First-Party Vs. Third-Party Personal Insurance Claims

A first-party insurance claim involves filing a claim directly with your own insurance company for damages or losses. This type of claim typically covers incidents affecting you or your property. On the other hand, a third-party insurance claim refers to the process of filing a claim with someone else’s insurance provider, usually after an incident where you are not at fault. This claim is filed against the insurance of the party responsible for the damages or injuries suffered.

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Your insurance policy contains a set of promises that your insurer makes to you about what it will pay for if a “covered” event happens.

The insurance policy also contains a set of rules that you, the policyholder, must follow to receive payment from the insurer. This includes making timely payments of your premiums.

An insurance policy is, therefore, a contract between you and your insurance company.

Your insurance company will not pay for any event not covered in your policy (usually referred to as “exclusions”).

Common exclusions include injuries resulting from intentional or reckless acts like street racing, or from extraordinary sources like nuclear radiation.

Another exclusion that has become common in recent years is an injury that results while driving in a ride-sharing program like Uber or Lyft.

There are two types of insurance claims that an injured person may bring, depending on the factual situation.

This distinction is important to understand when evaluating insurance coverage options.

What Is a First-Party Claim?

A first-party insurance claim, in the context of insurance, refers to a claim filed with your own insurance company following an accident or injury. This type of claim is made by policyholders who have purchased insurance and is used to request compensation for covered losses or damages incurred in accidents. For instance, if you damage the trunk of your car by backing into a pole, filing a claim with your own insurance company would be a first-party insurance claim.

After you file, the insurance company looks at your policy to determine whether you carry the type of coverage needed for them to compensate you for the particular type of loss.

In this example, the relevant policy would be collision coverage. If you have the coverage, the insurance company will reimburse you for the amount of money your trunk repairs cost, less your deductible.

Making a claim on your uninsured/underinsured motorist policy is a first-party claim, which you can read more about on our page: Four Benefits of Uninsured/Underinsured Motorist Bodily Injury Insurance.

What Is a Third-Party Claim?

A third-party claim in insurance refers to a type of claim that is initiated by an individual who is not the policyholder or the insurance company itself. This typically occurs in situations like a car accident caused by another driver. In such cases, you, as the victim, have the right to file a third-party claim with the at-fault driver’s insurance company to seek compensation for your covered accident-related expenses. For example, a drunk driver runs a red light and collides with your vehicle. In such an auto accident, you will likely file a claim with the drunk driver’s insurance company.

In this example, the driver’s insurance company would be responsible for your damages. This is because a drunk driver’s liability coverage covers injuries caused by his negligent driving.

Because there is no contract between you and the at-fault driver’s insurance company, there are several benefits of filing a third-party claim. You may make claims for damages that your own insurance policy may not cover. Examples of such damages would be payment for medical expenses, pain and suffering, mental anguish, and lost wages.

Imagine you’re involved in a car accident caused by another driver running a stop sign, leading to vehicle damage, a broken arm, and whiplash. In such cases, you might file a third-party insurance claim.

This claim involves notifying the at-fault driver’s insurance company, detailing the incident, injuries sustained, and seeking compensation for medical expenses and property damage.

The claims process can be complex and overwhelming. Regardless of whether you are dealing with a third-party or first-party claim, get advice from an experienced personal injury attorney.

The attorneys at Armstrong Lee & Baker LLP are knowledgeable and experienced in the rules, procedures, and the law relating to first-party and third-party claims. Contact our Firm today for a free consultation regarding your claim or potential claim.

What Is Third-Party Insurance?

Third-party insurance, often called liability insurance, is designed to protect individuals or businesses from claims made by an external or “third” party. Essentially, it provides coverage if the policyholder is found responsible for causing damage to someone else’s property or injuring another person. In situations where you are legally liable for harm to others, this policy helps cover the resulting costs, protecting your personal or business assets from significant financial losses.

In Texas, this insurance type is particularly relevant in contexts like auto accidents and premises liability cases. For example, if a Houston driver is at fault in a car accident, their auto liability insurance (a type of third-party insurance) would cover the damages to the other driver’s vehicle and medical expenses for injuries they may have caused.

Definition

Third-party insurance is a type of policy where the insured individual or business (the first party) pays premiums to an insurer (the second party) to receive financial protection against claims made by an external party (the third party). Unlike first-party insurance, which covers the policyholder’s own losses, third-party insurance covers the costs associated with damages or injuries the policyholder causes to others. It’s essential in situations where a party could be held legally responsible for harm to someone else.

For example, in an auto accident, if a driver is found to be at fault, their third-party auto insurance will cover the damages sustained by the other driver. The primary benefit of third-party insurance is that it transfers the financial burden of these claims from the insured party to the insurer.

