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Legal Terms: A Personal Injury Glossary

personal injury terms

Legal terms can be confusing, especially when you’re in the middle of a personal injury case.  You shouldn’t have to go to law school to know what we are talking about, so we created your very own Personal Injury (PI) Glossary.  This list should help you get familiar with some words you may hear during your PI case.  For more general legal terms, read 7 Common Legal Terms Explained.

Accident Report – A detailed, formal recording of an event documented from the scene of an accident by an authority figure, such as a police officer.

Alternative Dispute Resolution – The use of methods other than litigation to resolve a legal dispute, such as arbitration and mediation.  See arbitration and mediation.

Arbitration – The hearing and settlement of a legal dispute by a neutral third-party whose decision will usually be final.

Assignment of Benefits – A transfer of benefits provided by an insurance policy to a party other than the insured.

Assumption of Risk – When a person voluntarily and knowingly exposes himself or herself to the possibility of injury.

Bodily Injury – Any damage to a person’s body, i.e. broken bones, bruises, burns, cuts, nerve damage, etc.

Burden of Proof – The plaintiff’s obligation to prove that his or her allegations are true.

Causation – The act of making something happen.

Claim – A civil action relating to the physical or mental harm suffered by the plaintiff due to the negligence of the defendant.

Compensation – Something that makes up for a loss, usually of monetary value.

Damages – Payment recovered in a case for injuries or losses caused by another person’s negligence.

Duty – An obligation to use the standard of care for the safety of others that a reasonable person in the same circumstances would use.

Expert Witness – A person who is allowed to testify at a trial because of special knowledge in a particular field that is relevant to the case.

Fault – An intentional or negligent failure to act reasonably, according to law, or according to duty.

Fraud – A blatantly false statement of fact intended to persuade another person to give up something valuable or a legal right to which he or she is entitled.

Good Faith – Honest intent to fulfill a promise to act or to act without taking an unfair advantage of another person.

Gross Negligence – A conscious disregard of the need to use reasonable care, which is likely to cause foreseeable injury or harm to persons, property, or both.

Hazard – A condition that increases the probability of damage or injury.

Insured – The individual covered by insurance.

Insurer – The company that provides coverage through an insurance policy.

Liability – An obligation one is legally bound to perform.

Limitation of Risk – The maximum amount an insurer is obligated to pay in any one loss event.

Loss – The monetary value assigned to an injury or damage in a personal injury claim.

Mediation – A non-binding method of resolving a case in which a neutral third party, agreed upon by both parties, attempts to help them reach a mutually agreeable settlement.

Negotiation – To arrange or settle by discussion and mutual agreement.

Notice to Insurer – A written notice to an insurance company about an incident upon which a claim is based.

Occupational Disease – An illness caused by long-term employment in a particular line of work.

Personal Injury – The area of law which covers all physical, financial, and emotional injuries caused by another’s negligence.  For more information on PI, read How To Handle A Personal Injury Claim.

Prognosis – The anticipated chance of recovering from an injury, based upon the symptoms and nature of the particular case.

Proximate Cause – The primary reason why an injury or damage occurred and without which the accident would not have happened.

Statute of Limitations – A law that determines the period of time that someone has to file a legal action, usually beginning when the injury or damage occurs.

Strict Liability – A legal doctrine that holds a defendant liable for harm caused by their actions regardless of their level of care.

Tort – A civil or private wrong committed against a person or property that results in legal liability.

Underinsured Motorist Coverage (UM) – An auto insurance policy provision that extends coverage to injuries and property damage caused by a motorist without enough insurance coverage.

Uninsured Motorist Coverage (UIM) – An addition to a standard auto insurance policy that provides coverage in the event the other driver is both at fault for the accident and is not insured.  For more information on UM and UIM, read What Your Insurance Agent May Not Be Telling You About Your UM/UIM Policy.

Workers’ Compensation – Employer insurance providing medical coverage as well as compensation to employees for economic losses due to a job-related injury or illness.  For more information on workers’ comp, read How Do I Get Workers’ Compensation?

Wrongful Death – A claim made on behalf of the survivors or beneficiaries of a person who has died as the result of wrongful conduct, either negligent or intentional.

If you have any more questions regarding personal injury claims or any other legal work, contact the attorneys at Kelly & West today.

