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Insurance Claims Dos & Don’ts

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The Dos

Do call your agent as soon as a covered event takes place. As soon as you get home from the car accident, or even before you go to the doctor, call your agent.

Do review and understand your coverage before talking to your insurer or your agent. Read the “Coverage” and “Exclusion” sections of you policy in particular.

Do take and keep detailed notes of all conversations with insurance company representatives, and get names, phone numbers, and job titles of people you speak with, including their supervisor’s name.

Do consider whether you might have insurance coverage under some other insurance policy as well. Many people have more than one policy that might cover a claim. In particular, look at homeowner policies, “umbrella” policies, and materials that came with your credit cards.

Do take pictures, if possible. That doesn’t mean you should sneak a “PatientCam” into surgery with you, but take pictures of your destroyed vehicle, fire-damaged home, or injuries if you can.

Do be honest and forthcoming with your insurer. Even if it is embarrassing, it is better if your insurer knows all the facts. Failing to be candid with your insurer might invalidate your policy or cause a denial of coverage.

Do understand the difference between replacement coverage and depreciated or actual cash value. If your policy provides replacement coverage, don’t settle a personal property loss for “actual cash value.” You may be required to replace the lost items before getting your full reimbursement if you have replacement cost coverage.

Do keep all receipts of meals, lodging, and purchases made in connection with time spent pursuing your claim or recovering from your injuries from the time of the covered event until final settlement with your insurance company.

The Don’ts

Don’t give any recorded or written statements to your insurer until you are sure you understand your coverage. Remember you are not required to allow the insurance company to record your telephone conversation. If you have doubts, do consult an attorney.

Don’t automatically accept the estimate or appraisal of your losses given to you by the insurer. Insurance companies will often try to get you to accept their estimator’s or contractor’s repair or replacement estimates, which might be a bit low. DON’T sign any releases or waivers of any kind until you obtain legal advice. A bad financial situation after a major loss may make it seem necessary for you to accept a premature, inadequate settlement from your insurer. But you may remember destroyed items after you have signed a release as to payment for your personal property inventory or other claims. For these reasons, it is advisable to consult an attorney before signing a release or waiver. Be sure to read the fine print on any payment from the insurance company.

Don’t accept any check that says “final payment” unless you are ready to do so.

Don’t ignore time limits set by your policy. Most policies require a signed proof of loss within a certain time limit. Be sure you comply with this requirement unless you obtain a written waiver from your insurance company. Many policies allow you only one year from the date of loss in which to bring a legal action if your claim has not been adjusted fairly. If your claim has not been settled to your satisfaction eleven months after your loss, consult an attorney immediately. A failure to do so could result in the loss of your right to sue.

Don’t forget that you have a contract with your insurer. Your insurer has a legal obligation to provide the coverage it promised to you. Be insistent about enforcing that obligation.

Motor Vehicle Accidents – An Overview

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Cases arising out of automobile accidents are by far the most common type of personal injury case pending in our court system today. This is not surprising, given that every 10 seconds, someone in the United States is involved in a car accident, according to the National Highway Traffic Safety Administration (NHTSA). Except in those states where legislation eliminating fault as an issue has been passed (no-fault laws), these cases are typically governed by the law of negligence. Generally, people who operate automobiles must exercise “reasonable care under the circumstances.” A failure to use reasonable care is considered negligence. A person who negligently operates a vehicle may be required to pay for any damages, either to a person or property, caused by his or her negligence. The injured party, known as the plaintiff, is required to prove that the defendant was negligent, that the negligence was a proximate cause of the accident, and that the accident caused the plaintiff’s injuries. If you have been involved in a motor vehicle accident, you must not hesitate to seek legal counsel from a personal injury attorney experienced in automobile accident cases in order to best protect your interests.
Fault

As with other types of accidents, figuring out who is at fault in a traffic accident is a matter of deciding who was negligent. In many cases, your instincts will tell you that a driver, cyclist or pedestrian acted carelessly, but not what rule or rules that person violated. Fault issues can be complicated, and an experienced attorney will look to a number of sources, such as police reports, state traffic laws, and witnesses, to help you determine who was at fault for your accident.

