How to File a First Party Claim: Dealing With Your Own Auto Insurance Company

See how to file a strong first-party claim with your own insurance company. Learn about available coverage, and what to do if the insurer won’t pay.

When you file a claim with your own insurance company, you are filing a “first-party” claim. If you file a claim with someone else’s insurance, it’s called a “third-party” claim.

You expect fair compensation any time you submit a claim to your insurance company for a covered event. But adjusters will always put the insurance company’s finances ahead of your best interests.

Here we unpack when you should file a first-party claim and the coverage types that pay you after an auto accident. You’ll learn what to expect from the adjuster, and your legal right to have your claim handled in good faith.

How to File a Strong First-Party Insurance Claim

As soon as possible after a car accident, call your insurance company to let them know. They will ask for the date and location of the accident, and other facts about your claim.

If you’re filing a property damage claim in addition to an injury claim, you may be given two claim numbers. Your claim will be assigned to an insurance adjuster who will call you within a few days.

1. Prepare to Talk with the Adjuster

The better organized you are, the better your chances of reaching a fair injury settlement with your insurance company.

Create an organized accident file, including a copy of your insurance policy, the police report, the contact information from others at the accident scene, and any paperwork you’ve already received from the insurance company.

Write detailed notes about how the accident happened and the medical treatment you’ve had so far. Your notes should include the name and contact information for each of your medical care providers, and a list of out-of-pocket money spent on medications, bandages, crutches, and the like.

Keep a diary of your medical treatments, pain levels, and help you’ve needed because of your injuries. If you’ve had trouble sleeping, bad dreams, or anxiety since the accident, include that information as well. Your accident diary will also support your claim for pain and suffering.

2. Be Careful Giving Recorded Statements

Sometimes an insurance adjuster will come to your home, but usually they contact you by phone. The adjuster will ask you to give a “recorded statement,” meaning they will interview you about the accident and your injuries while recording everything you say.

You are not required to talk to the adjuster until you’re ready. You’ve put them on notice of your intent to file a claim and can take your time before providing detailed information.

Never give a statement to an insurance adjuster when you are upset, tired, confused, in pain, or taking heavy medication.

When you’re ready, the adjuster will want you to describe what happened and ask you questions. Think about each question before you answer. Don’t guess. It’s perfectly okay to say, “I don’t know.”

Be prepared to give the adjuster specific information, such as which ambulance company transported you, to which hospital, and if you are still under a doctor’s care. Have your notes and other paperwork in front of you to help you answer accurately.

It helps to prepare a recorded statement worksheet to help you think about what the adjuster might ask and how you’ll answer.

Watch What You Say

The adjuster will ask questions about your medical condition. They might show concern about your injuries, but don’t allow them to minimize your pain and suffering.

The adjuster might start by saying something like, “How are you feeling today, Mr. Smith?” In everyday polite conversation, a standard response is, “Fine, thank you.”

That’s not the right answer when speaking to an insurance adjuster about your injury case. If you start the conversation by saying you’re fine, you’re already giving them some information they can use against you.

Be especially careful when the adjuster makes a comment or statement and asks you to agree with it. Stick to your story, and don’t let the adjuster twist your words.

Even though it’s your own insurance company, the adjuster can’t commit to paying any money until the investigation is complete. That said, you have the right to be represented by a car accident lawyer, who will deal with the insurance company so you don’t have to.

While your insurance company has a legal obligation to treat you fairly, they will try to get by paying you as little as possible.

3. Limit Access to Your Medical Records

The adjuster will need to review your medical records before agreeing to pay the costs of extended treatment. Insurance companies are only required to pay reasonable medical bills, so they review every bill and record carefully.

The adjuster will ask you to sign a release form permitting the insurance company to access your medical records. You do not have to sign their version of the medical release form.

Before you sign, read the release thoroughly. Be sure it’s a limited release that only gives access to your medical records related to the current injury. Some insurance companies have forms allowing them to request records from any of your doctors, for any illness, at any time during the past five or ten years.

Don’t give the adjuster access to confidential information from doctors who have nothing to do with this claim. With a general release, the insurance company will sift through your records looking for a previous injury or other information they can use to deny or minimize your claim.

Adjusters normally won’t question the medical treatment you receive immediately after an accident. However, problems often start when the treatment becomes extended.

One of the biggest mistakes people make is running up bills for weeks of chiropractic treatments or physical therapy that the insurance company didn’t pre-approve.

Beware of “accident doctors” who inflate your medical bills with questionable treatments. You may be on the hook if the insurance company won’t pay.

When to Contact Your Insurance Company

You need to contact your insurance company as soon as possible after an accident, even if you’re planning to file a claim with the at-fault driver’s auto insurance.

