How The Insurance Company Settles Your Personal Injury Claim

Once you've made an injury claim with an insurance company, it's adjuster will go to work to investigate, value, and settle (or not) your case.

You've filed an injury claim with an insurance company. Now what? The most important things to know are that the insurer wants to get all of the necessary facts before it agrees to settle your claim, and it wants to resolve your case in the cheapest way possible. That is how insurance carriers make money.

If a personal injury lawsuit has not been filed and the insurance adjuster has been unable to get all of the facts that he/she feels are necessary to make an offer, he/she will either not make an offer or will only make a very low one. Adjusters are simply not going to settle cases if they feel that they are missing something.

After the case is in suit, if, for whatever reason, the defense attorney is still unable to get all of the important facts, it is very likely that he/she will continue to make only a lowball offer and may just let the case go to trial. The reason for this is that insurers tend to believe that, whenever they can’t get the necessary facts, the injured person is usually hiding something.

Investigation of Your Claim

The adjuster wants to get the following information before making a settlement offer on a personal injury claim:

  • what the insured says about how the accident happened
  • what the injured people (the claimants) say about how the accident happened, including a tape recorded statement, if the injured person will give one
  • the police reports prepared in connection with the accident, if any
  • all other written reports related to the incident
  • all of the injured person’s medical records and bills relating to the injury
  • all of the injured person’s medical records going back as much as twenty years for all injuries to the same part of the body at issue in the current claim
  • the injured person’s proof of earnings, if he/she is making a lost earnings claim, and
  • information about any prior personal injury claims made by the injured person

Analyze the Facts and Determine a Settlement

Once the adjuster has the information, he/she will review it thoroughly. You can rest assured that the adjuster will read every page of your medical records. If the hospital missed one page in its photocopying, the adjuster will most likely catch that and ask your lawyer to get that page. Adjusters believe that missing facts could be damaging facts to the plaintiff.

Next, the adjuster will analyze the facts and think about the value of the case. The value of a personal injury claim is based on liability and damages. Your injuries and financial losses (damages), and a connection of fault for your losses to the defendant (liability), are used to calculate a settlement amount.

The first thing that the adjuster considers is whether the plaintiff can prove that the defendant was negligent, and what the plaintiff’s chances of winning at trial are.

The second thing that the adjuster considers is how badly the plaintiff was injured, and what damages a jury is likely to award at trial. The adjuster will also consider the intangibles of the case -- i.e., facts and circumstances that are likely to sway a jury emotionally in one direction or another. Important intangibles are considerations like:

  • whether any of the potential witnesses have lied
  • whether the plaintiff appears to be a likeable or unlikeable person
  • whether the plaintiff has a criminal record, or
  • whether the plaintiff has been treating with high quality health care providers

Inconsistencies in Your Story

Lying is dynamite in a personal injury claim. If a plaintiff lies, and the lie is exposed, he/she will generally lose. If the defendant, or one of the defendant’s witnesses, lies, that often means a substantial verdict at trial. Adjusters know this. They will factor lying and potential lying into their valuation of the claim.

Similarly, the quality of the plaintiff is an important aspect of valuing a claim. Nice plaintiffs do better with juries. Nasty plaintiffs turn juries off. That is human nature. Adjusters will certainly take the plaintiff’s nature into account. If you have a personal injury claim, and know that you have a habit of losing your temper, you will need to break yourself of that habit -- especially before your deposition -- so as not to let that affect the valuation of your case.

These are just some of the factors that can affect how an adjuster values a personal injury claim. If you were in an accident and have any questions about what the insurance adjuster is doing in your case or are having any problems trying to settle the case, consider contacting a nearby attorney.

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