Courts look to a number of factors in determining whether a driver was negligent. Some of these factors include, but are not limited to, the following:

  • disobeying traffic signs or signals;
  • failing to signal while turning;
  • driving above or below the posted speed limit;
  • disregarding weather or traffic conditions;
  • failing to drive on the right side of the road; and
  • driving under the influence of drugs or alcohol.

Causes of Automobile Accidents
A driver may also be liable for an accident due to his or her intentional or reckless conduct. A driver who is reckless is one who drives unsafely, with “willful and wanton disregard” for the probability that such driving may cause an accident. A driver could be found reckless, for example, if he or she drives in a threatening or harassing manner out of “road rage” and causes an accident. (Criminal charges will also stem from such behavior). Road rage is defined as “an assault with a motor vehicle or other dangerous weapon by the operator or passenger(s) of another motor vehicle or an assault precipitated by an incident that occurred on a roadway.”

Statistics compiled in 1997 by NHTSA and the American Automobile Association showed that almost 13,000 people had been injured or killed since 1990 in crashes caused by aggressive driving. According to a NHTSA survey, more than 60 percent of drivers consider unsafe driving by others, including speeding, a major personal threat to themselves and their families. About 30 percent of respondents said they felt their safety was threatened in the last month, while 67 percent felt this threat during the last year.

Traffic safety and law enforcement organizations are renewing efforts to identify and penalize aggressive drivers-those who speed, tailgate, zip from lane to lane, flash headlights in frustration, and engage in other dangerous driving practices. The NHTSA defines aggressive driving as a progression of unlawful driving actions such as:

  • speeding-exceeding the posted limit or driving too fast for conditions;
  • improper or excessive lane changing;
  • failing to signal intent;
  • failing to see that movement can be made safely; orv
  • improper passing-failing to signal intent, using an emergency lane to pass, or passing on the shoulder.

Avoiding an Accident
If you are confronted by an aggressive driver, the NHTSA recommends that you take the following actions:

  • Get out of the way: first and foremost, make every attempt to get out of his or her way.
  • Put your pride aside: do not challenge the aggressive driver by speeding up or attempting to hold-your-own in your travel lane.
  • Avoid eye contact: eye contact can sometimes enrage an aggressive driver.
  • Avoid gestures: ignore gestures and refuse to return them.
  • Report serious aggressive driving: you or a passenger may call the police, but, if you use a cell phone, pull over to a safe location.

Drunk Driving
Every 30 minutes, someone in this country dies in an alcohol-related crash. Last year alone, over one million people were injured in alcohol-related traffic crashes. In a lawsuit arising from a drunk driving accident, in addition to the intoxicated driver being held liable for the injuries he or she caused, a bar or social host may be liable for damages if they served an obviously intoxicated guest, who then drove and caused an accident. The fact that the person who served the intoxicated driver alcohol may be held liable does not relieve the intoxicated driver of liability, however. Experienced personal injury attorneys are aware of the many laws governing legal responsibility and can help you identify who might be held responsible for your injuries, including people or businesses you may not have considered.

Accidents that are Not Caused by the Drivers Involved
In certain cases, accidents are caused by factors unrelated to the conduct of any particular driver. For example, an automobile accident may occur due to a defect in someone’s automobile. In such a case, an automobile manufacturer or supplier may be responsible for injuries caused by a defect in the automobile under the law of product liability. A product liability suit is a lawsuit brought against the seller of a product for selling a defective product that caused physical injury to a consumer or user. If a manufacturer of a product creates a defective product-either in designing, manufacturing, or labeling the product-the manufacturer is liable for any injuries the product causes, regardless of whether the manufacturer was negligent.

Another example of a situation where a driver may not be at fault for an accident is where a mechanic fails to properly repair a vehicle, and the failure causes an accident. In such a case, the person who improperly repaired the automobile, and his employer, may be liable for the injuries sustained under the theory of negligence.

