Claims Process

After an accident, it is essential that you receive the medical care that you need. Regardless of whether you choose to pursue a personal injury claim, if you are injured in an accident, please seek medical attention immediately. At Wallace Pierce Law, we encourage our clients to keep in touch with us while they are in treatment. Our Client Relations Legal Assistant tracks each client’s treatment progress and checks in with clients by phone or email every one to two weeks. We ask clients to keep us up to date with information regarding when they have scheduled appointments and what the results of those appointments are. It is of utmost importance for a client’s health and for their claim that their doctor’s orders are strictly followed.

If a client needs help scheduling an appointment with a medical provider, we are happy to assist in locating a provider as well as communicating with the provider to make an appointment. Once a client lets us know that they are done with treatment related to injuries sustained during the car accident, we work on collecting bills and records from each medical provider. If the client receives bills from any provider, it is important that he or she pays these bills in a timely manner, with the hopes that a settlement will later be reached so that these expenses will be reimbursed. If a client cannot pay a bill on time, he or she should call the medical provider and attempt to negotiate a low minimum monthly payment that can be made to the provider until a settlement is reached and the provider can be paid in full. Often a medical provider will take into consideration that a patient was involved in an accident and is awaiting a pending settlement, so it never hurts to let the provider know if this is the case. If a client has trouble paying a bill and cannot work out something with the medical provider, he or she should contact Wallace Pierce Law for help and advice with this situation.

A member of our staff can confirm with the client the name and location of each medical provider visited in relation to the accident. Our office sends a copy of the client’s signed Authorization of Medical Release of Information to each provider requesting bills and/or records for all dates of service related to the accident. Once records are requested and paid for (if necessary) by Wallace Pierce Law, it can normally take 30-60 days for a medical provider to send us those bills and/or records. During this time in the process, we also ask the client to fill out a copy of our Employment and Lost Wage Verification form and have their employer sign it. Clients with specific types of lost wages such as sales commission or those who are self-employed should talk to the attorney before filling out this form. In addition, we ask every client to calculate out-of-pocket expenses related to the accident, including prescription medication costs, cost of any medical equipment, and gas for mileage to and from each medical appointment.

Once all medical bills and records have been collected in addition to out-of-pocket expenses and lost wage information, a paralegal reviews that client’s file to prepare a demand package to send to the at-fault driver’s insurance adjuster. Before we send anything to the insurance adjuster, we send a copy to the client in the form of a Pre-Demand Verification (PDV) document so that the client can also review the numbers. Once we receive back a signed copy of the PDV from the client, we can prepare to send the completed demand package to the adjuster.

A demand package must contain several specific elements in order to effectively present a claim for compensation to the at-fault insurance company. The biggest need is for physical evidence that supports the plaintiff’s story of the accident and resulting injuries. The demand will include copies of all medical bills and records for any treatment that can be linked to injuries sustained during the accident, as well as a police report, if available, that provides the mechanics of the accident. Any statements from witnesses that support the claim plus verification documents for lost wages and out-of-pocket expenses can be useful. The package should also contain a letter outlining the total costs of medical expenses, lost wages from work, out-of-pocket expenses, and damages for pain and suffering, as well as the severity of injuries sustained and how they were treated. Once the package is sent to the adjuster, our office follows up at regular intervals with the adjuster and vigilantly sends any additionally requested information to support the claim.

Once the insurance adjuster receives the demand package, he or she will take time to review it and assess its validity. If the at-fault insurance company accepts liability for the accident, our office can typically expect to receive an initial offer for settlement from the insurance company within 30-45 days after the adjuster has received the demand. Once we receive that offer, we call the client and obtain a dollar amount at which the client gives our office “authority to settle.” That number gives us an idea of what the client is expecting in terms of compensation and sets a minimum limit for settlement. In all cases, we will attempt to achieve a settlement for as much money as possible as long as it is over the client’s minimum limit. After receiving an initial offer and discussing it with the client, our office can make a counteroffer to the insurance adjuster.

The length of the negotiation process can depend on the client’s number set for settlement authority, the caseload of the particular insurance adjuster handling the claim, the adjuster’s requests for additional information, and a variety of other factors. It is important that clients remain patient during this phase while the attorney works to achieve the best possible outcome in terms of compensation. The lawyer and adjuster will continue to present offers and counteroffers until an agreeable settlement above a client’s authority to settle number has been reached. Once this agreement is made, the case can be considered settled. If an agreement cannot be reached or the insurance adjuster denies liability in the accident, then our office will discuss the possibility of a lawsuit with the client. However, the vast majority of personal injury cases reach a suitable settlement and never make it into a courtroom.

Reaching a settlement does not mean that a client can immediately access their settlement funds. First, all medical providers must be paid for services if they treated the client on a lien basis. Basically, a lien allows a client to receive treatment without payment upfront in exchange for the guarantee of payment after a settlement has been reached. If a settlement is not reached, the client will still be responsible for the amount due to the provider. Our office may also work to reduce the liens if possible so that the client may receive as much of their settlement as possible. Again, this part of the process can take some time, so it is essential that the client remains patient. Wallace Pierce Law will keep the client updated on the progress of this phase, and once all outstanding bills have been paid, the client can come to our office for the disbursement of their check.