How an Insurance Adjuster Calculates Accident Injury Claims

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When involved in an accident that is the fault of another individual or business, you are likely to get a settlement from the accident to offer compensation for injuries, damages, missed work, and/or pain and suffering. Because cases such as this rarely make it to court, your settlement will more than likely rest in the hands of an insurance adjuster… at least the starting point for the settlement. That being the case, we are going to take a look at how these insurance adjusters come about their final recommended figure.

Step 1: Talk to the Policy Holder

If you are the claimant in the case, the insurance adjuster will first seek to talk to the actual policy holder to get his or her side of the story. The adjuster will normally then get a copy of the police report to compare the accounts to see where things are and are not lining up for further investigation.

Step 2: Investigate the Claimant

As I am sure you know, car insurance fraud is big business these days, so the adjuster is going to want to make sure you, the claimant, are not hustling a settlement. So, one of the first things the adjuster will do is run your data through the database to see any previous claims that were made. If the search and investigation come up clean, the adjuster will move to the next step.

Step 3: Requesting Documentation (Discovery)

In law suits, there is something called discovery, part if which is the prosecuting attorney handing over all related documentation to the defense. Cases such as this are no different, as the adjuster will reach out to your attorney for all supporting documentation related to the claim. He or she will want to see all medical bills, earnings records, tax returns, property damage, etc.

In addition to the above, it is not out of the ordinary for the insurance adjuster to investigate the health of the claimant to see if any of the injuries being attributed to the injury were already existent. Until the adjuster has gone over every piece of information, and this could take time, there will be no settlement offer.

Step 4: Determining the Value of the Claim

Once all the information has been gathered and analyzed, the adjuster will then try to answer a few key questions:

  • Can the claimant win the trial if this goes to court? If so, what are the overall chances of the claiming winning the case?
  • What would the jury award in a case such as this?

In coming about these conclusions, the adjuster will look at damages that can be calculated, such as loss of earnings and medical bills, as well as those that do not have a specific price tag, such as pain and suffering. Now, even though there is no “technical” dollar value attributed to pain and suffering, adjusters have a formula, as will your attorney, to calculate what pain and suffering will be worth based on the injury as well as how long it will take to recover and any possible lingering aftereffects that could impact your quality of life.

Step 5: The Offer

Once all the calculations are completed, the adjuster will present an offer to your attorney. The first offer is likely to be a lowball offer, meaning they will try to settle the case for the least amount possible based on the information they have. They are hoping the offer is attractive enough to get you to agree to it but not so high as to cause the company any excess loss.

This is where a skilled and experienced car accident injury attorney comes into play. If the adjuster has had experiences with a specific attorney or the attorney’s firm in the past, the initial offer will be based on those experiences as well. For instance, if you hire a local attorney who is just starting and has little to no experience in these types of cases, you better believe the adjuster will try to exploit this. However, if your attorney has a reputation for playing hardball, that initial offer will be much higher because the adjuster already knows they will not be able to pull the wool over you attorney’s eyes.

Do You Need a Personal Injury Attorney?

As you can imagine, these cases can go on for quite a bit of time and when insurance adjusters are called, it gets even more complicated. Because of the nature of these cases, it is always best to consult with an injury attorney to ensure you are getting the best possible settlement. If you would like to discuss your case, give us a call at 855-633-0888 . Your consultation is free of charge and you are under no obligation to use our services for talking to a member of our team. If you would like to learn more about our services before contacting us, please click here .

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