Other factors, such as poorly maintained roads and malfunctioning traffic control signals can contribute to cause an accident as well. Improper design, maintenance, construction, signage, lighting or other highway defects, including poorly placed trees and utility poles, can also cause serious accidents. In cases such as this, government entities may be potential defendants. Special rules apply to claims and lawsuits brought against governmental bodies, however, and good legal advice is critical to preserving and winning such claims.
Conclusion

In all of the above cases, it is essential that accident victims take prompt measures to preserve evidence, investigate the accident in question, and have physicians or other expert witnesses thoroughly evaluate any injuries. If you have been a victim of an automobile accident, do not hesitate to call upon personal injury attorneys who are skilled and experienced in motor vehicle accident cases to assess your situation and determine the best methods for you to obtain any compensation available for the damages you suffered.

What to do if you are in an accident

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Immediately after the accident
If you are involved in an automobile collision, stop. Most states require an individual not to leave the scene of an accident, even a minor one, without first stopping to see whether there are damages or injuries. A person may be criminally prosecuted for leaving the scene of an automobile accident.

Next, check for injuries. Generally, you should not move an injured person. Call an ambulance, if necessary, and the police. If you are unable to call, ask somebody else to call the police to report the accident and inform the police of the number of people who are injured, so that enough emergency personnel respond to the scene.

If possible, notify oncoming traffic to proceed with caution by setting out flares, turning on your hazard lights, or raising the hood or trunk of your vehicle.

You and the other driver should exchange information, including the other driver’s name, address, phone number, drivers license number, license plate number, insurance carrier, policy number, and agent’s name and telephone number. You should also provide the same information to the other driver.

Obtain identifying information from any witnesses to the accident, and ask the police officer who investigates the scene to provide you with a business card and the “incident number,” so that you can obtain an accident report.

You may also want to take notes about where and how the accident occurred, road conditions, speed limits, traffic control devices, weather, lighting, and what the cars were doing at the time of the collision. However, if you end up in litigation related to the accident, you may be required to share these notes with the other party.

Even if you think you are at fault, do not say so. The other driver may share the fault or other factors may have caused the accident. An admission of fault may be used against you later on.

When the police arrive
Cooperate fully with the police when they arrive, and stay at the accident scene until the police tell you that you can leave. When you speak to the police, tell them only the facts of what happened, and do not draw any conclusions. Do not admit responsibility for the accident to the other drivers, passengers, witnesses or the police. Responsibility or liability is a legal matter that is not always easy to determine. Inform the police of any injuries and witnesses.

Soon after the accident
Photograph your injuries and the damages to your car. Gather all automobile insurance policies in your household for evaluation by an attorney, and inform your insurance company of the accident. Obtain legal advice before filling out insurance documents, giving recorded statements to any insurance company, or meeting with any insurance company representative. It is especially important to consult an attorney before giving a statement to the other driver’s insurance company. Do not sign any check or document from any insurance company without first consulting an experienced personal injury attorney.

Consult a physician as soon as possible. You may experience a time lag between the collision and full awareness of the extent of your injuries. Certain injuries may not be apparent until sometime after an accident. By not seeing a doctor, you risk delaying your treatment and aggravating your injury. Even minor soreness can be an indication of a more significant injury. Therefore, if you believe there is any chance you may have been injured, you should see a doctor as soon as possible. An insurance company may argue that the failure of an individual to see a doctor right away indicates that an injury must have resulted from an unrelated event after the accident. The longer you wait for medical treatment, the more difficult it will be to connect the injuries to the accident. Be sure to report any memory loss, headaches, blood or fluid in your ear, dizziness, ringing in your ears, disorientation, nausea, or confusion.

Later
Within a few days of the accident, record all important information, license numbers, and the year, make and color of all vehicles involved, and the details of the accident, including date, time, location, road conditions, traffic controls, and weather conditions. If you have not yet contacted an attorney, you should talk to a lawyer that has the experience, dedication and ability to maximize your compensation and minimize the frustration, delay and confusion that you may experience when you make an injury claim.

