Presenting Your Personal Injury Claim



Contents of a demand package

The demand package represents one of the most important aspects of your personal injury claim. A claim is presented to the at-fault insurance adjuster when a demand package is sent to that insurance company for review. The demand package must be very carefully prepared and reviewed in order to ensure a successful outcome for your claim.

There are several essential components to a demand package, including:

    • A well-worded and succinct Demand Letter outlining exactly how you were injured and why you deserve compensation
    • A copy of the accident report created by the investigating officer at the scene
    • Copies of all medical bills and records related to injuries sustained as a result of the accident
    • Verification of your lost wages from work that were incurred as a result of the accident
    • Out-of-pocket expenses, including prescription medication costs, medical equipment expenses and travel-related expenses associated with the accident.
    • Any evidence of pain and suffering that resulted from the accident
    • Miscellaneous documentation, such as witness statements, pictures of the scene of the accident, pictures of injuries, etc.

These elements give an idea of what evidence Wallace Pierce Law considers when compiling a demand package on behalf of one of our clients. The actual contents of a successful demand package may vary from claim to claim.

How to obtain a police report

The police report contains important details related to your accident and is typically filled out by the investigating officer at the scene of the accident. To get a copy of your accident report free of charge, submit a request for Your Accident Report. You may also make a formal request to the North Carolina Department of Motor Vehicles by filling out the official Accident Report Request Form. We have provided a copy of that form here: DMV Request Form. Send this form along with a check for $5, made out to NCDMV by U.S. mail to:

      Traffic Records Branch
      Crash Reports Unit
      3105 Mail Service Center
      Raleigh, NC 27699-3105

Be sure to include a copy of the police report in the demand package that is sent to the insurance adjuster. It may also be useful to keep a copy of the report for yourself.

Obtaining bills and records

Medical bills and records represent vital pieces of evidence in presenting your personal injury claim to the insurance adjuster. As a patient of a medical provider, you will receive patient bills in the mail related to your treatment. However, the format of these bills differs slightly from the bills an insurance adjuster requires to assess your claim. The adjuster will need bills that contain specific medical coding, and you will need to explicitly request this type of coding to be present on your bills from the medical provider. Specifically, you should request itemized bills for your dates of service that include CPT and ICD-9 codes and reflect any patient or insurance payments. CPT and ICD-9 codes are basically diagnosis and procedure codes that let the adjuster know exactly what kind of treatment you received. As far as medical records, you should be able to request those directly from your medical provider for all dates of service related to the accident without any certain specifications.

If you have hired a lawyer to handle your case, they can request medical bills and records required for a demand package on your behalf. Generally, an experienced car accident lawyer will have no trouble obtaining the proper types of medical bills and records to aid in the presentation of your claim. However, in order for the lawyer to request on your behalf, you must sign a form that authorizes the medical provider to release your protected medical information to the law office. See an example of Wallace Pierce Law’s Authorization for Release of Medical Information form here. As stated above, you will also likely receive bills from each provider throughout the process, but these bills are different than the kind an attorney’s office needs to present your claim. The insurance adjuster requires specific medical coding and proof of insurance payments, if applicable, to be present on each bill. Thus, the law office will request these special bills as well as records on your behalf with your signed consent. However, you should continue to pay your medical bills as you receive them from each provider. If you are having trouble paying your medical bills on time, please read our article on Paying for Medical Treatment.

Calculating lost wages

If your injuries sustained during a car accident caused you to miss work, you may be eligible to claim compensation for lost wages from the at-fault insurance company. To calculate your lost wages, multiply the number of hours missed due to your accident by the hourly rate paid to you by your employer. It is important to verify this information with your employer using something like our Employment and Lost Wage Verification Form. A W-2 tax form may also serve to verify this information. If you are a salaried employee, or are paid on commission, lost wages may be more difficult to calculate. Wallace Pierce Law would recommend that instead of attempting to estimate these types of lost wages on your own, contact a North Carolina personal injury attorney to help you properly calculate what you would have earned, if not for your involvement in the accident.

