How To File Accident Insurance Claim | Personal Injury

Accident Insurance Claim

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If you unexpectedly suffer a personal injury the last thing that you want to think about is how you are going to pay the bills. Luckily, with accident insurance, filing a claim is simple and straightforward so you can get cash benefit and get on the road to recovery.  

Accident insurance is supplemental insurance that helps you pay for things that your medical insurance does not. If you are injured and have to miss work accident insurance can help cover your expenses while you are out of work. Some of the expenses that accident insurance can cover include, groceries, childcare, personal bills, car payments, and even your mortgage.

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How to file a supplemental accident insurance claim online for personal injury 

Filing an accident insurance claim for a personal injury is typically a simple process that can be completed quickly and easily. To complete an accident insurance’s claim with Guardian Direct®, you will need to provide itemized billings from the treatment provider(s). Guardian Direct will verify your information and, when your qualified accident is verified, your cash benefit will be sent directly to you, not to your doctor or the hospital. Once you have the cash you are free to use the money where it makes the most sense to you, whether that be paying your deductible, on utility bills, or your mortgage, you can use the money as you see fit.  

The claims process for accident insurance is typically very different than how medical insurance claims are traditionally filed. With most health plans typically your doctor or the hospital files the claim for you, it gets sent to and processed by the insurance company automatically.¹ With health insurance your benefit is paid directly to your doctor and you never see any of that money. While health insurance typically covers the bulk of your medical expenses, it does leave major financial gaps. By having accident insurance, you can help fill the financial gaps that medical insurance leaves behind.  

Settling a personal injury claim 

Settling a personal injury claim with an insurance company can seem like a complex process, however, it is really all about getting you the payment that you deserve. Although accident insurance covers a broad spectrum of injuries and treatments it does come with certain limitations. As a supplemental coverage it is designed to work alongside your major medical insurance and help cover financial gaps that might exist. Some common limitations include:  

  • Types of injury – injuries that are a result of an unexpected qualifying accident are covered. Sicknesses or chronic medical conditions do not receive any benefit under accident insurance.   

  • Amount of cash benefit – the amount that you will receive in compensation depends on the type and severity of your injury as well as the type of treatment that you receive. Treatment and services such as ambulance rides, overnight hospital stays, and required imaging will all be taken into account when your claim is processed.  

  • Cause of injury – Not all injuries are covered by accident insurance. Some common activities that are typically not covered include injuries sustained while participating in extreme sports such as hang gliding, parachuting, skydiving, ballooning, or getting injured while abroad. Additionally, if you are hurt while at work, accident insurance will not cover you because workers’ compensation may.  

This is why it is important for you to send in itemized billings from the treating provider(s). when you submit your claim so that your claim can be validated. Once you have sent in all of the documentation you will be contacted by a claims adjuster from Guardian Direct who will finalize your cash benefit. Most claims can be finalized within 7 days, getting you the money that you need, as soon as possible.

Difference between AD&D, Workers’ Comp and Personal Accident Insurance claims

Accidental death and dismemberment (AD&D), workers’ comp, and personal accident insurance all can help you and your family to maintain financial stability if you are injured. Each of these three coverages is designed to help fill a different gap, for example, workers’ comp is for injuries that happen while at work, AD&D is meant to cover only the most extreme injuries and death, and personal accident insurance provides coverage for accidents big and small that occur outside of work.  

Before purchasing any insurance product, it is important to consider the full scope of the plan that you are hoping to purchase. The table below gives a quick run-down of what typically is and is not included in AD&D and Accident Insurance policies. 

What is typically included
What is typically not included
AD&D
Coverage in case of death or dismemberment occurring as the result of a covered accident.
Death or dismemberment due to disease, sickness, or chronic illness.
Dismemberment includes all any loss of body part or function, including hearing, eyesight, speech, or limbs.²
If the death or dismemberment occurred as the result of excluded activities including extreme sports, committing a crime, or while under the influence.
Personal Accident Insurance
Coverage if you have an accidental injury that occurs outside of work.
Accidents that occur while under the influence.
Coverage for unforeseen accidental injury.
Accidents that occur while at work.
Direct cash payment that you can use for groceries, bills, and medical expenses.
Accidents that happen while participating in extreme sports.

When it comes time to actually get compensated for your covered accident through your accident insurance policy, you will receive one lump sum payout after you submit all of your itemized billings and the claim is validated. In some cases, you will need ongoing treatment after a covered accident, with accident insurance you are typically able to submit additional claims and receive additional benefit payments.

How will a personal injury claim affect my insurance?

Many people may be hesitant to file an insurance claim because they are worried about how it will impact their rates in the future. This is a legitimate concern because with some insurance products, making a claim may typically raise your rates.  

Personal accident insurance, however, is a bit different because it is issued on a year-to-year basis. This means that your premiums cannot be raised within your contracted period. The premium that you sign up with is good for the duration of the term.³ If you are injured accidentally you can file a claim without having to worry about whether your rates will be raised.

Living expenses following an accident insurance claim & Insights 

The feature that sets accident insurance apart from regular medical insurance is that the cash benefit is paid directly to you. This allows you to put the payment towards any expenses that you have that medical insurance alone does not cover.⁴ After filing a claim, you can pay for expenses including:   

  • Mortgage 

  • Groceries 

  • Utility bills 

  • Childcare 

  • Car payments 

  • Medical bills 

Accident insurance plans are considered gap insurance, meaning they are designed to pay for these items that you would ordinarily pay out-of-pocket. With deductibles getting higher each year, having coverage that can help with unforeseen expenses is a good way to help protect your financial stability giving you the flexibility you need should the unexpected happen.  

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Sources

  1. https://www.medicalbillingandcoding.org/insurance-claims-process/, accessed 3/5/2021

  2. https://www.investopedia.com/terms/a/accidental-death-dismemberment-insurance.asp#:~:text=Accidental%20death%20and%20dismemberment%20(AD%26D)%20insurance%20is%20usually%20a%20rider,%2C%20eyesight%2C%20and%20hearing). (2020) accessed 3/5/2021

  3. https://www.healthmarkets.com/content/supplemental-accident-insurance accessed date 3/5/2021

  4. https://www.ehealthinsurance.com/resources/affordable-care-act/accident-insurance (2021) accessed date 3/5/2021



Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.Invalid Date)

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