Parties Involved

There are three main parties involved in a third-party insurance claim:

• The First Party: This is the policyholder who purchases the insurance policy. In a third-party insurance context, the first party is the individual or business that could potentially cause harm to others.
• The Second Party: This is the insurance company that provides coverage to the policyholder in exchange for regular premium payments.
• The Third Party: This is the individual or entity who suffers damage or injury due to the actions of the policyholder. The third party files a claim against the policyholder’s insurance to seek compensation.

For instance, in a Houston car accident where one driver rear-ends another, the driver at fault is the first party, their insurer is the second party, and the other driver who experienced damage or injury is the third party.

Coverage

Third-party insurance typically covers expenses related to bodily injury, property damage, and sometimes even non-economic damages, like pain and suffering, caused by the insured. This coverage ensures that if you’re responsible for causing harm, your policy can help cover the third party’s losses. Here are some specific types of coverage provided by third-party insurance policies:

• Bodily Injury: Medical expenses for injuries suffered by the third party, such as hospital bills, rehabilitation costs, and ongoing treatment.
• Property Damage: Repair or replacement costs for the third party’s damaged property, such as their vehicle or personal belongings.
• Pain and Suffering: Compensation for non-economic damages like pain and suffering in cases where serious injury occurred.
• Lost Wages: Reimbursement for income lost by the third party due to their injuries, if they are unable to work during recovery.
• Rental Car Costs: If the third party’s vehicle is damaged, third-party insurance can cover rental car expenses while their vehicle is being repaired.

In Texas, minimum liability limits are mandated for auto insurance policies to ensure that drivers have a basic level of third-party coverage. According to the Office of Public Insurance Counsel, Texas law requires drivers to carry at least $30,000 in liability coverage per injured person, up to $60,000 per accident, and $25,000 for property damage.

Examples

Common examples of third-party insurance include auto liability insurance, homeowners insurance, and general liability insurance for businesses. Here are some scenarios where third-party insurance would apply:

• Auto Liability Insurance: In an auto accident where one driver is at fault, their liability insurance will cover the costs of damages to the other driver’s car and any medical bills for injuries.
• Homeowners Insurance: If a visitor slips and falls on your property, they may file a third-party claim against your homeowners insurance policy to cover medical expenses.
• General Liability Insurance for Businesses: Businesses often carry third-party liability insurance to protect themselves from claims made by customers or clients. For example, if a customer is injured in a store due to a hazardous condition, they can file a claim against the business’s insurance.

For Houston residents, these types of third-party insurance policies are not only beneficial but often legally required. For example, drivers in Texas must have liability insurance to cover any accidents they may cause, and homeowners can be held responsible if someone is injured on their property.

Legal Requirements

In Texas, drivers are legally required to carry minimum levels of third-party liability insurance for auto coverage, and businesses may also be required to have third-party insurance depending on the industry. This guarantees that, in the event of an accident, there are sufficient funds available to compensate those harmed.

The Texas Department of Insurance requires minimum liability limits of:

• $30,000 for bodily injury per person
• $60,000 for total bodily injury per accident
• $25,000 for property damage

This minimum coverage, known as 30/60/25 coverage, is designed to protect other drivers and their property in the event of an accident. Businesses that interact directly with customers or clients, such as retail stores and construction companies, may also be required to carry general liability insurance to protect against third-party claims. This ensures that if a customer or client is injured due to the business’s negligence, they can be compensated through the business’s insurance.

Steps to File a First-Party Insurance Claim in Texas

While third-party insurance covers claims made by others, it’s also essential to understand the process for filing a first-party insurance claim, which covers your own losses. Here are the steps Houston residents should follow:

1. Notify Your Insurer: Contact your company as soon as possible after an incident. For example, if your car is damaged in a Houston accident, reach out to your auto insurer to start the first-party claim process.
2. Document the Incident: Gather all relevant documentation, including photos, videos, police reports, medical records, and any witness statements. This evidence is critical in establishing your claim’s validity.
3. Submit a Proof of Loss Form: Many insurers require you to complete a form that details the extent of your damages or injuries.
4. Get an Estimate: Your insurance company may require an estimate of the repair or medical costs. They may send an adjuster to evaluate the damage.
5. Negotiate with the Insurer: Insurers may initially offer a lower amount than expected. Don’t hesitate to negotiate or provide additional documentation to support your claim.

Seek Legal Assistance if Needed: If your claim is denied or you encounter difficulties with your insurance company, consider consulting a Houston personal injury lawyer to protect your rights.

We can Help with Your First-Party and Third-Party Insurance Claim

Contact the experienced insurance claims attorneys at Armstrong Lee and Baker LLP Today. We can help with your first-party and third-party claim insurance. If you need help with your first-party insurance claim or your third-party insurance claim, our Houston insurance lawyers are here to help.

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