How Does The Claim Process Work?

The aftermath of an accident can be overwhelming, with the stress of dealing with injuries, property damage, and insurance companies adding to the weight. Knowing the differences between a claim and a personal injury lawsuit, along with the steps involved in each, can ease your worries and help you get through this challenging period.

Claim vs Personal Injury Lawsuit

A personal injury claim is a formal request for financial compensation made by an individual who has suffered harm due to someone else’s negligence. Typically, these claims are filed with the at-fault party’s insurance company (though in some cases, they may be filed with the victim’s own insurance company). The goal of the claim is to obtain the appropriate compensation without having to file a lawsuit.

A personal injury lawsuit arises when a settlement cannot be reached because the injured party is unsatisfied with the compensation offered by the insurance company. A lawsuit is a formal process in which the injured person seeks damages from the at-fault party through the court system.

Steps Involved in a Claim

Report the accident: Contact your insurance company as soon as possible after the accident to provide the necessary details.
Gather evidence: Collect information such as photos, injury reports, and witness statements. You may need to provide this information to support your claim.
Hire a personal injury attorney: It’s always a good idea to consult with a personal injury attorney to ensure that your rights are protected.
File a claim: Submit the claim to the insurance company, providing all the necessary documentation and evidence. At this stage, the insurance company will investigate the claim.
Follow up on your claim: Stay in regular contact with your insurance company to ensure that your claim is being processed in a timely manner.
Negotiate a settlement: If the insurance company makes an offer, you can negotiate the terms of the settlement. Be prepared to provide additional information or evidence supporting your claim.
Accept or continue negotiation: Once a settlement is reached and you’re satisfied with the outcome, you can accept the offer.

How Does Insurance Company Investigation Work for a Personal Injury Claim?

When you initiate a personal injury claim, the insurance company will assign a claims adjuster to your case. Here are some key steps in the insurance company investigation:

Initial Contact

  • The adjuster will likely contact you to discuss your claim and ask for any initial information, including how the injury occurred and what your initial medical treatment entailed.

Document Collection

  • The adjuster will request documentation related to your injury, such as medical records, police reports, witness statements, and evidence of lost wages if you had to take time off from work.

Inspection of the Accident Scene

  • In some cases, the adjuster may visit the scene of your accident to gain a better understanding of the circumstances.

Expert Consultation

  • Depending on the complexity of your case, the adjuster might consult with experts such as medical professionals or accident reconstruction specialists to verify the details of your claim.

Review of Documentation and Evidence

  • The adjuster will review all collected documentation and evidence to determine an accurate value for your claim.

It’s important to remember that the claims adjuster’s goal is to minimize the insurance company’s financial liability.

Explanation of Possible Outcomes: Approval, Partial Approval, Denial

The claim process begins when you seek compensation for the damages you’ve suffered due to your injuries. The potential outcomes of your claim include:


When the insurer accepts liability for the damages caused as a result of your injuries, they will compensate you in the amount that you requested. This outcome is considered an approval of your claim.

Partial Approval

In some cases, the insurer might only accept partial liability for your injuries. This means they acknowledge responsibility for some damages, but not all that you have claimed. Partial approval can result in a reduced compensation amount. Agreeing to a partial approval can be a strategic move in some situations, as if may be in your best interest to settle the claim rather than move forward with a trial.


A denial occurs when the insurer argues that they are not liable for the damages you have suffered. In this scenario, they reject paying any compensation. Denials can occur for various reasons, like the insurance company believing they have evidence that disputes their insured’s fault or that your injuries were pre-existing and not due to the accident.

If your claim is denied, you may need to file a lawsuit and take your case to trial.

Steps Involved in a Lawsuit

Consult an attorney: If you’re considering filing a lawsuit, consult with your personal injury attorney to discuss your options and the likelihood of success.
File a complaint: Your attorney will draft a formal complaint on your behalf, detailing the specifics of your case and the damages you’re seeking.
Serve the defendant: The defendant (the party you’re suing) must be formally notified of the lawsuit and provided with a copy of the complaint.
Pre-Trial Discovery: In the discovery phase, both your attorney and the opposing counsel exchange information, evidence, and witness statements to understand the basis of each other’s case. This stage allows both sides to evaluate their respective arguments and determine their strengths and weaknesses.
Negotiation & Settlement: Before the trial, the parties often engage in negotiations in an attempt to reach a mutually acceptable settlement. It’s crucial to have a skilled lawyer by your side who can effectively advocate for you and secure a fair settlement on your behalf.
Trial: If negotiations fail, your case proceeds to trial. The trial could be conducted before a judge or a jury, depending on the circumstances. Your attorney will present your case, arguing on your behalf and using the gathered evidence to prove the at-fault party’s negligence.
Awarding Damages: If the trial concludes in your favor, the court will determine the compensation you’re entitled to receive. This amount may include reimbursement for medical expenses, lost wages, emotional distress, and other damages related to your injury.
Appeals: If either party is dissatisfied with the verdict, they may have the option to appeal the decision.

The claim process for personal injury cases can be quite complex, and the outcome you receive heavily depends on the specific circumstances of your case and the legal representation you have. By seeking the assistance of an experienced personal injury attorney, you can navigate the claim process with ease and achieve a favorable outcome.