How to handle insurance companies after a personal injury Their adjuster is not on your side.

Report the injury, give your own insurer the cooperation your policy requires, and give the other side’s insurer the basic facts and nothing else. Then treat, document, and wait for your doctors to know what you will need before anyone puts a number on the claim.

Why your insurer and theirs are different

A first-party claim is a claim you make against your own insurance policy. A third-party claim is a claim you make against someone else’s policy because that person injured you. Almost every mistake people make with insurers after an injury comes from treating those two calls the same way.

Your own policy is a contract, and it contains a cooperation clause: you have to report the loss, answer questions, and provide the documents your insurer reasonably needs. The other side’s carrier, meaning its insurance company, has no contract with you. Its duty of good faith runs to its own policyholder, not to the person making a claim against that policyholder.

How long the insurer has to answer

Silence from an adjuster is measurable. Under the Fair Claims Settlement Practices Regulations published by the California Department of Insurance, section 2695.5 gives an insurer 15 calendar days to acknowledge a claim and 15 calendar days to give a complete response to a communication from a claimant. Section 2695.7 gives it 40 calendar days after receiving proof of claim to accept or deny in writing, and 30 calendar days after an agreement to settle to send the payment.

Insurance Code section 790.03 defines the unfair claims settlement practices those regulations enforce, including failing to act reasonably promptly on claim communications and forcing a claimant to sue by offering substantially less than what is eventually recovered. If a carrier is ignoring those deadlines, you can put the dates in a letter, and you can report the conduct to the Department of Insurance through its consumer help and complaint process. What those regulations do not do is give you a private lawsuit against the other side’s carrier. In California a bad faith claim, a lawsuit against an insurer for mishandling a claim, belongs to the policyholder, so if the insurer mistreating you is your own, that is a different and much stronger position than being a claimant against someone else’s policy.

What to send and what to withhold

Send what proves the loss and hold back what opens your history.

• Send: the incident report, the photographs, the names of witnesses, the bills and records for the treatment related to this injury, and pay records showing what you lost by missing work.
• Send in writing: every substantive communication. Confirm phone calls by email the same day, with the date and what was said.
• Hold back: a blanket medical authorization. Offer one limited to the body parts at issue and a date range that starts shortly before the injury.
• Hold back: your description of your injuries, until your doctors have finished describing them.
• Hold back: a recorded statement to the other side’s adjuster. There is no obligation and no upside.
• Do not post about it. A photograph of you at a birthday party becomes an exhibit, and nobody who sees it will know you went home twenty minutes later.

Who pays the medical bills until settlement

This is the practical problem in most injury cases, and it has nothing to do with who was at fault. The at-fault insurer pays once, at the end, in a single settlement. Nothing forces it to pay a bill as it arrives, and in the meantime the bills come anyway.

• Your health insurance. Use it. It is the cheapest money in the case, and its right to be repaid is limited by statute.
• MedPay, in a vehicle case. It pays medical bills regardless of fault, up to its limit, and it pays fast.
• Treatment on a lien. Some providers treat now and are paid from the settlement. It keeps care going, and it raises the balance that has to be negotiated at the end.
• Workers’ compensation, if you were on the job. It runs alongside the injury claim, and the employer’s insurer will assert a lien against any recovery under Labor Code section 3852.

A lien is a claim on your settlement held by someone who paid for your care. Two California statutes cap the largest ones. Civil Code section 3040 limits a health plan or disability insurer lien to one third of the money due to you when you have a lawyer, and one half when you do not, and it reduces the lien pro rata, meaning in proportion, for attorney fees and costs and by any comparative fault percentage. Civil Code section 3045.1 creates the hospital lien for emergency and ongoing care. What gets negotiated on that line at the end of a case often matters more to your net than the size of the settlement.

How long you have to sue

Code of Civil Procedure section 335.1 gives you two years from the injury to file a lawsuit for assault, battery, or injury caused by the wrongful act or neglect of another. Section 338(c) gives you three years for damage to your property. The California courts summarize the general rules on their deadlines to sue page.

The short one is the dangerous one. If you were hurt on public property, by a public employee, or by a government vehicle, Government Code section 911.2 requires a written claim to that entity within six months of the injury. A fall in a city park, a crash with a transit bus, and an injury at a public hospital all run on six months, not two years. Filing an insurance claim does not satisfy it, and the two year statute cannot rescue you from missing it. The entity then has 45 days to act on the claim under Government Code section 912.4, and once it mails a written rejection you have six months to file suit under section 945.6. The sequence is six months, then 45 days, then six months, and none of it is forgiving.

The three things that lower an offer

In our cases the same three facts show up in almost every low valuation, and none of them are about how badly someone was hurt.

1. The gap. A delay before the first medical visit, or a month with no treatment in the middle. To an adjuster a gap reads as recovery, whatever the reason for it was.
2. The early statement. “I’m okay” said in week one, before the imaging, becomes the baseline everything after it is measured against.
3. The incomplete record. Symptoms mentioned to a friend and not to a doctor do not exist in the file. If a body part hurts, it belongs in the chart at the first visit.

When you do not need a lawyer

Not every injury claim needs representation, and we would rather tell you that than take a case that does not need us. If liability is admitted, your treatment was a single visit, there is no wage loss, and the offer covers your bills with room left over, handling it yourself is reasonable. For a small property loss with no injury, the California small claims court works and does not involve lawyers at all.

Call an attorney when liability is disputed, when a public entity is involved and the six month clock is running, when treatment goes beyond a few visits, when there is a lien or a workers’ compensation claim in the background, or when the adjuster starts asking for recorded statements and open-ended authorizations. Our frequently asked questions page covers what happens after the first call, and our practice areas page shows the case types we handle.

How to handle the two adjusters

Separate the two adjusters and treat them differently. Cooperate fully with your own carrier because your policy requires it. Give the other side the incident, the date, and the place, decline the recorded statement, and narrow the authorization. Use your health coverage to keep treating, keep the record complete and uninterrupted, and write down every date. Then let your doctors finish before anyone values the claim.

If a deadline is close, if a government entity is involved, or if the offer arrived before your treatment did, tell us what happened and we will tell you what we see. There is no fee unless we recover.