Opening and Reporting Claims



Know Your Options for Filing a Claim

When you open a claim with an insurance company, you are reporting the fact that an accident occurred. Reporting a claim is different than presenting a claim, which involves sending a package to the insurance company demanding compensation related to an accident. Before you get to presenting the claim, you must first open the claim with the insurance company after there has been an accident.

Whether or not you should file a claim with your own insurance company following an accident may depend on the type of accident you were involved in as well as your individual policy and company. If you are not the at-fault driver in a motor vehicle accident and you sustain injuries from that accident, you have several options that involve both your own insurance company as well as the insurance company of the at-fault driver.

Opening a Claim with At-Fault Insurance

First, you may choose to file a claim with the insurance company of the driver determined to be at fault by the investigating officer in the accident. The at-fault insurance company will cover reasonable expenses incurred as a direct result of the accident, including the cost of medications and medical treatments, lost wages, mileage to and from medical providers, as well as damages for pain and suffering. Your personal insurance policy will not be affected if you open a claim with the at-fault insurance company.

Opening a MedPay Claim

Your second option involves both your own insurance company and the at-fault driver’s insurance company. After opening a claim with the at-fault company, you may choose to file a claim with your own company for MedPay, also known as Medical Payments coverage, if you have this type of coverage on your policy. Opening this type of claim is considered a no-fault claim to your insurance company. MedPay is an optional coverage you can purchase from your automobile insurance company that covers the cost of medical bills for you and your passengers if you are ever involved in a motor vehicle accident. Since you pay for MedPay coverage on your policy, it makes sense to open a claim to obtain the money you are entitled to by your own insurance policy. However, some insurance companies strongly discourage opening MedPay claims when you are involved in an accident and may drop clients for frequency of incidents.

Opening a Claim with Your Own Insurance

The third option is to open a claim only with your own insurance company rather than either of the first two options. If you choose to do this, your deductible will apply but may be refunded to you later when your insurance company completes the subrogation process with the at-fault insurance company. The at-fault insurance company must accept liability in order for you to be reimbursed for this deductible, as subrogation basically entails your insurance company obtaining the reimbursement from the at-fault insurance company on your behalf. This claim is also considered no-fault, but sometimes an inexperienced representative may inadvertently key in the claim as at-fault, which hurts you as the insured. Some companies strongly discourage opening claims like these through your own company and suggest that if you are in an accident and you are not at fault that you file the claim through the at-fault insurance company instead of through your own company.

If You Are the At-Fault Driver

If you are the at-fault driver in an accident, your options for opening a claim are limited to filing with your own insurance company. Your insurance company will cover the cost of the damage to your car, your medical expenses if you have MedPay coverage, the damage to the person’s car that you hit,  and the medical expenses of the person whose car you hit if they are injured. In this case, your collision deductible would apply and you may be faced with a surcharge depending on your individual policy and company. If you report your involvement in an accident for which you have been deemed at fault to your insurance company, they may choose to cancel your policy. Additionally, it is extremely likely that your insurance premium will increase as a result of reporting your claim.

The Process of Opening a Claim

There are clear advantages and disadvantages to opening a claim with an insurance company, whether you are the at-fault or not-at-fault driver in an accident. However, it is important to remember that if you are injured in a car accident, you may acquire large amounts of medical expenses that you will be responsible for paying. The auto insurance that you purchased on your vehicle may be able to help cover some or all of those costs that you may otherwise have to pay out-of-pocket. If you’ve decided to file a claim through either insurance company, your timing can be important to the validity of your claim. Most lawyers would recommend filing the claim with insurance as soon as possible in order to begin the process of demanding for damages incurred. You cannot be too early in filing a claim, but you can be too late, as in North Carolina personal injury cases carry a three-year Statute of Limitations after which the injured may not pursue compensation or a lawsuit related to injuries sustained from an accident. Read more about the Statute of Limitations on personal injury cases in North Carolina.

In order to open a claim with the at-fault driver’s insurance company, you will need the insurance information for that driver. This information can be found on the Driver Exchange Form given to each party involved in an accident by the investigating officer at the scene. It serves as a temporary “police report” that gives each party the information needed to file a claim with insurance. The Driver Exchange Form provides the names and addresses for all drivers involved in an accident as well as information about each driver’s insurance company.

Say you are rear ended by another driver and break your arm in the accident. You are transported by ambulance to the emergency room and once your arm begins to heal you seek treatment by a physical therapist. Your health insurance covers some of the medical expenses but you are still responsible for paying for parts of your treatment. You wish to be compensated for these bills by the party that caused the accident, so you must open a claim with the at-fault driver’s insurance company. Though it would be prudent to speak with a Personal Injury Attorney as soon as possible, you choose not to speak to an attorney at this time and open the claim on your own. You locate their insurance information on the Driver Exchange Form and see that their insurance is through Company X. How can you open the claim? Most insurance companies will have a specific phone number to call in order to file a claim and these can be found by entering the name of the company and the word “claims” into an Internet search engine.

You have found the phone number to open a claim with Company X. When you call, what kinds of questions will the claims representative ask you about your accident? It may be helpful to have your Police Report available when you are opening your personal injury claim. Learn how to obtain your Police Report and what kinds of information it contains here. The claims representative who helps open your claim will ask you for the policy number of the at-fault driver as well as to confirm the contact information of that person. Be sure to emphasize that you are opening a bodily injury claim against the at-fault driver. The representative may ask you to explain the mechanics of the accident, who was involved in the accident, and if anyone sustained any injuries. Try to give the claims representative basic, factual information that will assist them in opening the claim but do not reveal too many details at this time. The claims representative should give you a claim number as well as the name of the adjuster assigned to your case after you have opened the claim. Ask for the contact information for that adjuster so that you are able to contact them when needed regarding your claim.

You have successfully opened your bodily injury claim. If you are still receiving medical treatment for your injuries associated with the accident, continue following the doctor’s orders until they declare you released from treatment. If you are finished with treatment, the next step in your personal injury case will involve obtaining medical bills and records from each medical provider you saw for injuries related to your car accident.



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