Insurance Claims and Negotiations Flashcards
6 cards from real accident attorney practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Insurance Claims and Negotiations flashcards as text
What is an 'independent medical examination' (IME) and who typically requests it?
Answer: A medical evaluation ordered by the defense or insurer to assess the plaintiff's injuries and causation
IMEs are requested by insurers or defense counsel and conducted by a physician of their choosing to challenge the severity, causation, or treatment of the plaintiff's claimed injuries.
What is 'bad faith' insurance handling?
Answer: An insurer's unreasonable refusal to settle a valid claim, pay benefits, or properly investigate, exposing it to extra-contractual damages
Insurance bad faith occurs when an insurer violates its duty of good faith and fair dealing by unreasonably denying claims, delaying payment, or failing to defend, potentially exposing it to punitive damages.
What is a 'policy limit' demand and why does it matter in settlement negotiations?
Answer: A demand that the insurer pay its full policy limits to settle the claim, which if refused can expose the insurer to excess liability
When a plaintiff makes a policy limit demand and the insurer unreasonably refuses, the insurer can be held liable for the full judgment even if it exceeds the policy limits.
What is an 'offer in compromise' or Section 998 offer (in California) in personal injury litigation?
Answer: A statutory offer to settle that shifts cost-burden to the rejecting party if they fail to beat the offer at trial
Statutory offers (like CA CCP 998) incentivize settlement by requiring the party who rejects and then fails to do better at trial to pay the other side's post-offer costs.
What is a 'lien' in the context of a personal injury settlement?
Answer: A claim by a third party (insurer, hospital, or government) against the settlement proceeds for benefits paid on the plaintiff's behalf
Medical liens, Medicare/Medicaid liens, and workers' compensation liens must be resolved out of settlement proceeds before the plaintiff receives the balance.
What is 'first-party' vs. 'third-party' insurance coverage in accident claims?
Answer: First-party claims are against your own insurer; third-party claims are against the at-fault party's insurer
First-party claims (PIP, MedPay, collision) involve the insured claiming against their own policy, while third-party claims target the liability coverage of the at-fault party.