding the numbers behind personal injury claims can help set realistic expectations. Below are some important statistics on the insurance process.

⇒ The Percentage of Claims Resolved Through Settlement vs. Filing a Lawsuit

Approximately 95% of personal injury claims are resolved through settlements with the insurance company without the need to file a lawsuit. Only a small percentage of cases require escalation to a formal lawsuit.

⇒ The Percentage of Lawsuits Resolved Before Trial

Of the cases that do go beyond the insurance claim and into litigation, the vast majority (over 90%) still settle before reaching trial.

⇒ Average Insurance Claim Settlement Timelines

Most cases take longer than you think they will. The timeline will depend on the circumstances of the accident. Simple cases with minor injuries often settle in 3-6 months. Cases involving serious injuries or disputed liability commonly take about 18 months. At the high end, complex cases that go to litigation can take 3+ years, depending on court calendars and whether they go to trial.

⇒ The Percentage of Claims Involving Uninsured Drivers

Nationwide, about 14% of drivers are uninsured. In California, the rate is a little higher. Current estimates suggest that 16-21% of drivers on California’s roads are uninsured.

⇒ Percentage of Drivers With Only Minimum Coverage in California

Statewide statistics are limited, but experts say that a significant portion of California drivers carry only the minimum required liability coverage, which is currently 30/60/15. Many experts note that the minimum coverage is often insufficient to cover serious injury claims, especially with rising medical costs.

⇒ The Economic Costs of Motor Vehicle Crashes

In 2019, motor vehicle crashes in the United States had an economic cost of $340 billion, according to NHTSA data. This number includes the total value of medical expenses, property damage, lost productivity and wages, and other costs. When quality-of-life impacts are included, the total societal cost of car accidents rises to $1.4 trillion.

Additional Useful Statistics

Medical expenses make up a large portion of crash costs. Property damage alone accounted for roughly $115 billion (about a third of the total costs).
Alcohol-impaired driving crashes cost about $69 billion in economic losses.
In California, minimum insurance requirements increased in 2025 to better address rising costs, but many drivers still carry only the legal minimum.

These statistics show why it is important to act carefully after an accident and consider professional legal help. Every case is unique, and outcomes depend on the facts of the case. For advice about your situation, consult with a qualified personal injury attorney.

Conclusion: Navigating the Insurance Claim Process

Dealing with an insurance claim after suffering an injury can feel overwhelming. This guide is designed to take the fear factor out of the process, walking you through the key steps, common challenges, and important concepts.

As you move forward, keep these essential issues in mind:

⇒ Insurance Companies are Profit-Driven

Even highly rated companies that generally serve their customers well are focused on maximizing profits. This means their adjusters are often under pressure to settle claims for as little money as possible. What feels like a fair offer to you may be viewed by the insurer as a loss to their bottom line. Understanding this reality helps you approach the claims process with realistic expectations and stronger advocacy.

⇒ Evidence and Documentation are Critical

The strength of your claim depends heavily on the quality of your evidence and your ability to prove your version of events. Thorough medical records, clear photos of the accident scene and injuries, witness statements, police reports, and detailed notes about how the injury affects your daily life all make a significant difference. Good documentation helps prove both liability and the full extent of your damages. Without it, even valid claims can be undervalued or denied.

⇒ Early Legal Guidance Can Improve Outcomes

Consulting with a personal injury attorney soon after your accident often leads to better results. An experienced lawyer can handle communications with the insurance company, protect you from common pitfalls and insurer tactics (such as recorded statements or premature settlements), gather important evidence, and negotiate more effectively. Many people receive significantly higher compensation when they have professional representation.

⇒ Understanding Insurance Policies Empowers Injury Victims

Knowing the basics – such as policy limits, exclusions, first-party versus third-party coverage, subrogation, and bad faith practices – puts you in a stronger position. When you understand how the system works, you are less likely to accept unfair offers and more likely to protect your rights.

In the end, the insurance claim process is designed to help injured people recover, but it does not always run smoothly or fairly. By staying informed, keeping strong records, and getting help when needed, you can navigate the process more confidently and work toward the fair compensation you deserve.

Thank you for reading this guide – we truly hope that it proves helpful. If you or a loved one has been injured, we encourage you to reach out for a consultation. At Bisnar Chase law firm, we are here to help you understand your options and fight for the best possible outcome.

We look forward to assisting you and wish you a full and speedy recovery.

About Bisnar Chase Personal Injury Attorneys

Bisnar Chase is a top-rated firm, earning a reputation as one of the most effective personal injury law firms in California.

