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Title 31 Pennsylvania Code § 146.2(b) defines a first party claimant as an "individual, corporation, association, partnership or other legal entity asserting a right to payment under an insurance policy or insurance contract arising out of the occurrence of the contingency or loss covered by such policy or contract." First party claims are different from third party claims, in which people assert right to payment under another party's insurance policy or insurance contract.
First party claims can arise in a number of situations, most commonly being issues relating to motor vehicles but also in cases involving homeowner insurance or commercial property. While first party claims should seem to be easier to resolve than third party claims, some insurers may delay or deny claims for dubious reasons.
Is your insurance company delaying or has it denied your first party claim? Contact Ciccarelli Law Offices as soon as possible.
Our experienced personal injury lawyers in West Chester have office locations in Springfield, Kennett Square, King of Prussia, Lancaster, Philadelphia, Malvern, Plymouth Square, and Radnor. You can have our attorneys review your case and help you understand all of your legal options when you call (610) 719-3190 to schedule a free, no obligation consultation.
Following a motor vehicle accident or any other event resulting in injuries or damage to property, a policyholder is often required to report the incident to his or her insurance company within 24 hours. The insurer will, in turn, open an investigation relating to the claim.
People who have filed first party claims will want to retain legal counsel before making any statements to insurance companies about their accidents or incidents. It is important to remember that comments made to insurance agents may be used later to reduce or possibly even deny compensation.
After an insurer completes its investigation, it will typically offer a settlement check. If the settlement amount is less than what the policyholder needs or expected, the policyholder may send a demand letter that states a specific amount of compensation expected.
An insurance company can either offer to pay the full amount of compensation sought in the demand letter, offer to pay an amount of compensation less than what was sought in the demand letter, or deny the claim entirely. A knowledgeable personal injury lawyer can effectively represent you in negotiations with your insurance company and file a lawsuit if necessary.
Many insurance policies contain conditions known as appraisal clauses, usually short paragraphs that allow for an alternate method of determining a settlement when there is a dispute between a policyholder and insurance company over the amount of the loss involved. The policyholder and the insurer both have the right to invoke the appraisal clause.
After one party invokes the appraisal clause, the policyholder and the insurer both hire competent appraisers—at their own cost—to assess the loss. The appraisers will independently evaluate the loss and discuss their findings in an attempt to reach a mutually agreeable figure.
If the two appraisers cannot reach an agreement over the amount of loss, they will select and agree to an independent third party often referred to as an "umpire." If they cannot agree on an umpire, the matter is referred to the court that has jurisdiction and a judge will select an umpire.
Half the cost of hiring an umpire is paid for by the policyholder and the other half is paid by the insurer. The umpire and the two appraisers account for what is usually known as the appraisal panel, and any amount that is agreed to by two of the three members of the appraisal panel will become final and binding on all parties.
Understanding the Insurance Policy Appraisal Clause: A Four-Step Program — View a 2006 University of Tulsa College of Law article discussing appraisal provisions in insurance policies. The four steps outlined in this paper are: appraisal v. arbitration, selection of an appraiser, the power and authority of appraisers, and appraisal as a condition precedent to a lawsuit. The article concludes that in the context of insurance, appraisement "has become the methodology of choice for resolving disputes over value of property and the amount of an insured loss."
Evaluating First party Property Claims with Multiple Causes Under the Efficient Proximate Cause Doctrine | American Bar Association (ABA) — The ABA identifies itself as one of the world’s largest voluntary professional organizations, with more than 400,000 members and over 3,500 entities. View a 2012 ABA Section of Litigation article discussing causation analysis as it relates to first party claims. The article concludes that first party property claims can involve "highly complex issues of causation," and an "understanding of the policy language, governing law, and facts of the claim" can help determine an appropriate evaluation of coverage.
If you need assistance filing a first party insurance claim in southeastern Pennsylvania, it is in your best interest to quickly seek legal representation. Ciccarelli Law Offices represents individuals in communities throughout Montgomery County, Chester County, Delaware County, Lancaster County, and the greater Philadelphia area.
Our West Chester personal injury attorneys handle cases on a contingency fee basis, which means you will not pay our firm anything unless you receive a monetary award. Call (610) 719-3190 or submit an online contact form to have our lawyers provide a complete evaluation of your case during a free initial consultation.