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    What You Should Know About Bad Faith InsuranceYour insurance company is legally obligated to deal with you “fairly and in good faith.”  When you file insurance claims, such as claims for bodily injury and/or property damage under your auto policy, that good faith obligation is tested.  After all, the insurance company’s bottom line and your best interests are at odds.  The more claims a company denies and the less it pays o claims it accepts, the more profit it makes.  But you’ve paid your premiums and deserve to be fully compensated for your losses up to the limits of your coverage. 

    Most often, insurance companies investigate and administer claims professionally, deny only those claims they reasonably believe are invalid, and attempt to evaluate and settle valid claims fairly.  Sometimes, they get it wrong, even though they have acted fairly and in good faith.  When that’s the case, the policyholder can file a breach of contract lawsuit and go to trial to recover the compensation to which he/she is entitled under the policy.  

    If the insurance company does not act fairly and in good faith, the policyholder has grounds to file an insurance bad faith lawsuit and, if successful, recover not only what is due under the policy but also either punitive or multiple damages.  Here is what you should know about bad faith insurance lawsuits in North Carolina.

    What Laws Support an Insurance Bad Faith Lawsuit?

    In North Carolina, there are two sources of insurance bad faith law, state statutes and common law (court decisions).  A policyholder can file an insurance bad faith lawsuit based on either or both, but where the court determines that both apply, the policyholder must elect to recover under one or the other.

    Statutory Insurance Bad Faith

    Under the North Carolina Unfair and Deceptive Trade Practices Act, a policyholder can recover “treble damages,” three times the amount of any damages caused by the insurance company’s “unfair” or “deceptive” behavior.  Such behavior is not limited to, but definitely includes, any of the fourteen “unfair claim settlement practices” defined in a section of North Carolina’s insurance statutes.  

    Among those unfair claim settlement practices are:

       *     misrepresenting pertinent facts or policy provisions relating to the coverages at issue,

       *     failing to acknowledge and act reasonably promptly upon communications with respect to claims,    

       *     refusing to pay a claim without conducting a reasonable investigation of all available information,

       *     failing to affirm or deny coverage of claims within a reasonable time after proof-of-loss statements are completed,

        *     forcing the policyholder to resort to litigation without attempting to settle in good faith,

        *     attempting to settle a claim for  less than a reasonable man would have believed he was entitled,

         *     failing to promptly settle claims under one coverage where liability is reasonably clear (e.g., property damage claims) in order to influence settlement of claims under another coverage (e.g., personal injury claims) and

         *     failing to promptly and reasonably explain the basis in the policy or applicable law for denial of a claim or the offer of a  compromise settlement.

    Common Law Insurance Bad Faith

    In addition to liability based on those North Carolina statutes, North Carolina courts have held that an insurance company is responsible for bad faith wrongdoing when it refuses to pay policy benefits after receiving and recognizing a valid claim or otherwise acts solely in its own interest, provided, that there must also be some “aggravating” or “outrageous” misconduct by the company that harms the policyholder.  Such additional misconduct has been described as including “fraud,” “malice,” “gross negligence,” “willful and wanton conduct,” or “reckless disregard.”  Those can be difficult to prove and have to be considered and determined based on the facts in each case.  

    The theory in the bad faith case decisions is that a judgment awarding the policyholder only what is due under the policy (for breach of contract) does nothing to discourage the insurance company (and other insurers) from engaging in such bad behavior when responding to future claims.  Under those circumstances, the court’s judgment may also require that the company pay the policyholder punitive damages that may be much higher than the value of the original claim or the policy limits.

    Should You Consider Filing an Insurance Bad Faith Lawsuit?

    North Carolina does not recognize a claim for bad faith against someone else’s insurance company.  Also, your insurance company may treat you “fairly and in good faith” yet still deny your claim in whole or in part.  When it accepts liability, it may still honestly and reasonably disagree with your calculation of your covered losses.  

    As you should understand, based on this very brief introduction to the applicable law, distinguishing between good faith (though rigorous) and bad faith insurance company conduct is difficult and can only be done on a case-by-case basis.  It requires the kind of analysis that can best be done by an experienced attorney.  

    Our attorneys at Kelly & West have helped hundreds of clients with their insurance claims.  If you have filed a claim and feel that your insurance company is ignoring you, unnecessarily delaying its response or otherwise treating you unfairly, you are welcome to contact us at Kelly & West and arrange for a free consultation.