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Accidents can happen to anyone, anywhere. Some accidents are caused by another party's fault, while others are the result of our own negligence. While minor accidents can be brushed off, serious ones can cause a lot of problems economically and medically. You may need hospitalization, which means medical bills and long-term care. Because you're in the hospital, it will result in missed days at work and loss of income. So how do I file a first party insurance claim in Florida?

People in Florida purchase an insurance policy to offset the financial consequences of a Fort Lauderdale personal injury brought about by accidents. To make sure you get fair and just compensation from your first-party claim, make sure you get legal advice from experienced insurance claim lawyers in Florida.

What Is a First-Party Insurance Claim? 

How Do I File a First Party Insurance Claim in Florida

People are required to purchase an insurance policy as a means of protecting themselves in case of unforeseen events. In exchange for paying their premiums, policyholders can request compensation for medical treatment and loss of income. In case of an accident, your insurance carrier can cover the necessary expenses arising from an accident, regardless of who was at fault. This is called a first-party insurance claim.

This type of claim is typically used when there is no other party involved in an accident. It is when you, the policy holder, take out a claim against your own insurance company. Your insurance carrier will then compensate you in accordance with what's stated in your insurance policy benefit.

Typical examples of first-party insurance include:

  • Personal Injury Protection (PIP)
  • Health Insurance
  • Uninsured/Underinsured Motorist Coverage
  • Med-Pay Insurance
  • Renter’s Insurance

Differences between a first-party and third-party claim

While processing your claim, you might hear the terms first-party and third-party insurance claim. A third-party claim is a claim made against the insurance company of the other party, instead of your own. This usually transpires when you sustain injuries from another person's mistake or negligence, and you want to file a personal injury lawsuit against them.

Does this mean that you can skip the first-party claim and go directly for a third-party claim if the other person is clearly at fault? The answer to that is no. Florida is known as a "no-fault" state, which means that under the state's insurance law, all parties are responsible for paying any damages or injuries incurred on their end, regardless of whose fault it is.

This means that even if the other person is at fault, you have to go through your insurance company first and take a claim out of your own insurance policy. Once this is done, you can then go ahead and file a third-party insurance claim against the insurance carrier of the other party if your own policy benefit is not enough to cover the extra-contractual damage or injuries sustained.

How to File a First Party Insurance Claim

To make sure you get the most out of your first-party claim, here are the steps you need to take:

1. Call the appropriate authorities. The process starts with you calling 911 after the accident transpires. The agent will dispatch the appropriate authorities to deal with the accident, be it the police, the fire department, or the paramedics. Calling 911 is better than trying to resolve the problem yourself or driving yourself to the hospital. If you are able to, get the names of the responding officers.

2.  Get yourself treated. If your injuries are severe, you will be taken to a hospital straight away. Otherwise, the paramedics will treat you on the accident scene. Police officers will interview you and get your statement regarding the accident. If you are worried that you might say something that could get you in trouble, you may contact your lawyer after you contact the authorities so someone can represent you.

3. Call your insurance company. The next step is to call your insurance company to inform them about the accident. If you want to protect yourself, seek the advice of a reasonable attorney first, to ensure that you don't say anything that could jeopardize your claim. Of course, you shouldn't lie to your insurance provider, but after the accident, you might be too dazed and confused, and your story might seem unreliable because of it.

4. Get the appropriate documents. Your property insurer will give you a list of requirements that you need to fulfill to get fully compensated on your claim. Remember the officers who responded to the scene? Contact the authorities and secure a copy of the official police report. Aside from this, you will need other documents, such as the record of your hospital stay, a measure of damage to property, and an estimate of the entire cost of repairs. 

5. Submit your documents. Once you submit everything that your insurance company needs, they will begin their own investigation. They will conduct their own appraisal of structural damage, and will also talk to the officers who were at the scene. Your statements to the authorities and the insurance company should match, or it might end up with a factual dispute, which can ruin your chances for fair compensation.

6. Assignment of benefit. The company will then calculate your payout based on the terms of the policy and the results of their investigation. The turnaround time for this varies, so make sure to check with your adjuster to find out. 

What Is a Bad Faith Claim?

In a perfect world, the injured party will get the compensation they need to transition back into normal life without financial difficulties. However, insurance companies are businesses, not charities. Insurance companies may look for ways to lower the final compensation value or deny it completely.

In a lot of cases, the compensation offer is inadequate, and the company is hoping that the policyholder will be desperate enough to take it because they need the money for repairs and hospital bills. If you receive the computation for damages recoverable, and the number feels low to you, it's time to consult a reliable insurance claim attorney.

Your attorney will appraise the document and if there are obvious signs of bad faith, you can file a claim against your insurance provider for first-party breach of contract or bad faith action.

What Constitutes as Bad Faith?

First-party bad faith happens when the insurance company fails, in good faith, to give the policyholder fair and just compensation within the policy limit. Nowadays, bad faith does not only mean inadequate policy payout, it can also mean a breach of insurance contract action or fraud. Here are some activities that fall under bad faith in accordance with the Florida Statutes (section 624.155):

A women holds a tablet about to fill out a form in a Ft Lauderdale office
  •  A failure on the part of the insurer to settle the claim in good faith, even if they have the capacity to do so
  • Releasing payments to the insured without proper documentation or explanation of the process and the factors that affected their final judgment
  • Delaying the payment of claims, or delaying the investigation process
  • Not responding to the policyholder's queries or attempts at communication throughout the entire process
  • Making changes to the policy terms without the knowledge of the policy owner
  • Denying an insurance claim without proper explanation
  • Material misrepresentation of facts with the goal of devaluing or denying the claim maliciously.

