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How Does an Insurance Company Handle a Personal Injury Case?

Apr 18, 2022 | Personal Injury

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When you’re dealing with a personal injury case, it’s very likely that you’ll be working with an insurance company. This might be an auto insurance company in the case of a car accident or it might be a commercial insurance policy if you suffer from a slip and fall accident at a business.

Understanding how the process works and what to expect throughout the claim will help you prepare for every phase of the process. Here’s a look at how insurance companies handle personal injury cases.

The Role of the Insurance Adjuster

Once you open a claim with the insurance company, they will assign an insurance adjuster to your case. The adjuster is tasked with reviewing the case and investigating evidence to learn more about what happened.

The insurance adjuster’s main role is to determine the value of your claim. As you go through the process, keep in mind that the insurance adjuster does not work for you or your best interests. Instead, the adjuster is focused on limiting the financial damage of the claim for the insurance company while avoiding a lawsuit.

Cases that settle outside of court generally cost less for insurance companies if they can reach agreeable terms with the victim.

The final role of the insurance adjuster is to get the injury victim to accept a settlement offer and sign off on the claim to close it out without a lawsuit.

How Insurance Adjusters Reach a Settlement Amount

Settlement offers for personal injury cases require that the adjuster review three main factors when calculating a settlement offer.

  1. Tangible expenses incurred, including medical bills
  2. Lost wages or reduced capacity to work
  3. Pain and suffering

Some claims have additional factors for the insurance adjuster to consider before placing a value on it. The tangible expenses are the easiest to calculate, though the insurance adjuster might claim that certain expenses do not apply to the claim and decline those. This can happen when a victim has a pre-existing condition that worsens due to the accident and the adjuster believes the insurance company shouldn’t have to pay for those expenses.

As the adjuster works through calculating the settlement offer, the adjuster also has to consider two factors before making a settlement offer.

  1. Insurance policy limits. The insurance company can’t pay out more than what the insurance policy outlines. For example, a car insurance policy must only have $25,000 per person in bodily injury for an accident. So unless the insured wanted more coverage than that, the policy might max out at that limit.
  2. How strong the injury victim’s case is. Some personal injury cases are extremely clear, such as in the case of medical malpractice where the surgeon leaves a tool inside the patient’s body. A drunk driving accident that injures another driver is another example. The stronger the victim’s case, the more the insurance company will want to offer a fair settlement and close it out without a lawsuit because taking the case to court could mean large expenses for the insurance company.

Considerations for Dealing with an Insurance Company

Insurance companies are not your friend. No matter how nice the adjuster seems, they have a job to do to mitigate the financial impacts of your accident on the insurance company’s bottom line. Throughout the process of working with the insurance company, keep these things in mind.

  1. Look at hiring a lawyer. Most lawyers offer a free consultation to discuss your case and get to know you. There’s no reason to avoid these free services.
  2. Collect evidence. Take photos at the scene, keep a journal of what’s happening in your medical care, itemize expenses, etc. The more evidence you have, the better.
  3. Work with your attorney to send a demand letter that outlines your expenses and the settlement you require to close the case based on your total expenses. This can help speed up negotiations with the insurance adjuster.

Dealing with insurance companies and their processes can be challenging. It’s best to have an advocate fighting for your interests in the case. Contact Stewart & Stewart for a team of attorneys who will protect your rights and avoid low-ball settlement offers from the insurance company.

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