What is a Third-Party Administrator (TPA)?
Filing an insurance claim is the first step you need to make in order to be compensated for your medical expenses, lost earnings and other damages caused by the incident.
If you sustain injuries resulting from an accident, you are entitled to file an insurance claim either with your own insurer or the insurance company of the responsible party – immediately after seeking medical help.
According to experts in insurance claims processing services, the most important steps you need to take when filing an insurance claim due to an accident include:
- Call your insurance agent regardless of who was at fault when the accident happened
- Follow your agent’s instructions regarding the documents that you need to provide in support of your claim
- Keep all documents related to the accident including receipts, invoices and bills
- Take notes of the communications and conversations you have about the accident. It is important for you to know the names of persons you spoke with, and what they said at what date and time. Furthermore, you also need to know how to contact those persons to facilitate their traceability.
The things you need to find out from your insurance agent include:
- Time limitations for filing insurance claims and submitting documents and bills
- Time limitations for settling disputes
- The date when the insurance company will possibly contact you
- Whether an estimate for your injuries is necessary
- Whether your insurance covers a rental car while your car is undergoing repairs and by how much
Insurance claims are classified into two categories and each type is applicable depending on who is at fault for the accident, the type of accident that took place, and the extent of a person’s insurance coverage.
First Party Claims
A first party claim is one that you file with your own insurer. If for example you hit someone while driving your own car, you should file a first party claim with the insurance company that covers your car.
Third Party Claim
A third party claim is filed with the insurance company that covers another person or business. It is applicable if for example you were hit by a car while crossing the street or you’re a passenger in a car that was at fault in an accident. When these incidents occur, you are entitled to file an insurance claim with the auto insurance company of the driver.
Filing an Insurance Claim
If you are found at fault in an accident that resulted in an injury, you must report the incident within 24 hours to your insurance company. If the accident wasn’t your fault, this is what you need to do:
1. Contact the insurer of the car that was involved in the accident.
The main purpose of this step is to let the insurance company of the “responsible” party know about the chain of events that led to the accident as well as the extent of the injuries you sustained.
2. The insurance company investigates and verifies your claim.
As part of the investigation process, you may be required to provide photos of the accident, names of witnesses, or additional details about the accident. Additionally, you may be asked to submit to an independent medical exam by an insurer-appointed physician.
3. The insurance company issues a settlement check.
After the investigation and verification process, the insurance company calculates the value of your claim then issues a settlement check. If the insurer denies your claim or if you believe that the settlement amount is too low for your injuries and lost wages, make an appeal to the insurance company to reconsider their decision. You may be required to submit to further examinations or provide additional evidence to strengthen your claim.
You can make these steps easier with expert help from insurance claims management companies.
Grounds for Denial of Insurance Claims
An insurance claim can be denied for a number of reasons including:
- The claimant may have waited too long to file a claim after an accident
- The claimant fails to submit to an independent medical exam
- The car accident where the claimant is involved is not covered by his/her insurance plan
If your insurance claim is denied for whatever reason, the insurance company will notify you. Should you wish to appeal your case, you should take time to read the insurance policy of the responsible party. If your claim is denied or if you want to know more about the appeals process, you should seek the assistance of a trusted insurance claims processing service. They help you expedite your insurance claim and ensure you take the appropriate steps to resolve your claim.
If you intend to file an insurance claim, make things easier for you right from the start by seeking the assistance of a trusted insurance claims management company like Action Claim Service.
Call us at (888) 691-1095 or visit our website for all of your claims processing needs!
Related posts