Document all of your losses, including medical bills, reasonable transportation costs related to the injuries, future medical treatment, lost wages, future loss of earnings, the effect on your family, and the effect on your life. An experienced attorney can help you identify all losses that may be related to your accident.

Car Accident Facts

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» 13,000 people have been injured or killed since 1990 in crashes caused by aggressive driving. If you have been a victim of aggressive driving, click here to tell us about your case.

» Every 30 minutes, someone in this country dies in an alcohol-related automobile crash. If you have been affected by an alcohol-related accident, click here for an evaluation of your case.

» Improper design, maintenance, construction, signage, lighting or other highway defects, including poorly placed trees and utility poles, can also cause serious accidents. If you haven’t brought a personal injury claim because you didn’t think there was another driver to blame, contact us to evaluate other potential defendants.

» Road rage is defined as “an assault with a motor vehicle or other dangerous weapon by the operator or passenger(s) of another motor vehicle or an assault precipitated by an incident that occurred on a roadway.” If you have suffered as a result of someone else’s road rage, contact us!

To learn more about car accidents and what actions you should take, visit our car accident faq.

No-Fault Insurance

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The laws of the state in which the accident occurs determine who pays for the damages from an automobile accident. Basically, in a no-fault insurance state, fault is not placed on either party, and each driver generally submits a claim to his or her own insurance company instead of establishing blame. Many states, including Florida, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, Pennsylvania, and others, have some form of no-fault insurance laws. No-fault auto insurance is widely misunderstood, and is applied differently in every state that offers it. If you are in an automobile accident, you should contact an experienced personal injury firm to discuss how the relevant state law views fault and to determine how fault or no-fault laws may affect your right to recover damages for injuries.
How no-fault insurance works

“No-fault insurance” describes any automobile insurance system that requires drivers to carry insurance for their own protection and limits their ability to sue other drivers for damages. In an accident under a no-fault system, your auto insurance company will pay for your damages up to your policy limits, no matter who was at fault for the accident. Other drivers involved in the accident are covered by their own automobile insurance policies.

Under a pure no-fault system, drivers would be entirely covered by their own policies and could never sue any other driver for damages, but no state currently uses a pure system. All no-fault states use parts of the no-fault system and parts of the standard-liability system, under which a party is responsible for the cost of damages he or she causes, so lawsuits are permitted under some circumstances in all states.

The amount and type of no-fault insurance required varies from state to state. Some states allow injured parties to sue if their injuries are severe, while others allow suits if the total costs reach a certain dollar level. Many modified no-fault systems pay for economic damages up to the policy limit, but allow the injured party to sue for non-economic damages if the amounts of these damages are greater than a specified amount. These thresholds also vary from state to state. Therefore, you should contact a personal injury law firm experienced in car accidents if you are in an accident in any no-fault state to determine and analyze the relevant laws.

Choice no-fault
Choice no-fault insurance laws create two classes of insured drivers in some states by retaining parts of both the no-fault and the traditional fault-based systems. Pennsylvania and New Jersey have implemented versions of choice no-fault laws. Under a choice system, drivers choose whether they want to be insured under a no-fault plan or retain some traditional tort rights similar to modified no-fault. For example, if a driver chooses a pure no-fault plan, he or she may not be able to sue negligent drivers for non-economic damages, but he is also immune from such suits. However, if the driver retains traditional personal injury suit rights, he or she can sue other drivers who have also chosen to retain their tort rights, but, in exchange, they can sue him or her. An experienced attorney can help you work through the complicated issues regarding fault, whether you are in a fault or a no-fault state.

A no fault insurance policy
If you live in a no-fault state, the no-fault part of your auto insurance policy is usually called personal injury protection (PIP). Different states’ PIP packages cover different expenses, but benefits generally include most injury-related expenses, including medical costs, lost wages, compensation for loss of services, funeral expenses, and death benefits. Some damages, such as pain, suffering, emotional distress and inconvenience, are generally not covered by no-fault insurance coverage. Also, medical expenses or lost income above any established limits are not covered, and other insurance coverage is typically needed to cover physical damage to vehicles.
Conclusion

Although no-fault, in its purest form, would arguably simplify recovery of damages for automobile accident injuries by entirely eliminating any concept of fault, no state currently has a pure no-fault system, and it is unlikely that any state will ever adopt one. The current no-fault and fault systems vary significantly from state to state, and can be very confusing. An attorney experienced in motor vehicle accident cases will be able to help you sort through the applicable state laws and choose the path for recovery that’s best for you.

