Difference Between a Personal Injury Claim and a Lawsuit

  • By:David Bate

When an injured person seeks monetary recovery after a car accident or other incident causing physical harm due to the negligence of others, this will always involve a personal injury ‘claim’ but not necessarily a lawsuit.  In most cases, a lawsuit is filed only after an initial attempt has been made to settle the personal injury claim with the insurance company of the person at fault for the injury.   There may be some cases in which the injured person’s attorney will file a lawsuit immediately, by-passing the injury claim process. This can occur in situations where it is likely that the insurance company will deny liability, thereby making settlement negotiations fruitless. In other cases, the filing of the lawsuit can assist the injured person in making a claim against his own insurance company, utilizing the uninsured and underinsured portion of this insurance policy.   Claiming money damages for auto accidents can be very complicated, and it is always beneficial to have an experienced and thorough Coeur d’Alene ID car accident lawyer to receive maximum compensation, regardless of how the claim proceeds.

Personal Injury Claims

Personal injury claims are normally filed with the appropriate insurance company first, depending on state insurance laws. For car accidents in “no fault” states, the injured party will first submit personal injury claims to their own insurance company, which then decides whether the claim is valid or not. In “at fault” states, the insurance company of the negligent party to an injury claim will be responsible for covering damages. Premises liability injury claims can be different in terms of how the parties are assessed in any state, but the concept of personal contribution to the injury by the injured claimant is still a part of the process (sometimes referred to as ‘comparative negligence’). All insurance companies have the authority to investigate a personal injury claim before paying any benefits, and many times this can result in a claim denial or a low settlement offer with a requested full release of future medical coverage. This is why it is never a good idea to handle your own personal injury claim without an attorney if the injuries are serious.

Lawsuits

Lawsuits arise from personal injury claims that are denied by the appropriate insurance company, or from cases when the insurance company may be negotiating in bad faith. Experienced personal injury attorneys understand insurance bad faith tactics and will pay close attention to how the company is responding to certain aspects of a personal injury claim. There could be much more financial recompense from a lawsuit when certain fact patterns suggest intentional acts by a defendant or their insurance company. In order to demonstrate ‘bad faith’ the plaintiff’s attorney must first prove that the denied claim was a valid claim that was denied by the insurance company without sufficient reason or after inadequate investigation. In most states, faith claims can only be brought against the injured person’s own attorney, not the insurance company of the at-fault driver. The plaintiff’s attorney must establish that the injury occurred to the plaintiff, and it was either the direct or indirect responsibility of the defendant. In addition, the plaintiff’s attorney must prove that the defendant owed a duty of care to the plaintiff and that the defendant breached that duty of care.

Trials

Once a lawsuit is filed, the case will be scheduled for trial if it does not settle. In some states either the plaintiff or defendant can request a trial date. In other states the court, on its own initiative, will schedule a trial.  Typically insurance companies will move a case to trial if it believes that a jury will be hostile to the plaintiff’s claim.  Plaintiff attorneys will ask for a trial date if the insurance company is making ‘low ball’ settlement offers. If the jury awards a verdict in favor of the plaintiff, in an amount that exceeds the dollar limits of the insurance policy, the defendant may be able to sue his own insurance company for ‘bad faith.’ Typically, the defendant will assign his right to sue to the successful plaintiff, who can then pursue the bad faith claim against the defendant’s insurance company.


Thanks to our friends and contributors from Bendell Law Firm for their insight into the difference between a claim and a lawsuit.

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