Building a successful auto insurance claim begins at the accident scene. No matter whose insurance company you turn to, you’ll need to establish the facts of your case.

Basic steps to take after an accident include:

  1. Stop immediately and check for injuries.
  2. Call 911 for police and emergency medical assistance.
  3. If paramedics want to take you to the hospital, let them.
  4. If another vehicle is involved, collect the other driver’s contact and insurance information, and contact information of any passengers and witnesses.
  5. Take as many photos and videos as you safely can of the vehicles, the accident scene, the surrounding area, and visible injuries.
  6. Ask the investigating officer for the police report service number.
  7. Contact your auto insurance company and file your injury claim.

Contact your insurance company whenever you’re involved in a motor vehicle accident. Even a minor fender-bender that wasn’t your fault can come back to bite you if you haven’t notified your insurance carrier.

You never know what people will do. The driver who caused that fender-bender might change their story a few days later and call your insurance company with a demand for money. Your insurance company would be in a tough spot if you hadn’t already told them about the crash.

Notification Clause

American auto policies almost always have a “notification and cooperation” clause. The clause means you agree to tell the insurance company about an accident, and you also agree to cooperate with the insurance company’s investigation.

Your insurance company has a duty to defend you if someone from the accident files a lawsuit. In most cases, that means your insurance will pay for a lawyer to protect your interests. You might lose that protection if you violate the notice clause in your policy.

Send a Confirmation Letter

After speaking with the insurance company, send a follow-up letter. In the letter, confirm that your claim is in process, and document your current injuries and ongoing treatment. The letter should be sent by certified mail, return receipt requested (this proves you sent the letter).

Keep a copy of the letter, with the mailing receipt, in your accident file.

Example Confirmation Letter to Insurance Adjuster

July 23, 2021

Susan Jones
Claims Adjuster
Northern Palms Insurance Corporation
123 Main Street
Phoenix, AZ 85016

Re: Claim Number 12-F2968
Insured: John Smith; DOB 02/25/1971
Policy Number: KA445782-S
Accident Date: 07/12/2021

Dear Ms. Jones:

Please let this confirm our telephone conversation on July 22, 2021, when we discussed the facts related to an automobile accident I was involved in on July 12, 2021. During our conversation, I notified you of my intent to file a claim under the Personal Injury Protection section of my insurance policy number KA445782-S.

I made clear that I was injured in the accident, and as a result have already incurred medical bills. I also made clear that I am currently unable to work because of the injuries I suffered in the accident.

I am under continuing medical care and will keep you informed of my condition. I will also send you written confirmation of my out-of-pocket expenses and lost wages.

Finally, please let this confirm my intention to fully cooperate in your investigation of my claim. Please contact me immediately if you have any questions.

Yours truly,

John Smith

Keep the lines of communication open between you and the adjuster. There’s nothing wrong with emailing or calling the adjuster regularly to ask about the status of your claim.

First-Party Auto Insurance Coverage Types

Auto insurance is a contractual agreement between two parties. When you purchased your car insurance policy, you became the “party of the first part.” Any claims you submit for payment under your insurance policy are therefore first-party claims. Your insurance company is the “party of the second part.”

A policyholder and their insurance company will always be the first and second party to the insurance contract.

When you file a liability claim under another driver’s insurance policy, you are filing a third-party insurance claim. It’s still a third-party claim even if you and the at-fault driver both have the same auto insurance company, because you have different policies.

Almost every state requires drivers to carry a minimum amount of liability coverage for bodily injury and property damage. Liability coverage pays for the other person’s damages if an accident was your fault.

You cannot make a first-party claim against the liability coverage on your own policy.

First-Party Property Damage Claims

Collision coverage, also called “comprehensive coverage,” pays for damage to your vehicle, regardless of who is at fault. If you have a car payment, your lender probably requires you to carry collision coverage.

Your collision coverage will pay to fix your car if an accident was your fault, or you discover a dent in your door, or you collide with a deer. Most policies require a deductible on collision coverage. The lower your premium, the higher your deductible.

When you’re in an accident caused by someone else, you may find it faster and easier to work with your own insurance company to get your car repaired. Then, your insurance company will seek reimbursement from the at-fault party’s insurance company.

Rental Car: Your insurance policy may cover the cost of a rental car while your vehicle is in the shop. Generally, the adjuster will approve a daily allowance for a certain number of days.

Sometimes the insurance company has an arrangement worked out with a rental company, so you don’t have to pay upfront and wait to be reimbursed.

First-Party Personal Injury Claims

Personal Injury Protection (PIP): In states with no-fault insurance laws, every auto policy must have Personal Injury Protection (PIP) coverage for you and your passengers. PIP may be an optional coverage in other states.

