Insurance claims and personal injury claims are similar but not identical. Although many people in California use them interchangeably, they are distinct legal processes. 

Insurance claims typically involve an individual and their insurance company. It could be for various reasons, like seeking compensation for car accident damages, a leaky roof, or other issues, based on an existing policy. 

“Personal injury claims are entirely different,” says car accident lawyer Walter Clark of the Walter Clark Legal Group. It usually involves pursuing legal action against a person or an entity to demand compensation for the harm they inflicted on you.

Let’s clarify these differences to provide a clear understanding of the steps you should take. Have a look.

Understanding Insurance Claim Basics

An insurance claim is simply an attempt to retrieve funds from your insurance company. Maybe your car was damaged, or your basement was flooded, but it is determined by what is covered in your policy.

Some things you will need to include with your claim are your policy number, evidence of the incident that occurred (such as photos or receipts), and an estimate of the total damage. Please ensure that you provide only the information specified in your policy, and take a moment to review the fine print carefully.

What is Unique in a Personal Injury Claim

In a personal injury claim, you are not simply calling your insurance company to have them cut you a check. You are directly suing the person or entity that hurt you. It could be a car accident where somebody rear-ended you at an intersection, or a slip and fall at a business, or even a doctor’s error that worsened your condition.

These claims hinge on negligence, so you must be able to demonstrate the responsible party’s duty of care, a failure to uphold that duty (breach), the link between the breach and the accident (causation), and finally, the resulting harm. You must prove that they, in fact, caused the injury. Proving these elements requires meticulous effort in compiling evidence such as police reports, witness statements, medical records, and all the receipts.

Personal injury claims usually include attorneys, lengthy negotiations, and potentially litigation in court if a fair settlement cannot be reached. The whole point is not always to get your car fixed or pay hospital bills. You are also trying to get compensated for the pain you had to go through—pain, stress, and areas that money does not directly fix, but helps anyway.

Steps Involved in a Personal Injury Claim Process

The process of claiming a personal injury begins with you collecting evidence of the incident. If it is a car accident, start by taking pictures of the scene, interviewing witnesses, and keeping an account of the medical reports or bills. Then you inform the at-fault party or their insurer. That is where you make your demand for payment.

Most claims are initially negotiated by attorneys or adjusters, who work to reach a settlement. If unsuccessful, it then becomes a lawsuit. You then proceed to discovery, exchange evidence, and possibly need to go to trial.

It does take months—or perhaps even years—but every step gets you that much nearer to receiving fair compensation for your loss.

Involving an Attorney

When the case is complex or the stakes are high, a lawyer plays a central role in personal injury cases. When the party at fault denies liability, the insurance company offers a lowball settlement, or the injuries are severe, a lawyer is your best bet.

Select a lawyer with experience in personal injury, ideally in California, since they are familiar with the local courts and legislation. Check for favorable reviews and a successful history of settlements and trials.

Lawyers can handle the legwork, including gathering evidence, negotiating, and making courtroom appearances. And most are on a contingency basis, so you only pay them if you win.