Negotiating With Your Own Insurance After an Injury

What are your rights and how much cooperation is required when you're settling with your own insurance company?

Updated by , J.D. · University of San Francisco School of Law

A claim you file under your own insurance policy—for example, under the uninsured or underinsured motorist coverage of your auto insurance policy—is called a "first-party" claim.

The rules for a first-party claim are set by the specific terms of your policy. And often your policy requires a bit more from you than a third-party claim (one filed with someone else's insurance company) might. Read on for helpful tips on negotiating with your own insurance carrier.

Cooperation Is Key to Negotiating With Your Insurance Claims Adjuster

As with all negotiations, how you act and what you do during the insurance settlement process will affect the outcome of your claim. In general, your own policy will require that you cooperate with your insurance company as your claim is investigated and resolved.

Of course, what cooperation means is subject to different interpretations. It usually comes down to what's reasonable under the circumstances. Your rights (including your right to privacy) must be balanced against the company's right to get enough information to process your claim.

Most policies spell out what you're required to provide, such as:

Timely notification. Your policy might limit the amount of time you have to notify the company of your claim. Even if you miss the deadline, however, your insurance company can't deny your claim unless it shows that it's been harmed in some way by the late notice. Learn more about contacting your insurance company after an accident.

Authorization for release of medical records. You must sign an authorization allowing your insurance company to obtain medical records for all medical treatment you received for any injuries stemming from the covered incident.

Authorization for release of work and income records. If you're claiming you lost income because of your injuries, you must sign an authorization permitting the insurance company to obtain your income information and relevant work records directly from your employer.

Be Careful What You Sign

If you're providing authorization for your insurance company to obtain medical or employment records, read the authorization form carefully. You shouldn't have to release records about any time period before the accident unless the insurance company gives you a legitimate reason for that kind of request.

You also don't have to release records of any medical treatment that isn't directly related to the covered incident. For example, if your shoulder was injured in the accident, you shouldn't have to provide records from your bunion surgery.

If the authorization is too broad, cross out the information you don't want to share. Then write in a sentence that limits the time period for which records may be obtained or that describes which medical records the insurance company is allowed to obtain. Be sure to initial all the changes you make.

Requests for an Independent Medical Examination (IME)

If your insurance company requests that you have an independent medical examination (IME), read the policy carefully to see what the terms are. In general, make sure:

  • there's only one examination
  • the insurance company agrees in writing to pay for it, and
  • it's arranged at your convenience, not just the doctor's.

Also, get a written statement from the claims adjuster, in advance, explaining the limits of the examination. You can only be required to undergo an examination of the injuries you claim and not a general physical exam.

Resolving Disputes With Your Insurance Company

If you have any dispute with your insurance company's adjuster over a medical examination, providing information, or following policy rules, don't take the adjuster's word as gospel. Read your policy. If you don't have a copy, the adjuster must provide you with one.

And if you reach a stalemate with your own company's adjuster about any point of negotiations or about the amount of the settlement offer, you might have to switch negotiation strategies or consult with an attorney.

The information in this article is from How to Win Your Personal Injury Claim by attorney Joseph Matthews.

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