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Auto Insurance Claims/Answering questions from the Claims Representative


QUESTION: After being hit as a pedestrian in a crosswalk there were two claims made... one by the driver who hit me and one by me to my auto insurance...  My Question is:  I have been sending documents and pictures to my insurance claim representative. The driver's claim representative has asked me for 1. The nature and extent of the claimed injury 2. Medical bills and reports from your treating doctor. 3. Wage Loss verification if a claim for lost earnings is being presented.  Should I respond the drivers insurance claim representative or send this information to my claim representative only?

ANSWER:   Hello Don,

You don't mention if you have California's optional PIP coverage.  If you do, your medical bills - up to the limit of your policy - would be covered by your own PIP coverage.  Wage loss claims would also cover you with PIP.  If you have PIP, there would be no reason at this time to provide your medical documents and wage loss documents to the responsible carrier.

If, on the other hand, you have no PIP and would be relying solely on the liability BI coverage on the other driver, that carrier would eventually be responsible for offering you a fair settlement for your loss.  But that, indeed, is the catch here!

Ordinarily a pedestrian that is struck by a car is facing less-than-minor injuries.  Add to that the likelihood that some of those injuries could be permanent.  And, the problem is, one often cannot predict the full extent of the injuries for months.  

Here's the point - the responsible carrier is attempting to minimize their obligations as soon as possible. From their perspective, if they can get you to document things early-on, to establish your loss early on - they can settle with you before the possibility that things could be more serious, and hence more costly.  And once you settle, you will sign a release that will relieve them - and their driver - of any further responsibility.

Understand that injuries may not be what they seem.  Before you even consider a settlement, understand fully the extent of your injuries.  If you really have only bumps and bruises with no complications, you will need to provide them with the information they need to settle your claim.  And, of course, be very reluctant to accept the first offer.  

Injury claim settlement is a very treacherous proposition.  However, if you think you can act on your own, make absolutely certain that your condition is completely resolved before you agree to settle.  If you are not at that point, simply tell the adjuster that you will provide her with the necessary documentation when you are resolved or released from care.  Much as she won't like that, it is completely your prerogative.

On the other hand, if you have what could be serious or permanent injuries I strongly suggest you consult with an experienced personal injury attorney.  Why so?  Because only a responsible attorney has the skill to successfully and fairly evaluate the total extent of your pain and suffering.  This, of course, far exceeds just your medical bills and lost wages.

And one final note, even if you do have PIP, for serious injuries injuries you are entitled to more than what PIP would ordinarily cover.

You can visit my websites for more specific information on BI settlement.

Hope this helps.

Jane Pytel

---------- FOLLOW-UP ----------

QUESTION: Thank you Jane for your clear answer... I do have PIP of which is called Medical on my policy. You said and I quote:("even if you do have PIP, for serious injuries you are entitled to more than what PIP would ordinarily cover").

The addition question I have is... my medical doesn't cover lost wages. Based on your statement is it possible I could get lost wages from my insurance or is that a cut and dry issue?



 Hello again Don,

I suggest you review your policy again.  By definition PIP (also called Medical in some states) does provide coverage for lost wages. Your best guide is your policy.  As a second resort, you could also call your agent.  If someone has told you that your coverage does not include lost wages, you need to confirm that.  In a nutshell, I doubt it.

And yes, you are entitled to more than just payment of medical bills and lost wages.  That is what BI Liabilty covers.  For serious injury you must consider two factors, economic damages and non-economic damages.  

The first, economic damages are fairly straightforward - lost income, medical expenses and other direct costs.

Non-economic damages are much more difficult to calculate, hence the need for an experienced personal injury attorney. These types of damages generally include such things as future medical bills, your age, any permanent limitations, your future earning capacity, activities you no longer enjoy or the prognosis for further problems you are apt to encounter.

Depending on your injuries, the decision you make now can have a serious impact on your future. But again, all of this is determined by the seriousness of your injuries.

To answer your direct question, no.  If for some reason your PIP does not cover lost wages (?) then your insurance company will not pay for them.  You receive benefits only for coverages you have purchased.

Good luck


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Jane Pytel


I can answer questions related to auto accidents, auto damage, auto theft claims, or personal injury claims. I am specifically suited to answer questions concerning insurance investigations and the effects of those investigations such as claim delays, claim denials, examinations under oath, or the special investigations unit. I can answer most any question that relates to proper claims investigations, or claims handling procedures and processes. I have authored several ebooks which provide claim guidance for consumers. Those books are available on Amazon Kindle: Power To Profit - will provide you with the knowledge you need to overcome the patterned obstacles that insurance companies will use to delay, devalue, or deny your valid insurance claim. The No Nonsense Guide to Accident Settlement - Teaches you how to manage your claim, how to identify the precise tactics likely to be used against you, and how you must respond.


12 years of experience with 3 major insurance companies. I hold an all lines adjusters license in Florida. I am well versed in claims handling, claims investigations, and industry standards related to both. The bulk of my experience stems from my 10 years as a police officer / detective. Building on that investigative experience, I became an SIU (Special Investigations Unit) Investigator. Accordingly, my unique expertise lies in the investigation of claims. What is necessary and related, what is not necessary and related? What constitutes a fair claims investigation? What recourse is available for consumers who suspect they are experiencing unfair claims delays? During the course of my experience, I became a certified trainer, instructing adjusters and investigators proper techniques for claims investigation and claims handling.

B.A., Communications, University of Miami 350 credit hours of intense investigative training, Miami Dade Police 80 hours of investigative training, various Federal Agencies, Miami, Fl Intensive Accident Reconstruction and Pedestrian Injury Analysis, NHTSA, National Highway Traffic Safety Agency, Oklahoma City, OK 2 weeks Auto Damage Appraisal, Winston Salem, NC Legal Principles Claim Specialist, AEI

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