PIP coverage won’t pay for property damage or pain and suffering.

In no-fault states, you are required to file with your PIP coverage after any car accident. You can’t file a claim against the other driver unless your injuries exceed a severity “threshold.”  The threshold usually means your medical expenses exceed your PIP coverage.

When your injuries are bad enough to exceed your PIP coverage, your case should be handled by a personal injury attorney for the best results.

Damages covered by PIP usually include:

  • Medical bills for doctor visits, therapy, and rehab
  • Out-of-pocket medical expenses
  • Lost wages
  • Replacement services

Medical Payments, or Med-Pay, is available as optional coverage in most states. Med-Pay has a lower limit than PIP, and only covers medical expenses, not lost wages or replacement services.

You can file a first-party claim for Med-Pay coverage no matter who caused the car accident.

Some policies will “double” the available Med-Pay coverage with proof you were wearing a seatbelt when the accident happened. If your policy has $5,000 in Med-Pay coverage, the limit may go up to $10,000 if you were wearing a seatbelt in an accident.

Uninsured and Underinsured Motorist Coverage: Some states require drivers to carry a certain amount of uninsured motorist coverage for bodily injuries, in case you are hurt in an accident caused by a driver who has no insurance.

In most states, it’s up to you to ask your agent for Uninsured (UM) and Underinsured (UIM) Motorist Coverage.

Just like with any optional coverage, you pay higher premiums for adding UI and UIM to your policy, but you have the protection of those coverages if you need to file a first-party injury claim.

Uninsured Motorist Coverage (UM) pays your bills when you’re injured in a car accident caused by a driver who doesn’t have insurance at the time of the crash.

Underinsured Motorist Coverage (UIM) helps pay for your damages when you’ve been seriously injured in an accident caused by a driver who has car insurance, but not enough to pay all your expenses.

Damages covered by bodily injury UI and UIM coverage include medical expenses, lost wages, and pain and suffering.

Bad Faith Legal Actions Against Your Insurer

Your insurance company has a legal duty to act in good faith. If you file a claim, and your insurance company gives you the run-around or refuses to cooperate in what you believe to be a valid claim, they may be acting in bad faith.

Every state has laws governing how an insurance company should treat claimants, especially first-party claimants.

Insurance companies may be acting in bad faith when they:

  • Fail to acknowledge or respond to your claim
  • Deny your claim without an explanation
  • Make an unreasonable lowball offer of settlement
  • Delay settlement for no reason when liability is clear
  • Fail to investigate your claim thoroughly or promptly
  • Make unreasonable or repetitive demands for documentation

If you think your insurance company is acting in bad faith, contact a personal injury attorney immediately. There’s more at stake than your original settlement demand.

Insurance companies who are found to be acting in bad faith are often forced to pay heavy “extra-contractual damages” to the injured claimant on top of paying for the original insurance claim.

Extra-contractual damages are high dollar amounts paid by the insurance company, not out of your insurance coverage.

In other words, if you and your attorney win a bad faith lawsuit, the court can not only force your insurance company to pay your rightful claim, it can also award an additional amount as a penalty against the company for its bad behavior.

Alternative Dispute Resolution

Stalled negotiations with the insurance adjuster are not necessarily due to bad faith. Sometimes it’s just an unwillingness on one side or the other to compromise.

If a first-party insurance claim can’t be settled, the next step does not have to be a lawsuit. Your case can go to arbitration or mediation.

Arbitration and mediation, collectively known as Alternative Dispute Resolution, or ADR, are other methods of settling your claim. If you and your insurance company are at a stalemate, you can ask them to participate in arbitration or mediation.

  • Arbitration is often binding, and the decision of the arbiter can’t be appealed. The ruling will bind you and your insurance company.
  • Mediation is typically not binding. The mediator’s purpose is to bring both sides together and get them to agree on a settlement amount. If mediation fails, a lawsuit can still be filed.

Many insurance contracts include language requiring you to agree to arbitration instead of filing a lawsuit. Insurance companies do not want to get involved in lawsuits with their insured.

If you and your insurance company agree to ADR, you have the right to represent yourself, but you can be sure the insurance company will have their lawyer at the table.

Most car accident attorneys offer a free consultation. Gather up your accident file and contact an experienced attorney. It costs nothing to get good legal advice early in the claims process.

Video: Filing First-Party Claims

 

First-Party Insurance Claim Questions

Charles R. Gueli, Esq. is a personal injury attorney with over 20 years of legal experience. He’s admitted to the NY State Bar, and been named a Super Lawyer for the NY Metro area, an exclusive honor awarded to the top five percent of attorneys. Charles has worked extensively in the areas of auto accidents,... Read More >>