Claim

A claim is the request itself, the packet of facts and documents an injured person (or their attorney) sends to an insurance company saying, in effect, “your policyholder caused my injury, and here is what I am asking you to pay for it.” It typically includes a description of what happened, medical records, bills, proof of lost wages, and photos or other supporting evidence.

Most claims are resolved administratively, meaning through correspondence and negotiation with an adjuster, without ever involving a judge. An adjuster reviews the claim, may investigate the facts independently, and eventually responds with an offer, a denial, or a request for more information.

A claim is not a guarantee of payment. It is simply the starting point of a process in which the injured person asks for compensation and the insurer decides how it wants to respond. What happens next depends heavily on the strength of the evidence behind the request.

No. A claim is presented directly to the at-fault party or their insurance company and is resolved outside of court. A lawsuit is a formal legal action filed with a clerk of court, served on the defendant, and decided under court rules and deadlines, with a judge overseeing the process from start to finish.

A claim can turn into a lawsuit if it cannot be resolved through negotiation. When an insurer denies a valid claim, undervalues it, or simply stops responding, the injured person’s remaining option is often to file suit and let a court decide the outcome.

In practice, the large majority of injury claims never reach a courtroom. They settle once both sides agree on a number, and the claim closes without a lawsuit ever being filed. Filing suit is generally treated as a later step, not the first one.

Because the two terms get mixed together in casual conversation, it helps to remember a simple rule: a claim is a request, a lawsuit is a legal case. Every lawsuit starts as a claim, but not every claim becomes a lawsuit.

A first-party claim is filed with your own insurance company, under your own policy. Examples include an uninsured or underinsured motorist claim, medical payments coverage after a crash, or a homeowner’s claim for damage to your own property. Your insurer owes you certain contractual duties simply because you pay premiums for that coverage.

A third-party claim is filed against someone else’s insurance company, typically the at-fault driver, property owner, or business whose negligence caused the harm. That insurer has no direct contract with you, so the process tends to move differently and often more slowly, since the adjuster’s job is to protect their own policyholder, not you.

The two types can run side by side. After a car crash caused by an uninsured driver, for instance, an injured person might file a first-party uninsured motorist claim with their own carrier at the same time there is no meaningful third-party claim to pursue.

Understanding which type of claim applies matters because the rules, forms, and leverage are different in each. A first-party claim is rooted in your insurance contract; a third-party claim is rooted in the other party’s legal responsibility for causing you harm.

A valid personal injury claim generally rests on four elements. Duty is the legal obligation the other party had to act with reasonable care, such as a driver’s duty to obey traffic laws. Breach is proof that the other party failed to meet that duty, for example by running a red light or ignoring a known hazard.

Causation is the link showing that the breach actually caused your injury, not some unrelated condition or event. Damages are the real, documented losses that resulted, such as medical bills, missed work, or pain and physical limitations.

Consider a driver who runs a stop sign and strikes another car. The duty was to stop and yield, the breach was running the sign, the causation is the direct collision, and the damages are the injuries and vehicle repair costs that followed. All four elements need to line up for a claim to hold together.

Insurance adjusters routinely look for a weak link in one of these four elements before they agree to pay, which is exactly why documentation, medical records, and a clear timeline matter so much from the very beginning of a claim.

The process usually begins with notice, meaning the injured person or their representative lets the at-fault party’s insurer know an injury occurred and that a claim is coming. This can happen quickly after a car crash, slip and fall, or other incident.

Treatment and documentation follow. The injured person seeks medical care, follows through with recommended treatment, and gathers records, bills, photos, and other evidence that will support the value of the claim later on.

Once treatment has progressed enough to understand the injury’s full impact, the claim usually moves into a demand phase, where a formal demand letter is sent summarizing the facts, the injuries, and the compensation being requested.

Negotiation follows the demand. The insurer responds with a counteroffer, a request for more records, or occasionally a denial, and back-and-forth negotiation continues until the two sides agree or reach an impasse.

If negotiation fails to produce a fair resolution, the final stage is filing a lawsuit, which shifts the claim into the court system and starts a new, more formal set of deadlines and procedures.

Under O.C.G.A. § 9-3-33, most Georgia personal injury lawsuits must be filed within two years of the date of the injury. This is the deadline for the lawsuit itself, not necessarily for when you first report the incident to an insurer, but the underlying claim needs to be resolved or converted into a lawsuit before that window closes.

Claims against government entities work on a much shorter clock. Under O.C.G.A. § 36-33-5, a person injured due to a city’s negligence generally must give written ante litem notice within six months of the injury. Claims against a county follow O.C.G.A. § 36-11-1, which generally requires notice within twelve months. These are notice deadlines, separate from and shorter than the two-year lawsuit deadline, and missing them can end a claim before it truly begins.

Missing any applicable deadline usually means losing the right to recover anything at all, regardless of how strong the underlying claim otherwise was. Deadlines do not bend for good excuses, so it is worth confirming which one applies as early as possible, especially in any claim that might involve a government vehicle, road, or property.

Georgia follows a modified comparative negligence rule under O.C.G.A. § 51-12-33. If you are found partly at fault for the accident, your compensation is reduced by your percentage of responsibility, and you generally cannot recover anything if you are found to be 50% or more at fault.

For example, if a claim is valued at a given amount but the injured person is found 20% at fault, the recoverable amount is reduced by that same 20%. The insurer’s own investigation almost always looks for ways to shift blame onto the injured person, because doing so lowers what they owe.

This is one more reason a claim needs solid supporting evidence from the start. Photos, witness statements, and official reports that clearly show how the incident happened make it much harder for an insurer to argue that fault should be shared unfairly.

A denial is not always the end of a claim. Insurers sometimes deny claims that have real merit, hoping the injured person will simply give up rather than push back. A denial letter usually states a reason, and that reason can often be answered with additional records, a clearer timeline, or an expert opinion addressing whatever the insurer claims is missing.

An undervalued offer is more common than an outright denial. Adjusters routinely open with a low number and wait to see whether the injured person accepts it or pushes back with more documentation. A written response that walks through the medical records, lost income, and ongoing effects of the injury can move the number substantially.

When negotiation genuinely stalls, that is the point where a claim may need to become a lawsuit. Filing suit does not mean negotiation is over, since many lawsuits still settle before trial, but it does put the claim under court supervision and firm deadlines that can push a stalled negotiation forward.