After an injury accident, many people just assume the insurance company will add up their medical bills, consider their lost wages, and provide a settlement check. In reality, insurance adjusters look at a variety of factors before deciding if a claim is valid and determining how much they think it’s worth.
Their main goal is to protect their profits and pay out as little as possible. They do this by scrutinizing every claim to determine who is responsible for the accident and by calculating the bare minimum of damages. That’s why it’s essential to hire a skilled lawyer to negotiate your settlement if you want to get the full value of what your claim is worth.
When you know how insurance companies assess claims, you can avoid some of the most common mistakes people make that get their claims devalued or denied. Here’s what you need to know about how insurance companies evaluate personal injury claims.
1. They look for evidence that the policyholder was responsible
Insurance companies don’t just take you at your word when you explain someone else caused your injury. Even if that’s what the police report says, the insurance company is still going to review all of your documentation and communications specifically to find out if there’s any reason to believe you caused the accident.
With that in mind, they’ll review all available evidence, including police reports, photos and videos, witness statements, vehicle damage, and surveillance footage before accepting liability. They want to be absolutely certain that a claim is valid. For example, if another driver ran a red light and struck your vehicle, they’ll look at all the evidence and assess the damage patterns before determining liability. If there’s any evidence that you were partially responsible for the accident, they’ll lower the value of your claim through comparative negligence based on your designated percentage of fault.
2. They set a ceiling for every claim
Once accepted as valid, every claim is given a maximum payout that the insurance adjusters don’t reveal, and you can’t negotiate a payout above this amount unless you file a lawsuit. Insurance adjusters will start every claim with a low offer to see if you’re willing to settle for less than what they think your claim is truly worth. Many people accept this low offer because they need money immediately or the offer appears to be good enough. However, it’s better to go through at least a few rounds to negotiate for more money. This is where your documentation will come in handy. Strong documentation will give you more leverage.
If the insurance company won’t offer fair compensation, filing a lawsuit might be necessary. If you pursue this route, it can make the insurance company more willing to negotiate fairly if they think there’s a risk of going to trial. Hiring an experienced personal injury lawyer can help you determine when it’s time to accept a settlement and when you might need to pursue a lawsuit.
3. They assess whether you followed your doctor’s instructions
In an attempt to find reasons to devalue or deny your claim, the insurance company will look at your medical records to verify whether or not you’ve followed your doctor’s prescribed treatment plan. If you missed appointments or stopped treatment early, the adjuster will argue that your injuries aren’t serious and you’ve already recovered. They might even argue that ignoring your treatment plan made your injury worse.
When you’re consistent about following your treatment plan, you have the solid medical documentation needed to prove your injuries and support your claim.
4. They calculate your financial losses
Insurance adjusters look at medical expenses first and then calculate your other financial losses. For example, they might calculate your past and future medical bills, lost wages, reduced earning capacity, and other expenses related to your injury. Maintaining good financial documentation is the best way to protect your ability to recover these losses.
5. They evaluate the strength of your evidence
Insurance companies can only evaluate your claim based on the evidence you provide. The stronger your documentation, the more likely you are to get compensated fairly. It helps to provide the following:
- Photos of the accident and general scene
- Photos of your initial injury and as it heals
- Medical records
- Bills and receipts
- Witness information
- Documentation showing lost income
- A journal documenting pain and recovery
The more evidence you can provide, the harder it will be for the insurance company to dispute the damages you’re claiming.
Protect your rights by hiring a lawyer
Insurance companies are more likely to offer a fair settlement when they’re negotiating with an attorney. Don’t negotiate on your own. Hire a skilled personal injury attorney and get the compensation you deserve.