If you have been injured in an accident in Colorado, your thoughts after receiving medical care are likely to turn to whether insurance will pay for your medical bills and other losses. But to obtain a settlement, you’ll need to be able to show who is at fault for the accident when you file an insurance claim.
Insurance companies pay claims for individuals they cover—their policyholders. After a car accident, for example, if you are at fault you might seek compensation for your car repairs if you have collision insurance. If someone else is at fault, you would seek compensation through their auto liability insurance.
Drivers are encouraged to exchange insurance information after being involved in a crash because they may need to contact the other driver’s insurance company.
- A claim you file with your insurer is a first party claim.
- A claim you file under an insurance policy held by another person, business or other organization is a third party insurance claim.
Although motor vehicle accidents are the most common example, first-party and third-party insurance claims arise in many different situations. For example, if your own uninsured or underinsured motorist (UM/UIM) coverage applies because the at-fault driver has little or no insurance, you may file a first-party claim with your own insurer. On the other hand, injuries caused by a negligent property owner, a dog owner, or a business typically involve third-party liability claims because you are seeking compensation under another person or company’s insurance policy. Understanding which type of claim applies is important because the claims process, available coverage, and legal issues may differ depending on the circumstances of the accident.
How Insurance Claims are Processed
Organizations like the Colorado State Patrol and the Rocky Mountain Insurance Information Agency advise motorists to contact their insurance company as soon as possible after a car accident. If you are not at fault but are sued by the other person involved in the accident, your insurance company needs information to defend you.
To obtain an insurance settlement after an accident, you have to deal with the insurance company representing the at-fault party, whether it is your insurer or another driver’s insurance.
Many insurers allow claimants to file initial information required for a claim online. You may also do it by phone. Once you have filed a claim, it will be assigned to a claims adjuster, who will soon initiate an investigation by contacting you.
The insurance adjuster will work to decide whether their company will pay the claim and how much they will pay. An adjuster will investigate who should be held responsible for the accident and the monetary value of your losses, such as medical bills, property (vehicle) damage, lost wages, and pain and suffering.
During the investigation, an insurance adjuster will evaluate much more than the accident report. Depending on the type of claim, the adjuster may review photographs, surveillance footage, witness statements, repair estimates, medical records, employment records, and other documentation that helps establish liability and calculate damages. In some cases, adjusters also consult accident reconstruction specialists, engineers, or medical experts before making a coverage decision.
Your medical records often become one of the most important pieces of evidence in the claim. Insurance companies typically compare your diagnosis, treatment recommendations, physician notes, and recovery timeline when evaluating the value of your case. Consistent medical treatment not only supports your recovery but also creates documentation that accurately reflects the extent of your injuries.
But make no mistake: an insurance adjuster’s job is to make sure the company pays the least amount possible to resolve the claim.
We suggest being cautious when speaking to an insurance claims adjuster. Anything you say will be held against you and the value of your claim.
- Do not admit or accept blame for the accident.
- Do not downplay your injuries or other losses.
- If the adjuster asks you to record a statement, decline to do so.
Insurance adjusters frequently request recorded statements early in the claims process because they are attempting to gather information while memories are fresh. However, injured individuals are often still receiving medical treatment and may not yet understand the full extent of their injuries. Answering questions too soon may unintentionally create inconsistencies or incomplete descriptions that are later used to challenge the claim. Before providing detailed statements to the at-fault party’s insurance company, consider speaking with an attorney who can explain your rights and help protect your interests.
Once the adjuster has finished their investigation, they will offer you a settlement or deny your claim. If you accept the settlement, you will be asked to sign a settlement agreement, which will end your claim.
Once again, you should be cautious of an insurance settlement offer. You need to be sure it covers your losses before accepting it.
Another important consideration is that settlement negotiations are often an ongoing process rather than a single offer and response. Insurance companies may begin with an offer that reflects only part of the available damages, expecting additional negotiations to follow. Carefully evaluating every settlement proposal allows you to determine whether it accounts for future medical treatment, ongoing rehabilitation, lost earning capacity, and other long-term losses before bringing the claim to a close.
In cases involving a serious injury, you should seek a Denver personal injury lawyer’s guidance. Some insurers will offer what looks like a large settlement very quickly. But this is an estimate based on previous payments for similar cases. It has little to do with your actual injuries and losses. The full extent of your medical bills and related losses may not be known yet.
We suggest having a personal injury lawyer review your case, including any settlement offer, before you accept an insurance check. An initial consultation is free, and will include a review of all available facts about your case.
When an insurance company’s settlement offer is inadequate, you have the absolute right to negotiate for more. It is best to have an attorney negotiate on your behalf. Initially the attorney would submit a demand letter, which spells out what you consider a proper settlement and why. If the insurance company rejects the demand, then you can file a personal injury lawsuit, which states your demands and asks a court to award damages.
At this point, the average person is dealing with matters of law that he or she probably does not understand in a fight with insurance company lawyers who do this kind of work every day. Hiring an experienced personal injury attorney who represents accident victims in disputes with insurance companies will improve your chances of a successful outcome
Who is At Fault in Your Accident?
The type of accident claim you will file — a first party or third party insurance claim — depends on who is at fault for your accident.
If you were clearly at fault, you would file a first party claim according to what policies you hold and what they cover, such as your coverage for injuries, homeowners’ insurance, or automotive collision insurance.
For example, if you rear-ended another driver because you had turned for a second to speak to a passenger, or you fell from a ladder while cleaning rain gutters at your home, you would file a first party claim.
If another person or organization was at fault, you would file a third party claim under their liability insurance. This could include the other party’s auto liability insurance, or homeowners’ or business insurance, which have liability components for accidents on the policyholder’s buildings and grounds.
For example, a third party claim would follow a car accident caused by another driver, or a slip-and-fall accident in a store, or a dog attack.
Who is at fault for an accident is not always clear. Colorado follows a modified comparative negligence system. This means that more than one person may share responsibility for an accident, and the amount of compensation available may be reduced if an injured person is found partially at fault. Because insurance companies frequently investigate whether they can assign some percentage of responsibility to the injured party, preserving evidence early can become especially important. Photographs, witness statements, surveillance video, and other documentation often provide valuable support when liability is disputed.
Anyone can deny responsibility and/or make counter charges, particularly if they fear higher insurance premiums or out-of-pocket costs from a claim. This is why insurance adjusters are sent to investigate, and why you need to protect yourself by advising your insurance company of an accident and potential claim.
The best way to protect yourself is to have an attorney do an independent investigation of the accident. That way, if your claim is disputed, you have the evidence at hand to prove your right to compensation. This is another service provided by a personal injury attorney you engage after an accident.
Contact Our Denver Personal Injury Attorneys
Make sure your interests are upheld after an accident that leaves you or a loved one injured. A personal injury attorney is your advocate after an accident, working to demonstrate who is responsible and helping you recover the compensation you deserve for your injuries and losses.
The Wilhite Law Firm has established a Heritage of Justice from decades of serving Coloradans who have been injured through the carelessness of others. Our attorneys have been serving Denver and the rest of Colorado for more than 50 years as a dedicated personal injury firm. Our accident attorneys have the experience and know-how to help you hold the party responsible for your injuries accountable. For more information on how we can help, contact us today.