Car Accident Injuries and Compensation

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Generally, an individual injured in an automobile accident may bring a claim or lawsuit to recover the actual expenses associated with property damage and medical costs, economic damages, and emotional and physical pain and suffering. Litigation involving motor vehicle accidents can be extremely complicated. Retaining an experienced lawyer familiar with motor vehicle accident damages will place you in the best position to receive the recovery that you deserve.

Damages
In automobile accident cases, as in all negligence cases, the injured party may recover for physical pain and suffering, mental pain and suffering, medical and rehabilitative expenses, past and future lost income, permanent impairment and permanent disfigurement. Typical damages may also include future medical bills that are reasonably certain, loss of enjoyment of life, and physical property damage. A previous injury does not necessarily affect the right to recover compensation. The injured party may still recover damages for re-injuring or aggravating the earlier injury. In order to document the damages, a person injured in an accident should keep a daily diary describing how the injury affects him or her and his or her immediate family.

Family member’s damages
The spouse of the accident victim may also be able to recover for damage to the marital relationship. Both the husband and wife usually bring the claim, which is known as “loss of consortium.” Loss of consortium generally refers to any negative effect on the marital relationship caused by the accident, and includes loss of the spouse’s love, companionship, comfort, affection, solace, moral support, sexual relations, ability to have children, and physical assistance in the operating and maintaining a home. Loss of consortium can be either temporary or permanent.

Insurance
Typically, an insurance company will compensate the victim for his or her damages. If the other driver has insufficient insurance or is not insured at all, the victim may be entitled to compensation from his or her own insurance company under an uninsured or underinsured motorist provision. Also, other insurance policies, such as the policies of other family members or employers, may provide benefits to the injured person. Even if the injured person was partially at fault, the law may permit a recovery. To protect yourself and your family in the event of an accident, you must contact an experienced attorney to review your insurance policies and to inform you of your legal rights under your policies.

Recovery Amount
The value of an automobile accident case depends on a number of factors, including how the state looks at fault, how easily the other party’s fault can be established, the type and seriousness of the injuries, the type of medical treatment required, and the amount of insurance coverage available. Other relevant factors may include how the accident happened, the extent of vehicle damage involved, whether the injuries are permanent or involve significant scarring, the amount of your past and expected future medical bills, and the effect of the accident on your income. Every personal injury case is different. Therefore, the assistance of an attorney experienced in handling automobile accident cases, is vital to determine the fair value of your personal injury claim.

Injuries received in a motor vehicle accident can be catastrophic. Serious and disabling injuries can affect not only the injured person, but family members as well. Even relatively minor injuries that require medical care and result in lost time from work can have a great impact on a family. If you are an automobile accident victim and have specific questions or concerns about compensation for your losses, contact an expert personal injury law firm to assist you by diligently pursuing the individuals or companies that caused your injuries, determining what insurance is available, and maximizing your recovery.

Uninsured or Underinsured Motorists

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Many drivers ignore motor vehicle insurance requirements, cannot afford to purchase insurance, or carry insufficient insurance. Uninsured motorist coverage is a form of insurance that pays for bodily injury that results from an accident with a driver who is legally responsible for the injuries, but has no liability coverage. Underinsured motorist coverage pays for bodily injury that results from an accident with a driver who has liability insurance with limits that are lower than the injured party’s underinsured motorist coverage limits. If you have been involved in an accident with an uninsured or underinsured driver, it is important that you contact an attorney at an experienced personal injury law firm immediately so you do not waive valuable legal rights.

