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How to file an umbrella insurance claim

Umbrella insurance is additional insurance that is available to pay claims after underlying insurance polices have been exhausted. Making a claim against an umbrella policy requires jumping through some technical hoops, and you will need an attorney to do it successfully.

Many people have umbrella policies to muscle up their basic coverage. When you make a claim on that bigger policy, that increased muscle by the insurance company, and their realization that they may have to pay more, will result in an effort by them to minimize your claim. By making sure to do certain things when the claim arises, and avoiding insurance traps, you can help your attorney help you.


Do get medical attention right away, if injured

The adjuster needs to know you received medical attention the day of the accident or collision, or immediately afterward once the symptoms of your injury appeared.

When a victim’s injuries are treated and documented right away, the case is taken much more seriously than if the claimant waited a while before seeing a doctor. Even if there appears no obvious sign of trauma at the moment, it is recommended to have a doctor check you over as soon as possible after an accident or collision.

Provide your doctor with as much information about your injuries as you possibly can. This is no time to be shy. Remember: the status of your health and future well-being are at stake. Your doctor needs answers to specific questions such as: Where exactly is your problem located? How often does it occur? How long does it last? What brings on the pain or makes it worse? Do any other symptoms occur at the same time?

Report any and all symptoms throughout your treatment. This will enable your physician or therapist to notate everything, which is critical in determining the worth of your claim. More importantly, your willingness to speak up helps the doctor to deal with the ongoing problems arising from your injuries. Soft Tissue injuries are especially important to document as the insurance companies will place greater effort in downplaying them or writing them off altogether. 

Do obtain evidence about who is at fault for the injury

When a person’s negligence causes a fall, accident, or traffic collision, they are liable for the damages due to their negligence.

If an accident occurs at at a person’s home, for example, according to the terms of their homeowners insurance, their carrier is responsible to compensate the victims for their injuries. The same goes for traffic accidents with the negligent driver’s liability insurance--to take care of the victims injured in the collision.

In most traffic accident cases, who is at fault, who is liable, is fairly clear and will not present much of an issue in presenting your claim to the insurance company. In some cases however, determining fault can be very challenging.

· Who had the green light?
· Who ran a red light?
· Did an unsafe lane change cause the collision?
· Was someone following to close?
· Was someone distracted or was not paying attention to traffic?  

Do watch what you say to insurers

If involved in an accident, you will quickly find yourself in contact with two insurance companies. The first company is your own. The second is the wrongdoer’s insurer (assuming he/she has coverage).

You should contact your insurance company within 24 hours of the accident. In terms of your own injuries, provide a basic description and nothing else. For example, you might say that your back and neck hurt, or that you have pain in your knee and hip, or that you suffered a broken hand.

Your company is entitled to know how the accident happened. Stick to the basics and leave it at that: date, time, place, and the very basic facts surrounding the other person or motorist’s negligence. Think about those classic war or spy movies where the star is being interrogated, but he does not know who the bad guys really are. They give name, rank, serial number. That is it. You do the same, even with your own insurance company.  

Do handle property damage right away

If you have auto collision coverage, or home damage, you should file a claim with your company to cover damages to your house or vehicle. Third-party claims for repair aren’t paid until liability is shown, and that usually takes time. 

Unless the other person’s company immediately accepts responsibility, it is best to open a property damage claim with your own insurance company right away. Under your home or auto collision coverage, there’s no dispute as to who is at fault, which means you won’t have to worry about delays in payments for repairs.

Be aware that a property damage claim is completely separate from a personal injury claim. You can immediately negotiate a settlement for your car repairs or for your vehicle’s replacement cost if it was totaled. Your injury claim, on the other hand, should not be settled until your medical treatment is completed and you’re ready to submit your demand package.   

Do contact a lawyer if your damages are significant

The insurance company employs an army of lawyers. They have entire legal division devoted to legally avoiding the payment of a valid claim, either through denial, delay or defense in court. It is common sense to get your own lawyer to combat their tactics.


Do not remain ignorant nor uninformed

This is a chess game, and you have to know the game and strategies to compete. Insurance companies aim to keep you depending on them, so they can give you the minimal help you need, at minimal cost to them. Prepare yourself with this short list:

· Know the steps you must take in the claims process.
· Know what constitutes liability.
· Document the full extent of your injuries.
· Document your property damage.
· Determine the best way to pay your medical costs.
· Determine the value of your personal injury claim.
· Put together a demand for compensation, also known as a demand package.
· Negotiate skillfully with the insurance adjuster.

