How Insurance Companies Determine Injury Settlement Amounts | AllLaw

If you’re negotiating a personal injury claim with an insurance company, you’ll probably have to deal with a “claims adjuster.” It may be helpful to understand how the adjuster normally operates before considering (or accepting, or rejecting and countering) a personal injury settlement offer.

Like an attorney, an insurance adjuster will want to investigate and gain a full understanding of the facts of the underlying accident and the claimant’s injuries and other losses (called “damages” in legal jargon). So what does this kind of research entail? What is included in the settlement offer valuation and what is next in the injury settlement negotiation process?

Reading: How do insurance companies settle personal injury claims

claim investigation

If you are filing a claim with the insurance company of the person you believe is responsible for your accident, you are filing a “third party” claim.

The first thing the adjuster will want to find out is what the policyholder (that’s the person you say is at fault for the accident) has to say about what happened.

In addition to speaking with the insured person to hear their story first-hand, the adjuster will read any police reports or accident reports related to the incident, speak with witnesses, and attempt to gather evidence (including surveillance video footage).

claimant investigation

Insurers have claims databases that allow adjusters to determine if the claimant has ever filed a personal injury claim. A good adjuster will also google the claimant to do a little background check, and may even hire an investigator to make sure the claim looks legitimate (the claim doesn’t say he has a debilitating back injury, while playing on a competitive soccer league, for example).

gather claim documentation

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The adjuster will contact the claimant (or the claimant’s personal injury attorney) to request documentation related to the claim. The adjuster will usually request documents such as medical bills, proof of income (for loss of income claims), tax returns, and proof of property damage.

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A good adjuster will go through the paperwork carefully, reading every page of medical records and bills to see if anything is missing, if anything suggests the claimant has had prior injuries or the claimant is faking it, or if the claim for loss of claimant’s income raises questions. An adjuster will not make a settlement offer and will not respond to a settlement demand without having everything necessary to value the personal injury case.

determining liquidation value

In order to value the case, the adjuster has to think about two things: 1) what are the chances that the plaintiff will win at trial if a personal injury claim is filed in court, and 2) how much could an award be made? sworn by the plaintiff in damages?

Damages generally fall into two categories: damages that can be accurately calculated (medical bills and lost wages) and damages that cannot be accurately calculated (including compensation for “pain and suffering”). for medical bills and lost wages, the adjuster simply does the math.

However, adjusters often discount medical bills if they appear to be “soft,” such as when the vast majority of medical bills come from health care providers other than doctors and hospitals. If, for example, a claimant had $7,000 in medical bills, but $6,500 of that was for chiropractic and physical therapy, the adjuster could reduce the medical bill claim in half for valuation purposes. Learn more about how “correct” medical treatment increases the value of an injury claim.

determining the value of a pain and suffering claim

This is the real fight, both for plaintiffs’ attorneys and insurance adjusters. But adjusters these days typically use formulas and specialized software to assign a value to pain and suffering claims.

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the first settlement offer

once the insurer has reached a settlement figure, it must decide what to offer. The first offer will be a percentage of what the insurer believes is the final value of the case. for example, the insurance company may require that the first offer be 40% of the value of the case. There is no industry-wide standard in this regard. Different insurers have different procedures. Learn more about the factors that determine personal injury settlement value.

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A very important point is that adjusters are often free to adjust the first offer depending on who they are dealing with. If the adjuster is dealing with an unrepresented claimant, the first offer will generally be low. (Get the basics on accident and injury claims settlements.)

how a lawyer can help you negotiate the settlement

If you think the insurance adjuster isn’t taking your claim seriously, or if you’re just not sure if you can get a fair outcome for your claim on your own, it might make sense to discuss your situation with an experienced legal professional.

perhaps the other party denies responsibility for your accident and the insurance adjuster sides with their own insured until they see clear evidence to the contrary. this is where a personal injury attorney will conduct their own thorough investigation of the accident, put together the best case for it, and convince the adjuster to come to the table with a fair offer.

Crafting a Personal Injury Demand Letter

One of the first things your attorney will likely do is prepare a written demand letter, in which:

  • explain your version of how the accident happened and exactly why the adjuster’s injury is to blame
  • describe the nature and extent of your injuries as a result of the accident
  • list the medical treatment you have received from each health care provider (along with an itemized list of the cost of that treatment), and
  • Explain the impact your accident and injuries have had on your life, including the limitations you are experiencing and your mental and physical pain and suffering.
  • Once the adjuster knows they are no longer a novice claimant, but an experienced attorney, they are likely to be much more responsive. Learn more about how attorneys decide whether to take a personal injury case and get tips on finding the right personal injury attorney.

    next steps in the injury settlement negotiation process

    Remember that the insurance adjuster’s first offer is only the first step in the injury settlement process. Whether you decide to get the help of a lawyer or not, your next best step will probably be to counter the adjuster’s offer with one of your own, ideally as part of a detailed demand letter. Learn more about how much to ask for in your injury claim letter.

    After that, it’s about understanding the minimum amount you’re willing to agree to in the settlement (remember, once you’ve made the deal and signed an agreement, you can’t go back and ask for more money) and your willingness to fight. for a fair result. Learn more about how the personal injury settlement process works. And if you’re ready to discuss turning your injury claim over to an experienced attorney, you can use the features on this page to connect with a personal injury attorney near you.

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