Tips For Submitting 1st Party Claim

If you intend to seek coverage from your own insurance, then you must submit a 1st party claim. Any accident victim that has submitted a 1st party claim must negotiate with the adjuster in their own insurance company.

Advice for those that expect to negotiate with own company’s adjuster

Be ready to cooperate. Still, do not go along with unreasonable demands.

Help your insurer by providing information on the reported accident. Still, do not relinquish your legal rights.

How to demonstrate cooperation

• Be sure to report the accident as soon as possible.
• Authorize the release of relevant medical records.
• Authorize the release of your income records.

How to maintain your legal rights

If you are asked to attend an IME (independent medical exam), make sure that all required conditions have been met.

—You should not have to attend more than one exam.
—Your insurance company should pay for the scheduled examination.
—The exam’s time and location should meet with your approval. If you need help with transportation, the insurance company ought to provide you with a mode of transport.
—You should receive written confirmation about the limits of the exam. The doctor should study and note only the injuries related to the accident, and not any others.

Understand that the examining physician should not have been given a chance to look at any medical records that related to a time before the accident. Do not let that same physician make unfounded assumptions. Have your lawyer call the adjuster’s office, if you suspect that he or she has made such an assumption.

Personal injury lawyer in Cayuga will ask you to pay attention to the comments or questions that the same examining physician might make. If any of the comments or questions suggests unfamiliarity with the medical issues that are related to your injury, share that fact with your lawyer.

The insurance company has selected the doctor that it wants to have doing the IME. An attorney should be able to develop grounds for questioning the company’s selection, if the doctor’s comments or questions seem to indicate a lack of expertise in the medical specialty that relates to your injuries.

Insurance adjusters cannot use the IME’s findings as a reason for saying that you have reached the point of MMI (maximum medical improvement). A declaration of your status, with respect to the desired recovery/improvement should come from the treating physician.

Even then, it is the same physician’s job to work with the recovered patient’s employer, in designing the work schedule for a returning employee. Sometimes that schedule calls for performance of the worker’s assigned duties during only a part of each day. Later, that schedule could be changed, if the doctor chose to support completion of such a change.

More to explorer