It will take some time and effort, but it will put you in a better position to make sure your insurance company really does handle your needs. 

Do not forget there are two types of personal injury claims

The process of documenting your losses needs to begin immediately, and the more complete the record, the better.

In personal injury claims, losses fall into two categories: 1) economic damages, and 2) non-economic damages. In order to obtain complete compensation for all your losses and injuries, you will need a written record of both.

Economic damages include medical bills and related expenses, proof of lost wages and income, out-of-pocket expenditures and any other actual costs that you incur because of the accident. These damages are the easiest to determine because you have bills and receipts to substantiate your claim.

Non-economic damages, on the other hand, are subjective in nature. They vary by individual and by case, and oftentimes, they exceed the value of the economic damages. Among other things, non-economic losses include pain and suffering, emotional distress, and mental anguish.

Non-economic damages do not involve out-of-pocket expenses. However, just as economic losses must be backed by documentation and evidence, so must pain and suffering. The burden of proof falls on the accident victim. Therefore, he or she must be able to substantiate non-economic damages with some sort of written record.

Keep organized files of both economic and non-economic losses. Place the information in folders or envelopes for easy access. As trying as this period may be, business cannot be overlooked. In other words, a personal injury victim must remember to keep a record of losses – along with a personal diary that explains what she or he has experienced since the accident took place.

Note: If you’re unable to document your expenses and losses in a substantive way, in the mind of the insurance adjuster, it’s as if those damages never existed. Document everything, no matter how minor or obscure it may seem.

Do not wait to make a claim

In California, for example, the Statute of Limitations to file a personal injury claim is two years. Be careful about getting too close to that deadline. You don’t want to wait so long that the statute is about to expire. Once the expiration date passes, you have no rights.

Do not sign anything

The adjuster will ask you to sign all sorts of forms. Don’t. Sign only what you need to in order to get payment for property damage. Avoid giving the adjuster the right to independently collect information about you, and your injuries, without your knowledge. Be especially wary of any document which is an authorization for release of information.

As for recorded statements in person or on the phone: Don’t. There are things you might say inadvertently -- things that mean nothing to you at the time – but that can be taken totally out of context, twisted around, and used to undermine your claim later on.

Carefully craft a written statement about how everything happened, when you’ve had time enough to do so, and to provide your version of the story to the insurance company when settlement time comes.

Just like a Hollywood gossip tabloid, the insurer wants you to reveal information that could later be used to make you look bad, in order to deny your claim or pay you less money than you deserve. The insurer will try to show discrepancies between anything you said in a tape recording, and the statements that you make during negotiations.  

Do not settle until you have healed

When can it be said that you’ve reached a point of being healed? That judgment should be left to the health care professional in charge of your treatment plan. He will know when you’ve healed enough to be released from further care. The physician will also indicate whether she believes you will need medical care in the future. Until that time comes, your claim should not be resolved.

In general, insurance companies prefer quick settlements, and here’s why: Shortly after a collision, the full extent of a victim’s injuries is unknown.

Consequently, the sooner the adjuster settles with you, the less money the insurer will have to pay you for your damages. That’s why you need to heal from your injuries before negotiating with the insurance company.

An accident victim should obtain medical services as soon as possible. Further, the victim should follow through on the doctor’s treatment plan and make every appointment. When settlement time comes, the record should indicate that the injury victim had every reason to be concerned about the condition of their health. 

Jumping cartoon

An insurance company’s primary goal is not to pay money to claimants; its to make a profit for their shareholders. In some cases, when paying claims, an insurance company will not notify you of the existence of other insurance policies, such as an umbrella insurance policy.

Insurance is very big business. Insurance companies rarely offer fair settlements to accident victims and property losses without considerable pressure. In almost every case, insurers must be forced to compensate accident victims fairly. The insurance company usually tries to skate by without disclosing the existence of an umbrella policy.

It is important to note that every dollar saved in paying claims is a dollar of profit for the insurance company and essentially a badge of honor for the adjuster. Thus, they will do everything they can to save every dollar and they are exceptional at it. And keep in mind we are not just talking about the other person's insurance company. Your own coverage company cannot be trusted to do what is in your best interest regardless of their claims that you are in “good hands” or that they are “on your side.” 

More expert advice about Home, Auto, and Theft Insurance

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S. Edmond El DabePersonal Injury Attorney

UCLA and Loyola Graduate. Edmond El Dabe specializes in traumatic personal injury claims suffered in Auto Accidents and Motorcycle Accidents. These include Wrongful Death and brain injury cases. These frequently involve claims against auto in...

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