How the Insurance Adjuster Handles Your Personal Injury Claim

When you're seeking compensation for an injury after any kind of accident, there's a good chance you'll be dealing with an insurance company. For example, if you get into a car accident, you (or your attorney) may talk settlement with the at-fault driver's car insurance company. If you file a personal injury lawsuit after a slip and fall, the property owner's homeowner's insurance or liability insurance is probably going to kick in. So it's important to understand how insurance adjusters work.

What Is an Insurance Adjuster?

When an insurance policy covers an incident, and an injury claim is filed, an "adjuster" (an employee of the insurance company) is assigned to the claim. The adjuster's job includes:

• investigating the accident that led to the claim
• figuring out whether their insured bears some or all of the blame for the accident
• gathering the claimant's accident-related medical bills and other documentation of their losses ("damages")
• getting a sense of the value of the injury claim, and
• negotiating a settlement with the claimant (or with the claimant's lawyer)

Understand the Insurance Adjuster's Motivation

It's important to remember that the adjuster works for the insurance company, not for you. The adjuster's focus is always on keeping any payout as low as possible so the insurance company is more profitable.

While insurance adjusters want to pay out as little as possible, they also want to avoid a personal injury lawsuit. If a case doesn't settle outside of court, and the lawsuit makes it all the way to trial, the judge or jury will make a decision on:

• who is at fault
• whether compensation is appropriate, and
• if compensation is called for, how much should be awarded.

This is all risky territory for an insurance company, as a damages award can end up being very high if the jury is sympathetic to the plaintiff. Legal fees and other costs associated with a trial can also add up quickly—expenses that don't help the insurance company's bottom line.

The insurance adjuster, then, generally has the job of getting the claimant to accept the lowest settlement offer possible, while avoiding a lawsuit.

How an Insurance Adjuster Decides on an Offer

In personal injury cases, insurance adjusters usually consider the same factors that juries would look at in deciding what the claim is worth. These factors include:

• actual expenses (i.e. medical bills) incurred, and those that will be incurred in the future
• lost income or lost ability to make a living
• the claimant's mental and physical "pain and suffering", and
• other negative effects of the claimant's injuries.

Some of these damages (those for actual expenses and lost income) are fairly easy to determine. Losses like "pain and suffering", on the other hand, are much more subjective. Learn more about "pain and suffering" in a personal injury case.

Insurance adjusters also consider two other key factors: policy limits and the strength of the plaintiff's case.

Policy Limits

An insurance company is never going to pay more than the maximum amount of the insurance policy. For example, if the at-fault driver carried $50,000 in liability insurance, the maximum the insurance company will ever pay out in connection with the accident is $50,000. If your damages exceed the at-fault person's coverage limits, you'll need to collect the difference directly from them.

The Strength of the Claimant's Case

If the plaintiff has a really solid case (like a medical malpractice claim where a doctor left a surgical instrument inside the plaintiff) then the insurer is more likely to offer a larger settlement, because a plaintiff's victory in court will be almost certain. If a plaintiff's case is fairly weak, then the insurer is likely to offer much less, since the claimant is likely to go to court and get nothing.

Learn more about how the insurance adjuster determines a settlement offer.

Tips for Dealing With an Insurance Company

Once you have an understanding of how insurance companies work and the motivation of the insurance adjuster is, you can use that information to your advantage to negotiate the best personal injury settlement possible. There are a few key things to consider.

Think About Hiring a Lawyer

This lets the insurance company know that you take your rights seriously and will be ready to file a lawsuit if you aren't given a fair settlement. Your lawyer also knows how to determine what your specific case should settle for, and can use their expertise to get you the best outcome. Learn more about hiring a personal injury lawyer.

Be Ready to Prove Fault and the Extent of Your Injuries

A police report, witness statements, and your own side of the story can help establish that the insured person was at fault.

Photographs, journals, medical records, and itemized statements of all bills paid and work lost are all essential to proving how badly you were injured.

Consider Sending a Demand Letter

In a demand letter, you spell out your side of the underlying incident, describe your injuries and other losses, and declare the amount of money you'll accept in order to settle the case. If you send a personal injury demand letter, negotiations with the insurance adjuster can begin at a number you believe is fair, not a number the insurance adjuster finds appropriate. Learn more about when the adjuster must respond to your personal injury demand letter.

What's Next?

Once an insurance adjuster is assigned to your claim, the ball with start rolling pretty quickly, and you'll need to make sure your rights are protected. Get tips on the first call with an adjuster after an accident. Now is also the time to decide whether you're comfortable standing up for yourself until you get a fair result, or if it makes more sense to hand things off to a legal professional. Learn more about handling your own injury claim and how a lawyer can help.