Personal Injury

What Is a Personal Injury Claim?

By David Goguen, J.D., University of San Francisco School of Law

When you have suffered an injury or some other loss for which another person (or a business or a government body) may be legally responsible, you may have a viable personal injury claim. That means you may be able to hold the at-fault party financially responsible for things like the cost of your medical care, your lost income, and other negative effects stemming from the injury. In this article, we’ll explain the basics of personal injury claims.

Common Kinds of Personal Injury Claims

Some of the most common personal injury claims arise after some pretty familiar scenarios. Your car is rear-ended at a stop light. You slip and fall on a puddle of water in the grocery store aisle. The neighbor’s dog gets loose and bites you. All of these incidents can form the basis of a personal injury claim (which would be filed against the other driver, the owner of the store, and the owner of the dog, respectively, using the examples we just mentioned).

Personal Injury Claims In and Out of Court

One thing to keep in mind is that “personal injury claim” is something of a generic term. Many people don’t realize that a personal injury claim can technically arise, play out, and reach resolution without the court system ever being involved (without a lawsuit ever being filed, in other words).

The Injury-Related Insurance Claim Process. In some instances, after an accident or other incident, a “personal injury claim” is filed with an insurance company, some back-and-forth negotiations take place, and the injured person receives a settlement check.

Think of the car accident example. After the crash, the injured person might open a claim with his or her own insurance company, or with the insurance company of the other driver. If things go smoothly -- the other driver was clearly at fault, the injured person wasn’t hurt that badly, etc. -- there is a good chance that the claim can be settled and the situation resolved without the court’s involvement.

Continuing with the car accident example, if you make the claim through your own insurance coverage, and the other driver is at fault, usually what happens is your insurance company pays your claim (cuts you a check) and turns around and gets reimbursed from the other driver’s insurer. Your insurance company may even ask the other driver’s insurer to pay any deductible you had to pay, so you may get that back too.

The Injury Lawsuit Process. In most situations where someone suffers significant injuries, or where the at-fault party is disputing responsibility, or where settlement just doesn’t appear likely, at some point the “personal injury claim” will likely take the form of a lawsuit.

That means the injured person (usually with the help of an experienced lawyer) files papers with the proper branch of their state’s civil court system, spelling out their case against the person who caused their injuries, and asking the court to find that person liable for the injured person’s losses (called “damages”). At this point, the injured person is known as the “plaintiff” and the person alleged to have caused the injury is known as the “defendant.”

After the plaintiff files the initial papers (these are known as the “complaint” and “summons”) and those documents are served on the defendant, the defendant has a certain number of days to respond, and the lawsuit proceeds from there.

It’s important to note here that the insurance process and the lawsuit process are almost never mutually exclusive. Insurance coverage plays a role in almost every personal injury claim, and often what starts out as an insurance claim ends up as a lawsuit. Sometimes the lawsuit is filed merely to spur settlement talks, and other times the parties end up battling it out all the way to trial.

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