Inside Insurance with Chris Saucedo

The insurance claims process can be complex, not to mention distressing. The circumstances surrounding insurance claims are often upsetting, which only adds to the stress. In this message, I’ll address an important change in the law regarding unpaid insurance claims along with an overview of insurance claims, a summary of the process for workman’s compensation claims and a brief discussion on settlements.

A Change in Interest Charges for Unpaid Claims
In February 2017, John G. Franchini, Superintendent of Insurance for the State of New Mexico, issued a bulletin concerning valid claims that remain unpaid 45 days after proof of loss has been provided. The bulletin stated that individuals filing such claims would be entitled to the amount due plus interest assessed at 1.5 times the prime lending rate set by the superintendent for banks within the state applicable at the time of the claim. For 2017, the rate is 1.5 times 3.75 percent, or an effective rate of 5.625 percent. This rate shall remain in effect until the superintendent issues a new bulletin on or after January 2018.

Understanding Insurance Claims
Insurance claims simply represent a means of providing financial compensation to mitigate damage or harm on behalf of a policyholder. In this respect, the basics for all insurance claims are the same: presentation of damage or loss by the insured, often on a standard form, along with supporting documentation. Claims are then submitted to insurers, which analyze both the details of individual claims along with their documentation to determine whether to approve, request further documentation or deny specific claims. Some policies provide partial payment to policyholders or their designated beneficiaries up front while the claim is being processed.

Of course, individual claims vary according to the details of the claims and the type of insurance involved. Many claims are quite complex. And unfortunately, insurance claims are frequently plagued with problems for individuals filing claims and for insurers alike. At SaucedoChavez, we understand the ins and outs of the insurance claim process. We work with individuals and insurers, acting as advocates for parties acting in good faith on both sides of the issue

If You Are Injured on the Job
Of course, if you are injured at work, your first concern must be to get out of harm’s way and avoid further injury. Do not hesitate to seek medical attention, especially in an emergency. After your medical condition is addressed, report the injury as soon as possible to your employer. If you suffer delayed pain or disability due to an injury, report the injury or disability as soon as you are aware of it. Failure to inform your employer of a job-related injury in a timely manner will bar you from seeking workman’s compensation.

In a non-emergency situation, or once an emergency situation has been stabilized, either you or your employer may choose a healthcare provider to provide treatment for the next 60 days. After 60 days, the party that did not choose a health provider has the option of doing so. You may also be entitled to indemnity benefits if your injury prevents you from working.

If your employer disputes your claim, you may contact an ombudsman or file a workman’s compensation complaint. If you haven’t already contacted an attorney, this is the time to do so.  Attorneys at firms like SaucedoChavez understand the process of presenting your best case, including choosing witnesses, providing documentation and evaluating your work environment at the time of your accident.

Settlements: What You Need to Know
If you suffer an ongoing disability as a result of a work-related injury, you may be entitled to a settlement. There are two types of settlement: lump sum and structured. Both types of settlement should include some provision for medical treatment.

There are four categories of disability: permanent partial disability, permanent total disability, temporary partial disability and temporary permanent disability. You may also be entitled to a settlement for disfigurement or scarring, even without suffering a disability.

The amount of settlement to which you may be entitled depends largely on the nature and extent of your disability. A law firm like SaucedoChavez can evaluate your injuries and your overall circumstances to empower you to obtain the largest settlement possible—either a lump sum or a structured settlement—or to proceed to court if necessary to protect your rights.

You have insurance questions, and we have answers. At SaucedoChavez, insurance is one of our major practice areas and one of my specialties. Give me a call, and I’ll start working on your insurance claim-related case right away!