First-Party vs Third-Party Insurance Claims
No one begins their day expecting an injury, but people suffer sudden accidents every day, keeping emergency rooms busy in Oklahoma and across the nation. Injuries can disrupt a person’s life in many ways, with ripple effects across all aspects of their work life, financial situation, and ability to accomplish daily routines. Severe injuries may impact the accident victim’s entire future if they cause permanent disability.
After an accidental injury, expenses can pile up quickly—and often the injury prevents a prompt return to the workforce. A successful insurance claim helps to provide compensation for the economic and non-economic consequences of an injury—the “damages” in a personal injury claim. The first step toward compensation requires determining whether the case requires a first-party insurance claim or a third-party claim with the help of a personal injury attorney in Oklahoma City.
What Is a First-Party Insurance Claim?
A person makes a first-party insurance claim against their own insurance policy—a policy they’ve bought for and paid premiums on themselves—when their damages are covered under the terms of the policy. The most common example of a first-party claim is one you make to your healthcare insurance policy when you’ve been to the doctor, become ill, or had an accident that was no one else’s fault. Other examples of first-party claims include the following:
- Making a claim against your property insurance after a house fire or storm damage
- A claim against your auto collision insurance policy after backing into a mailbox
- A claim against your uninsured/underinsured motorist coverage after an accident caused by an uninsured driver
- In a handful of no-fault insurance states, car accident victims file claims against their own auto insurance personal injury protection (PIP) policies
When you make a claim against something covered under the terms of an insurance policy you’ve purchased for your own protection, it’s a first-party insurance claim and your insurance company must live up to the terms included under the policy. Under these terms, the insurance company becomes the second party in the claim.
What Is a Third-Party Claim?
In a third-party claim, an injury victim files a claim against someone else’s insurance because they were responsible for the injury, typically through negligence. These claims are made against liability insurance that doesn’t belong to the victim. A negligent party is liable for an injury victim’s damages like property damage, medical expenses, lost income, and sometimes non-economic damages like pain and suffering. Examples of third-party insurance claims include the following:
- A car accident claim against an at-fault driver after a collision in a fault-based insurance state like Oklahoma
- A premises liability claim against a store owner after a slip-and-fall accident
- A claim against a manufacturer for a defective product injury
- A dog bite claim against a dog owner after a dog bite
- A malpractice claim after an injury caused by medical malpractice
When an injury victim makes a claim for damages like medical expenses, lost income, and compensation for pain and suffering against an at-fault party’s insurance company, it’s a third-party claim because the claim is against an insurance policy that someone else bought and paid for rather than their own policy.
Do I Need an Attorney for an Insurance Claim?
Some claims are relatively simple and simply a matter of paperwork; for instance, a claim for medical treatment against your healthcare insurance typically wouldn’t require an attorney. However, making a third-party liability claim requires documenting and presenting sufficient evidence of negligence, recklessness, or wrongdoing. An injury victim becomes the plaintiff in the case and has the burden of proving liability through a preponderance of the evidence. Contact an experienced attorney at Dan Davis Law for legal guidance in determining the best way forward for obtaining the maximum compensation available to you.