Founded in 1978, Bisnar Chase has nearly five decades of experience handling cases of all types and injuries of all severities. We have supported more than 14,000 clients, securing the best possible results for victims and their families when they need it most.

The entire Bisnar Chase team believes in the firm’s mission statement. We provide superior client representation in a compassionate and professional manner while making the world a safer place.

Top-Quality Legal Services Throughout California

Bisnar Chase is based in Southern California, but handles cases across the entire state. The firm’s primary base is in Newport Beach, but it also has locations in Los Angeles, Riverside, San Bernardino, and San Diego.

Our results speak for themselves: a 99% success rate and over $1 billion recovered for our clients.

Results matter, and we fight tirelessly to win the maximum possible compensation for our clients. But we also believe in our moral and social responsibility. As a prominent business in our community, we organize and participate in multiple charity initiatives. We put together hundreds of backpacks filled with supplies for those in need and award scholarships to deserving students every year.

But above all, we provide top-tier support for accident victims. Even a relatively minor injury can have a significant impact on your health and your finances. But our team is here to fight for your rights with the insurance company and recover the financial compensation you deserve.

Contact Bisnar Chase for a Free Consultation

If you have been involved in an accident and want the best attorneys, paralegals, and pre-litigation experts working on your case, you should contact Bisnar Chase as soon as you can. Call (949) 203-3814, or visit our website at www.BestAttorney.com for a free consultation.

We have been doing this for a long time and have a long track record of success. Let us fight for you and ensure you get the justice you deserve.

Bisnar Chase Facts and Stats

The firm was launched in 1978 and has been handling injury cases ever since.
We have helped more than 14,000 clients.
Bisnar Chase has an outstanding 99% success rate.
We have secured settlements and trial verdicts totaling over $1 billion.
A significant portion of our cases is resolved with insurance companies, without the need for litigation.
When required, we have the resources to go to trial. Our attorneys are highly experienced in the courtroom.
Locations in Newport Beach, Los Angeles, Riverside, San Bernardino, and San Diego.
Serving the whole of California.
We offer a free consultation and work on a contingency basis, advancing the funds needed to win your case and protecting you from out-of-pocket expenses.
If you are unable to visit us, we will come to you.

Disclaimer: The content of this guide is for informational purposes only. It should not be considered legal advice. The information and case results included in this guide are based on the experiences of Bisnar Chase Personal Injury Attorneys, but every claim and recovery is different. If you have been involved in an accident, contact Bisnar Chase for legal advice specific to your case.

I had an attorney for my truck accident who wanted almost 60% of what my case was worth. Worse than that, he was willing to settle for $5,000.00 with the insurance company even though I was still treating for whiplash and back pain. I contacted Bisnar Chase Personal Injury Attorneys because a friend recommended them. My case was handled exceptionally well! I was being kept notified throughout the whole process and only when I was comfortable with the settlement figure, did my attorney Gavin Long, accept it. I felt like we were working together and I felt listened to. I would refer Bisnar Chase to anyone who wants quality over quantity!

Lauren B

Bisnar Chase has been amazing with me through my lawsuit. I felt real compassion for my case and I was given their very best to make sure I was well taken care of. In addition to the great service given during my case, Bisnar Chase helped me get my son to his invited USA Football Team camp in Texas. They immediately offered to help fund the trip and are so supportive of his journey. I felt Kristi is just as excited for him as I am with this opportunity. Kristi has been an absolute delight to talk with. Bisnar Chase is more than I ever expected I could get in an attorney. I would recommend them to anyone!

Christina Del Real

I’m so impressed with this law firm. I lost my mother because of a seat defect when she was rear-ended in an auto accident and Bisnar Chase stepped up and took our case. The staff is wonderful and Brian Chase took his time explaining everything via phone with me. I’m honored to have the best of the best working on our family’s behalf, trying to get justice for my Mom, because of a negligent car company still manufacturing faulty seats. I look forward to working with this firm and am hopeful for a positive outcome. Thank you so much, Brian Chase. I know you will work your hardest on this case. God Bless you.

Natalie C.

I wasn’t sure if I needed a personal injury attorney because I’d never been in a car accident before. I assumed I’d just go straight through the other driver’s insurance but that quickly became a nightmare. I spent months fighting over the simplest of issues about my case, which was 100% the other driver’s fault. I hired Bisnar Chase to see if they could just take it over for me. I was really impressed with how much they communicated everything to me! I suddenly started getting calls from the insurance company, imagine that. My final settlement was 6 times what I asked for to begin with. Everyone I dealt with was really involved in what was best for me, not the insurance.

Lena Murillo