How The Insurance Adjuster Handles Your Personal Injury Claim

Once you file an injury claim with an insurance company, the adjuster goes to work. Here's how they approach personal injury claims.

Updated by , J.D. · University of San Francisco School of Law

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.

Understand the Insurance Adjuster's Motivation

When an insurance policy covers an incident, and a claim is filed, an "adjuster" (an employee of the insurance company) is assigned to investigate what happened and to figure out how much the claim is worth. 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 does not 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 ("liable"), whether compensation ("damages") is appropriate, and if so, how much. This is 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, without filing 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
  • "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.

The 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 plaintiff'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.

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 filing 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 her expertise to get you the best outcome. Learn more about hiring a personal injury lawyer.

Make sure you have clear evidence of fault and of the extent of your injuries.

Photographs, journals, medical records, and itemized statements of all bills paid and work lost are all essential to maximizing your recovery.

Consider sending a demand letter.

This is a letter in which you spell out your side of the underlying incident and state what you will 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.

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