How to Handle Bad Faith Claims

Handling bad faith claims is a complex process that you should not face alone. Remember that insurance companies usually have a knowledgeable legal team behind them. Keep in mind though, that these companies usually don't want lawsuits to reach the trial court. By hiring a reasonable attorney that can negotiate on your behalf successfully, you can get just compensation without going to trial.

Your attorney will look through your documents and look for evidence of a first-party breach of contract. The negotiation process requires a lot of back and forth, but if there's overwhelming evidence against them, the insurance company may relent and choose to settle with monetary compensation.

Keep in mind that your company knows you may want alternative dispute resolution methods because if the bad faith lawsuit goes to court, it will be a lengthy and expensive process for you. However, just because negotiations fail, it doesn't mean you need to go to trial. If your lawyer is able to obtain overwhelming evidence of bad faith on the part of your insurance company, the judge may move for partial summary judgment, wherein you get a court decision without a trial. This happens when you have enough evidence of bad faith to declare you the winner of the lawsuit.

When Do You Need Third-Party Insurance?

If the assignment of benefit on your insurance policy is not enough to cover excess damage and accident injuries, and if there's no evidence of bad faith or breach of contract from your insurance provider, you may want to file a claim for third-party insurance.

Third-party insurance claims are claims made against the insurance provider of the other party. Once you receive the payout from your own insurance company and it isn't enough, or if there's overwhelming evidence of fault on the other party, you may sue for damages. When accidents happen, both parties usually exchange insurance information so you can contact their provider if you want to file a claim. 

Filing for Third-Party Insurance Claims

You file your third-party claim in a similar fashion as a first-party claim, because you can ask your own insurance provider to handle the process on your behalf. Your property insurer will contact the other party's insurance company and make the claim on your behalf.

Because Florida is a "no-fault" state, the other party's insurance provider will question this move, and check if you've already done the necessary procedures to acquire your first-party claim. You must provide sufficient cause for the filing of a third-party insurance claim. Either that your insurance coverage is not enough to pay for excess damage sustained in the accident, or that you can provide enough evidence to prove that the other party is at fault.

Your insurance adjuster will work with the other party's insurance provider to look for evidence of fault. If it is determined that you are at fault for the accident, the other party may outright deny your claim. If another party is at fault, the other party's insurance provider will start to determine the compensation value. They might contact you directly to ask you questions or to request additional documents. Keep in mind that you are entitled to compensation subject to the other party's policy limits. 

Dealing with Third-Party Bad Faith Insurance Claim

Third-party bad faith claims are more complicated compared to first-person ones. This is because the goal of the other party's insurance provider is to prove you're at fault so they can devalue or deny your claim. Here are some actions that constitute third-party bad faith:

  • Falsely devaluing the other party's policy limit in an effort to undervalue the compensation you are entitled to
  • Misrepresentation of facts to delegitimize the claim's merit
  • Outright denying the claim without proper justification or thorough investigation
  • Failure to communicate with the aggrieved party and their representatives

Although you and the other party's insurance provider don't have a contract in place, third-party bad faith actions are still considered a breach of contract because the insurance provider is still liable to their client, which is the other party. It is the insurer's responsibility to properly compensate should their client cause bodily harm to others.

Getting Just Compensation for a First-Party Insurance Claim

So how do you ensure that you get fair and just compensation for a first-party claim, and avoid becoming the victim of bad-faith actions?

  • Read your policy thoroughly. Insurance providers often look for policy loopholes when they want to devalue or deny claims. Before signing any insurance policy, make sure you read it thoroughly. If possible, hire a lawyer to look through your policy to see if it is disadvantageous for you. Florida insurance law states that citizens must have Personal Injury Protection (PIP) and Property Damage Liability (PDL). However, just because it is a state requirement doesn't mean you don't exercise discernment when picking the right policy for you.
  • Keep an insurance journal. If you are in an accident, make sure to keep all documentation needed for insurance claims. Receipts, medical records, accident reports, damage appraisals, and other documents help your provider come up with an accurate compensation value.
  • Keep all communication with your insurance company. Save emails, text messages, and other forms of communication between you and your insurance provider. This will provide valuable evidence for your lawyer should your insurance claim go awry and you need to file a bad-faith claim against your provider.
  • Read your insurance policy from time to time. One common tactic to devalue a claim is to change the policy terms without the knowledge of the policyholder. When in doubt, ask for a copy of your policy, and then compare it with your original policy to see if any changes have been made.
  • Don't be tempted by easy money. An accident can give you a lot of financial stress, and insurance companies often take advantage of this. You may need money desperately for your hospital bills and home or car repair, but accepting the money without checking to see if you are getting the compensation that you deserve can put you at a disadvantage.

If you want your first-party insurance claims to be fair and free of any hassle, hiring an experienced insurance claim attorney from the get-go is the best option. VG Law is a Florida-based law firm that excels in first-party insurance claim assistant and bad faith litigation.

A man in a blue suit is on a touch screen computer filling out an insurance claim in a Fort Lauderdale office

After sustaining injuries and property damage from an accident, the last thing you need is to get taken advantage of by insurance companies. By hiring an experienced lawyer, you can get the maximum compensation you deserve so you can concentrate on healing and bouncing back without worrying about your and your loved one's economic needs. Give us a call and let us know how we can help you today.

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