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5 Steps to Third-Party Insurance Coverage

Posted on: November 18, 2022

LEGALLY REVIEWED BY:
Chi Hung Nguyen
November 18, 2022

 

third-party claimants include injured passengers

Semi-trucks, tractor trailer, and other large commercial vehicle trucks can be difficult to control and very heavy. The average passenger car is about 2,000-5,000 pounds, while a fully loaded truck can weigh more than 80,000 pounds. When a driver of one of these vehicles loses control and causes an accident with another car, the results can be devastating.

The first step on the road to recovery begins with understanding how to rebuild any damages and heal injuries. Those who suffer bodily injuries and property damage after being struck by a truck can seek remedies from the driver’s insurance company. Generally, these are known as third-party claimants.  Below, we discuss the must-ask questions an injured third-party claimant can ask when they are taking a look at their car accident or truck accident case.

First, there are a few potential categories of injured claimants: third-party claimants, first-party claimants or both.

Third-Party Claimants

Third-party claimants are those who bring a claim against the person who has insurance. This includes those who are hit by a truck or car, and any injured passengers in either vehicle.

First-Party Claimants

First-party claimants have their names on the insurance policy contract, or are granted permission to use the vehicle. Usually, insurance companies owe these named insureds a duty to act in good faith and fairly deal with them while also complying with any state laws for unfair settlement practices.

Both First and Third-Party Claimants

There are a couple examples of when a person can be both a first-party claimant and a third-party claimant. For example, if a person is hurt in a car accident after being struck by an underinsured or uninsured motorist, and he or she makes a claim with his own insurance company. In this case, the injured claimant makes a third-party claim under his first-party insurance policy.

Another example is when an injured claimant was a passenger in the at-fault driver’s vehicle. This injured passenger would have a first-party claim under the insured’s policy. The injured passenger would also have a claim with the at-fault driver’s insurance company as a third-party.

Below are five questions you can ask to break down third-party insurance coverage in your case.

  1. Was there an “occurrence”? Typically, insurance policies refer to accidents and events that trigger the insurance policy as an “occurrence” and define the term under the policy. This usually includes being around an ongoing and continuous condition that is harmful.
  2. What kind of damage? The accident, or occurrence, causes some type of injury or property damage. Injury is bodily injury from the accident. For example, having emotional distress after being cheated in a bad investment scheme can be harmful, but this by itself is not bodily injury or injury to property.

In some cases, property damage is defined as the loss of use and other physical damage to property (like exterior damage to your vehicle after your car accident). Property damage is typically actual contact with your vehicle. If an accident causes a pole to land in the road and block your way, but did not make contact, then property damage did not happen.

Usually, the damage suffered also needs to have happened during the policy time period.

  1. Is the damage excluded from insurance coverage?

These liability policies exclude damage caused to your own property. A policy exclusion is an insurance company trying to limit itself from having to be responsible for more than it intended. There are many types of policy exclusions. A few common examples are:

  • Driver Exclusions: This stops the insurance company for being liable or held responsible for damages caused by a person or a group of people who was not supposed to be driving. For example, the insurance company might cover an entire family except those who are between ages 18 and 21 years old.
  • Vehicle Exclusions: This stops the insurance company for being liable or held responsible for certain kinds of vehicles, like three-wheel vehicles or high performance vehicles under a regular, standard auto policy.
  • Territory Exclusions: This stops the insurance company for being liable or held responsible for accidents that happen outside a certain area, like driving outside of the state or 150 miles.
  1. Have the policy conditions been met? 

Insurance policy conditions are a list of requirements that the person with insurance coverage needs to meet if he or she wants to be able to make an insurance claim. A policy condition can be an action that needs to be taken, or circumstance and condition that needs to exist before a third-party claimant can receive benefits under the insurance policy.

For example, an insurance policy with a voluntary payments clause requires an injured claimant to notify the insurance company of the qualifying occurrence before it has to pay any benefits. Each state has different laws. A few states require the insurance company to show it suffered some kind of prejudice, usually an important disadvantage, before it can try to defend itself under a voluntary payments clause. There are limitations. An insurance company gives up, or waives, its defense under a voluntary payments clause if it already denied coverage of the claim.

In addition to the voluntary payments clause, there are several kinds of insurance policy conditions that are in most personal liability and commercial liability policies:

  • Duty to Cooperate: If the insurance company is defending its insured client against a third-party claim, then the insured has to cooperate and work with the insurance company by providing any requested information like the facts about the claim.
  • Bankruptcy: even if a person with insurance becomes bankrupt, the insurance company still has to fulfill its obligations and duties to the policyholder and third-party claimants.
  • Assignment: this clause states that the policyholder cannot transfer the insurance policy or extend coverage to an outside person or company without the insurance company’s written agreement to the transfer. This protects the insurance company from covering another party without being aware of it.
  • Subrogation: this refers to the insurance company stepping into the insured’s shoes. For example, when the insurance company makes payments to the claimant for the insured, the insurance company uses the subrogation clause to also claim the rights the insured would have had to recover from another party. In other words, the insurance company agrees to pay for what its insured owes, but also secures the insured’s rights so if someone else is responsible then the insurance company can try to get money it may be owed from the responsible person.
  • Mitigation of Damages: this clause requires the injured person to try to do what they can to help lessen the damages they suffered. This can be by taking any emergency or necessary measures to prevent the problem from getting worse, regardless of whether the he or she was part of the cause of the problem or not.
  • Notice Clauses (including notice of the occurrence and notice of the claim): you need to let the insurance company know by filing a claim before it is too late.
  • No Action Clause: this clause says that unless all of the conditions are satisfied and the terms of the insurance policy followed, there is no valid legal cause for which the insurance company can be sued.
  • Other Insurance Policy Clause: insurance companies try to prevent double-dipping claimants from recovering from multiple insurance policies and companies for the same injuries and damages.
  1. How much is my insurance claim worth?

An insurance company has to give a claim the dollar value it deserves, whether it is for the purpose of settling a case or judgment. This includes the costs involved in defending its client and insured person.

The value of your insurance claim depends on the extent of injuries and damages you suffered. Each person’s case is unique, and not all of the same claims or defenses apply to every case. This requires finding the right personal injury lawyer who can help evaluate your claim.

It is worth noting that an insurance policy is interpreted against the insurance company. This means that if there is a section in the insurance policy that is unclear, and both sides have different opinions about what the insurance policy says or means, then the judge should favor the insured person over the insurance company. If it comes down to choosing between the big insurance company who probably wrote most of the contract and the injured person who just wants the insurance company to be held responsible so that he or she can recover, then most judges have to lean towards the injured person.

Finding the right car accident or truck accident lawyer begins by asking the right questions. But these first questions are just the first step of a long journey to any settlement negotiation or lawsuit.

Contact an experienced personal injury lawyer

Navigating complex personal injury cases and handling insurance companies can make the recovery process even more difficult. Experienced attorneys strategically weigh the cost and benefits of each case to minimize the time and expense involved while maximizing their clients’ compensation.

Are you trying to secure your financial recovery with the help of experienced attorneys? If so, we can help.

The Pusch & Nguyen Law Firm has helped countless Texans handle their insurance disputes. Our experienced trial lawyers have gone up against some of the biggest names in the insurance industry while successfully bringing home payouts for clients. Our successful reputation speaks for itself, and with offices in both Houston and San Antonio, we are well equipped to assist Texans who are in dire need of our services. Register online for a free case evaluation or call us today at 713-528-8108 (Houston) or 210-702-3000 to schedule an appointment with a member of our team.

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