Out-of-pocket expenses

You may also be eligible to be reimbursed by the insurance company for out-of-pocket expenses related to injuries caused by the accident. For example, if you paid for any prescriptions related to your accident when you picked them up at the pharmacy, you should submit the receipts as evidence for your demand. Out-of-pocket expenses may include prescription costs, cost of medical equipment (such as an orthopedic boot you paid for out-of-pocket, a cane or a cervical collar), as well as expenses related to travel to and from medical facilities. To calculate travel-related expenses, you should document your mileage to and from each medical provider visit using your car’s odometer or a GPS. Depending on the insurance company, you may be able to be reimbursed at the standard IRS business rate or the IRS rate for medical miles driven. As of January 1, 2016, the standard mileage rates for the use of an automobile are 54 cents per mile for business miles driven and 19 cents per mile driven for medical or moving purposes. Above all, we recommend that you save any and all receipts related to the accident, as you may be able to submit these as evidence when you present your claim.

How is pain and suffering calculated?

Compensation for pain and suffering can be a difficult number to calculate for your claim. Pain and suffering is not a concrete, objective concept and will mean different things to different people, depending on their experiences. It is generally assumed that some compensation for pain and suffering will be offered by the insurance company on top of the damages for medical bills and other expenses, as the accident was not the fault of the victim in any way, but this is not always the case. To see how Wallace Pierce Law would estimate your damages for pain and suffering, check out our Pain and Suffering Calculator tool. For further information on pain and suffering in general, check out our article on Pain and Suffering.

Once you have all of the above elements prepared and reviewed, it is time to present the claim to the insurance adjuster, which means sending the entire demand package to that adjuster and waiting for a response.

How does an adjuster review my claim?

Once the insurance adjuster receives your demand package in the mail, they will typically review the claim within 30 to 45 days. If the company agrees to accept liability for the accident, the adjuster will make an initial offer on the claim. If they do not accept liability, they will deny the claim. For more information on what to do if your claim is denied, read our article Why Are Claims Generally Denied? If you receive an initial offer, it is up to you to decide to accept the offer or attempt to negotiate with the adjuster for a better settlement offer. During this part of the personal injury claim process, it can be extremely useful to have hired an attorney to handle your claim for you. Experienced personal injury attorneys understand the negotiation process better than most and may be able to work out a better offer than someone handling their own claim.

The insurance adjuster for the at-fault driver is never on your side, and that is important to remember as you are presenting your claim. Adjusters have certain tactics and tricks that they use to try to find a way to weaken your claim or show that you contributed in some way to the accident, deflecting responsibility for damages from their insured. When reviewing your medical records, the adjuster may look for pre-existing conditions in an effort to diminish your claim for compensation. If you have a pre-existing condition, the adjuster may be able to argue against causation in your claim. He or she can assert that the accident only served to aggravate a pre-existing injury and that it did not actually cause that injury. For example, if you were involved in another car accident 10 years prior and suffered lower back pain, and your most recent accident also caused you to have lower back pain, the adjuster may argue that your previous accident was the true cause of the lower back pain, not the more recent accident. Thus, it is important to consider what information you present to the insurance adjuster and to carefully review which medical records you are sending as a part of the demand package.

Another strategy that adjusters use is to ask the claimant to provide a recorded statement about the mechanics of the accident. Your own insurance company has the right to a recorded statement from their insured, but the victim has no obligation to the at-fault company to provide any kind of statement. Often adjusters will pressure the victim into giving such a statement by threatening to withhold any settlement money until this demand is met. If an insurance adjuster is telling you that he or she will not write you a check until you give a recorded statement, ask that they put this into writing and send you a letter with this information. If they do send you a letter, we recommend that you contact a personal injury attorney so that you can fully understand your rights in this situation. Giving a recorded statement could cause you to reveal details about the case that ultimately hurt your claim or allow the adjuster to show that you may have contributed in some small way to the accident. The latter would likely destroy your claim, as in North Carolina if you are found to be even 1 percent at fault for an accident, you are barred from collecting damages from the other party under the doctrine of contributory negligence. To learn more about the concept of contributory negligence, read Contributory Negligence: Basics.

After your claim has been sent to the adjuster for review, you must sit back and wait for an offer. If you are handling the claim yourself, refrain from calling the adjuster so that you do not offer them contradictory information or otherwise affect your claim in any way. If you have hired an attorney to handle your claim for you, absolutely do not contact your adjuster, as legally your attorney will handle all contact with the insurance company after the retainer has been signed. Be patient, and trust that all the hard work you put into presenting your claim will pay off.


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