Uninsured Motorists
Typically, uninsured motorist coverage protects injured drivers if the at-fault driver has no insurance. Uninsured motorist coverage can also apply when someone is injured in an accident with an unidentified hit-and-run vehicle. If a person has uninsured motorist coverage and is in an accident with an uninsured motorist, he or she can collect from his or her insurance company to recoup damages. If you are involved in an accident with an uninsured motorist, you should consult with an experienced personal injury attorney before you file a claim with your insurance company to ensure that you obtain all of the coverage available to you.

Underinsured Motorists
Underinsured motorist coverage provides compensation for injured drivers when the at-fault driver does not have enough insurance coverage to compensate the injured party in full for his or her injuries. An “underinsured motorist” is generally a person who is responsible for the injuries, but who has opted to purchase only the minimum policy required by law. If a person has purchased underinsured motorist coverage is in an accident with an underinsured motorist, he or she may be able to collect from his or her insurance company to recoup damages that are greater than the responsible party’s limits.

Collecting benefits
In order to collect underinsured or uninsured motorist benefits, a party generally must first establish that the underinsured or uninsured driver was at fault and that he or she suffered significant injuries. In the case of underinsured motorist benefits, the injured party must also collect the at-fault driver’s policy limits before collecting under his or her own insurance policy. An insurance company is typically entitled to a credit for any recovery received from the underinsured motorist’s policy.

Stacking Insurance Coverage
Uninsured and underinsured motorist coverage is “stackable” in some states and under some policies. Stacking uninsured or underinsured motorist coverage may permit a person to add together either insurance coverage from several motor vehicle policies or insurance coverage for several vehicles listed on one policy. In some cases, a person may select stackable coverage at the time he or she purchases the insurance.

Uninsured and underinsured motorist coverage protects a person if someone who does not have adequate insurance injures him or her in an automobile accident. If you are in an accident with someone who is uninsured or underinsured, do not settle with the other driver’s insurance company without first contacting an experienced lawyer. Some underinsured motorist policies are not required to pay if the insured person has settled with the other driver’s insurance company. This can be a very costly mistake. Therefore, you should consult with a personal injury law firm experienced in dealing with automobile accident cases before you settle any portion of your claim. An attorney can provide you with the information and support you need to obtain the best result available to you.

The James Law Groups Assists People Injured in Car Accidents

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Whether you are involved in a fender bender or you are suffering from catastrophic injuries, you need an experienced advocate to look out for you, protect your interests, and see that you are treated fairly by the insurance company.

James Law Group, LLC, in St. Peters, Missouri, has extensive experience representing clients suffering from injuries sustained in auto accidents. We will work tirelessly to secure the compensation you are entitled to receive. Our attorneys help people who have sustained serious brain injuries, burns, fractures, breaks, dislocations, neck injuries, whiplash, back injuries, nerve injuries, paralysis, and spinal cord injuries. We handle motor vehicle collisions, car accidents, and crashes involving the negligent and reckless conduct of other drivers in:

  • Alcohol and drug-related motor vehicle wrecks, collisions, and crashes
  • Drunk driving crashes
  • Hit and run accidents involving personal injuries
  • Rear end collisions and intersection accidents
  • Motorcycle accidents, crashes and collisions
  • Rollover accidents involving cars, trucks, SUVs and other motor vehicles
  • Semi-truck, eighteen wheeler, and tractor trailer crashes
  • Railroad Crossing Accidents
  • Uninsured and underinsured drivers
  • Wrongful death lawsuits
  • Brain Injury

The insurance company will work hard to limit your financial recovery. We work just as hard to maximize it. If you have been injured in a Missouri car accident, you can count on the experience and caring representation provided by the lawyers at James Law Group, LLC. Contact us today to get the legal representation you need to get the best outcome from your car accident claim.

James Law Group, LLC
14 Richmond Center Court
St. Peters, MO 63376
Phone: 636.397.2411
Toll Free: 800.229.7112
Fax: 636.397.2799
Representing clients throughout Missouri and the greater midwest. We
have experience handling personal injury, criminal defense and worker’s
compensation cases.

The choice of a lawyer is an important decision and should not be based solely upon advertisements.