Many car and other vehicle collision claims can be resolved on their own, with no input from a lawyer. If you wish to deal with the insurance company on your own, here is a framework to assist you in guiding your claim to resolution.

Settling Your Claim by Yourself

Processing your claim on your own means you will have to deal with two insurance adjusters – yours and the one for the other driver’s company. If the person who caused the wreck has insurance, then that adjuster will be the principal one to deal with.

Many individuals don’t believe they need to contact their own company, since “the wreck was not my fault.” That is incorrect. You are obligated to, by your contract, but it is not likely to affect future premiums.

If you have not been seriously injured, and there appears to be no permanent injury, by all means handle matters on your own. Most injury lawyers, in Ohio and around the United States, charge about one-third of the gross settlement amount. This ABA-approved rate is pretty uniform. Some law offices charge 40-45% if they are going to advance the costs, and the liability is questionable. Cost advancements include expected charges such as for medical documentation and physician depositions.

If your claim evolves into an action, meaning a lawsuit, then you can expect to spend the next 2-4 years working together with a lawyer. Even if you decide to retain counsel, know that many more claims settle than ever proceed to trial. This especially is true if the assigned judge rules in your favor on pre-trial motions.

How Claims Adjusters Think

In order to effectively deal with the insurance adjuster, it’s important to know how they see you and the claims marketplace. For all the high-tone talk about the American system of justice, the fact is the adjuster will perceive your claim as just another suspect demand for money. Fairness and truth – these notions won’t enter their thought processes.

Insurance companies are multi-billion dollar machines beholden to their stockholders. Restoring broken bodies and uprighting damaged families is not their concern.

Although some adjusters are surly, many are exceedingly friendly. In their training seminars they are taught to be pleasant, as a tactic, to gain control by winning your favor. It is a common mistake of claimants to believe that the other driver’s adjuster genuinely cares about them. They don’t. At all.

Adjusters compete for raises and supervisor positions. They are evaluated on the basis of numerical criteria – how much money they are able to withhold from deserving victims.

There are Two Distinct Claims – Property Damage and Bodily Injury

Remember that property damage claims are separate from those involving bodily injury. The claim for the damage to your car, truck or motorcycle will usually be resolved within about 2 weeks. Their property appraiser will examine your vehicle and declare it fixable or totaled. If it is the former you will be entitled to a rental car. If it’s totaled, the adjuster is under no legal obligation to provide you with a rental, while you scout for a new car. However some companies will pay for a rental for a few days, under certain circumstances.

Property adjusters will negotiate little, or not at all, once they’ve set a price for your totaled vehicle. They know that Ohio law favors them. The only way you can challenge their opinion is to file a lawsuit. This will take time and you will have to pay for your expert witness to come to court and advocate on your behalf. The cost in time and fees make this a too-costly victory at best.

This is an unfair provision in the law, but so far the Ohio Supreme Court and the General Assembly have been reluctant to design a fairer way. The state has an interest in forcing people to accept one-third or less. This keeps the courts from having backlogged dockets. You pay the price for this state-wide expeditious approach.

The bodily injury claim is different. You are entitled to full compensation for your losses. This includes the healthcare bills, lost wages, and other elements of loss. Added to this is an elastic and amorphous damages claim for “pain and suffering.” This allows for you to receive compensation for all your bodily pain as well as the psychological and emotional trauma you have experienced.

The Money Has To Come From Somewhere

Since the other driver was at fault for your injuries, your initial approach is against their insurance company for compensation. If those policy limits are minimal, or there is no insurance, then you will be pursuing a claim against your own company for uninsured or underinsured motorist coverage.

As a general rule of life, major collisions are caused by people who are irresponsible in all of their life spheres. That’s just the way they are. And they also have no insurance and no real assets. Usually these agents of mayhem have a history of bad driving. As a result, the most they can obtain is “high risk” coverage. It costs a lot for low policy limits.

It is uncommon for catastrophic wrecks to be caused by drivers who have the totality of their lives together. If you have strong uninsured/underinsured policy limits, your losses will likely be covered.

When you make a claim against your own company, they will treat you no differently than if you were not a customer. Their objective will be to minimize your recovery.  This is a very unpleasant surprise for some. They have a skewed understanding of how the auto insurance industry operates. Families insured with the same company, for decades, assume their loyalty will be returned. It won’t. Insurance companies rely on mass advertising to recruit new customers. Retaining you will not be as important as getting you to accept stripped-down, pared-to-the-bone compensation.

The Value of Your Claim

The value of a claim is usually unknowable at the beginning. However, after the medical bills have been received, along with the medical charts, the value dimensions will become more evident. Then a general value range will reveal itself.

A claim is worth the total of all the sustained losses. This includes medical bills, lost wages, future medical bills and lost wages, property loss and other elements such as permanent injury.

Negotiating Your Claim to Resolution

Whatever you believe to be the value of your vehicle collision, your demand should be framed in a way that will be recognized as legitimate by the adjuster. A shorthand way is to total your medical bills and multiply by a factor of three or four. But understand it will resolve for much less. The days of actually settling claims by a 3-4 times formula are gone. You want to initiate the bargaining process by beginning with a figure. Unlike when adjusters deal with lawyers, they often will make a specific offer to you before you have approached them.
Adjusters will judge you on how organized, prepared and professional you are. Keeping notes of all calls, having all documents together and speaking in an appropriate tone will project you in a most credible way. Print copies of all emails should be kept in the correspondence section of your file. Dignified but firm communications will enhance your image.

Adjusters evaluate billing statements and physician charts, and code select information into a computer program, most often Colossus. This software will provide the adjuster with a value range; you want to get to the top of it. The front line adjusters have no authority to give you more than that dictated by the computerized evaluation. After exhausting all attempts, ask to speak with their supervisor. It sometimes helps in obtaining extra dollars beyond the pre-set range.

If you are still unhappy, then you can request to have your matter heard in arbitration or mediation. Some insurance companies will permit alternative dispute resolution which does not require lawyer involvement. You can also file a Small Claims Court action. Those forums do not require lawyers.

Don’t Forget Subrogation Rights

After you bring your negotiated claim to a fine point, there remains another task. You may be required by your medical insurer to honor their subrogation rights.

If your medical insurer, Medicaid or Medicare paid for your accident-related medical bills, they did so under your policy contract. Now you are obligated to return those amounts. This requirement only applies of you actually obtain settlement funds.

If the amount you are getting for your injuries is nominal, then consider calling the subrogation department of your medical insurer. Inform them that you will end up with a paltry amount for all you’ve been through. A personal appeal will sometimes result in them trimming the obligated amount by as much as one-third. You have been, in effect, acting as their legal counsel in deriving funds they would ordinarily never get reimbursed.

If the Other Driver’s Insurer Has Ignored You

You have recourse if the defendant’s claims adjuster has deliberately ignored you or engaged in misrepresentation.

Ohio citizens can file a formal complaint with the Ohio Department of Insurance. This governmental agency is charged with the duty to safeguard consumer interests. They regulate insurance company practices and monitor the behavior of agents and adjusters.

Inquire about the process before filing your complaint:

Ohio Department of Insurance
Consumer Services Division
50 W. Town Street, Suite 300
Columbus, Ohio 43215
614-644-2658/800-686-1526 Consumer Hotline

While your complaint is being investigated for possible sanctions, you can still consider whether you should retain legal counsel. However Ohio maintains strict time limits for filing actions. If the lawsuit is not filed within the timeframe required by law, then all rights will be waived.

If a lawyer gets involved, they will consider whether two actions should be filed. One for the underlying vehicle collision, and the second for the insurance company’s violation of “bad faith” law.