How Claims Work
Claims are ordinarily handled in three ways: direct negotiations with an employer or adjuster; filing suit in a State or Federal court with litigation concurrent with negotiations; administrative legal proceedings before a State or Federal agency.
The amount of time required for claims processing, and the procedures involved, varies dramatically depending on the claim. The speed at which claims are handled often depends on the amount of work and time being committed to getting the claims resolved. If the claimant's representative is ignoring the claim, it is likely the employer or insurer will also ignore the claim, and claims processing will be prolonged. If progress is not being made in negotiations with a claims representative or employer, we may find it appropriate to commence a lawsuit or initiate an administrative proceeding. Often in maritime injury cases this is the best way to be sure a date is established whereby either the claim is resolved or a trial or hearing is held.
Sometimes, an employer, claims representative or insurance carrier will prolong the time it takes to resolve the claim as part of a strategy to force the claimant into a low settlement. Employers and insurance companies often monitor whether an injured person is inappropriately applying for unemployment, working against medical advice or engaging in activities inconsistent with the amount of the claimed medical disability. Surveillance is very common. Some employers are known to use job offers inconsistent with medical disabilities to entice a claimant into taking a job inconsistent with the disability claim.
While there is no specific rule as to how long it takes to process a claim, in Federal court in the Western District of Washington, a claim can take from 12 to 14 months, sometimes longer, after filing, before resolution by trial. There are also instances where, through active negotiation and substantial work on developing a claimant's file, a claim can be resolved within a few weeks or a month or two.
If you have been injured and are unable to work, with a resulting loss of income, waiting for your claim to be resolved can be extremely frustrating and difficult. Having a legal representative who actively pursues maintenance, temporary disability payments, unearned wages due under contract, or unpaid bonus can help, but these benefits may not apply in a specific case.
We do not advance funds for personal living expenses, and are not permitted to do so, but we can assist in explaining to creditors the particular circumstances causing a claimant to be in financial distress and, in appropriate cases, we have issued a letter to creditors providing for payment or payments at the time of settlement from settlement proceeds. We do not guarantee, assure or represent that a settlement in a particular case will be forthcoming, or the amount of a settlement, if any, and we require letters to persons other than our client state specific limitations regarding reliance on settlement proceeds payable in personal maritime injury actions.
In some cases, we may refer clients to an outside agency or private financial institution willing to make a loan against potential future personal injury settlements. Ordinarily, we do not recommend advance funding of settlements of this sort, but, upon request and in appropriate cases, we will provide our clients with information about agencies and businesses providing this service.
Where applicable law provides for current payment of an injured person's health care expenses, we will, as part of our written fee agree, commit to taking forceful measures to ensure that all health care expenses related to injury are paid without delay. If health care expenses have been turned over for collection, we will intercede in dealing with the collection agency, hospital, physician or other health care provider so our client is not bothered by health care providers seeking payment for services rendered.
Finally, as part of our written fee agreement, we commit to keeping our clients informed of the status of their claim and when they may expect their claim to be resolved. Expeditious and prompt claim resolution is promoted by our aggressive representation of a claimant's rights.
Claims processing and activities while a claim is pending, as described above, may have no relation to your specific case or claim. Only after a written fee agreement has been signed can we assess claims processing and activities that may apply to a specific case or claimant. Retaining an attorney to represent you regarding specific rights is an important act, and should not be based on advertising alone, including specifically this Web page and site. Call us for an immediate free initial assessment of your situation.