Steps the Insurance Company Uses to Settle Your Claim

insurance company plaque, 3d rendering

Once you have been involved in a serious accident with injuries caused by the negligence or recklessness of another, you likely filed a personal injury claim. You did this as a way to seek financial compensation for your ongoing expenses and to recoup your losses from the injuries you have endured.

In all likelihood, your injuries generated extensive medical bills, lost time from work, and great pain and discomfort. So can you expect to receive as compensation in an attempt to “make yourself whole” again by fully recovering from your injuries, or will the insurance company deny your claim?

Factors Concerning Your Claim

There are usually two factors that insurance carrier will look for to determine exactly if and how it will pay compensation for your injuries caused by their policyholder. First, the insurer will want to obtain every important fact in your case involving the accident and your injuries before offering a settlement. Next, it will want to know if you are handling the claim on your own, or if you have hired a personal injury attorney. Once they understand both factors, they will plan their attack to settle for the lowest amount possible, or deny the claim outright.

Not every claim file with an insurance carrier is settled. This is because the claims adjuster working for the insurance carrier will do their own investigation, determine what they think your claim is worth, and settle the case or not.

Because not every case is settled, it is important to consider hiring a reputable personal injury attorney who specializes in cases exactly like yours. Their years of experience in building a case and using supporting documents and evidence, will ensure you have a fair chance of obtaining adequate recompense. Your attorney will be ready for the actions, facts and evidence provided by the claims adjuster. Most claims adjusters will:

Investigate Evidence and Documents

The claims adjuster will work with their policyholder (the individual or entity responsible for your injuries) to hear their side of exactly what how the accident or incident occurred. All statements will be documented using a tape recorder, court reporter or both. The claims adjuster will obtain all written reports including police incident reports from the scene of the accident.

They will request and receive your medical records and expenses directly related to your injury along with medical records reaching back decades. Looking back at your medical history is done to determine if any of your injuries were acquired or developed before the accident or incident occurred.

The claims adjuster will also gain information on your actual earnings at work, and any lost wages or salary directly associated with you being away from your job due to your injuries. Most importantly, the insurance company will want to know if you have ever filed any personal injury claims previously, and what those claims involved.

Determining Responsibility

Often times, the responsibility of an accident or incident is left in the hands of the law enforcement officer documenting the scene. However, the claims adjuster working for the insurance carrier will perform their own investigation by analyzing facts, re-creating the scene, speaking to witnesses and reviewing past records of all parties involved.

The claims adjuster does this to determine if any potential witness is not telling the truth, if you are a likable or unlikable individual, if you have a criminal record, or have a long history of being treated for injuries or illnesses. The adjuster is looking for any inconsistency in your story to determine if you are lying about any part of your personal injury claim. Based on all the information they acquire, they will be able to determine the actual value of your claim.

However, your personal injury attorney has a firm understanding of all the steps taken by a claims adjuster and the efforts the insurance company case to thwart your claim and deny paying you compensation. Your lawyer will use years of experience and proven tactics to fight aggressively to protect your rights to help you acquire the financial recompense you deserve for the injuries caused by the negligence of others.