Injury Tips: How Insurance Adjusters Determine a Settlement Offer

If you’ve ever been the victim of a personal injury accident in Cape Coral, you know the resolution can be a long and arduous process.

In many personal injury cases, the insurance company with whom the claim is against will likely try to settle as quickly and inexpensively as possible. Insurance adjusters are assigned to the case and will try to keep the case from going to trial, instead determining a settlement amount that will cost them the least amount of money possible.

A personal injury accident is already an emotional and difficult affair, so it’s important to know how an insurance adjuster assesses a claim and determines a settlement amount. This knowledge will help you ensure that you are compensated fairly.

Let’s take a look at the process an insurance adjuster goes through so you can protect your rights.


Review and Investigate the Insured’s Story

Before an insurance adjuster can begin to determine a settlement offer, they need to gather as much information about the case as possible to make an informed decision. Adjusters will request all written police and accident reports the insured may have sent to the insurer, and may even speak to the insurer to hear the story firsthand.

Insurers and adjusters also have access to claims databases where they can investigate whether or not the victim or plaintiff has ever filed a personal injury claim in the past. In addition to researching the victim’s past for other claims, adjusters will most likely use social media and other online resources to investigate the victim’s personal life. Adjusters use this information to determine the validity of the plaintiff’s claim, and whether or not they can be trusted to be honest about the incident.


Analyze Documentation

Once an adjuster is familiar with the insured’s case, the adjuster will contact the victim personally or, more likely, the insured’s lawyer to request further documentation on the claim. This typically includes documents such as medical records or bills, proof of earnings, tax returns, and proof of property damage. Medical records will show not only treatments related to the incident in the claim, but also whether or not the insured had prior injuries or complaints regarding the body part injured in the current claim.

If the adjuster finds any previous issues related to the same body part, they will likely request all prior medical records involving that condition or body part. Adjusters will be interested in whether or not any of the insured’s current injuries can be attributed to a prior incident or condition, rather than the claim at hand.

The insurance adjuster’s job is to be as meticulous as possible when evaluating and investigating all documentation related to a claim. Adjusters read through every page of the medical and financial records they obtain, searching for any red flags or holes in an insured’s story. Settlement offers are not made until adjusters are satisfied that they have been provided with all the necessary information and documentation needed to make an informed decision.


Determine Settlement Amount

Once an adjuster is satisfied with the documentation on the claim, they will begin to determine a settlement amount. Adjusters will consider two factors when placing a value on a case: the plaintiff’s chances of winning should the case go to trial, and how much a jury might award the plaintiff in court. If an adjuster feels the plaintiff has little chances of winning at trial, regardless of the value of the case, the adjuster will most likely not offer much in the settlement.

After evaluating the insured’s chances of winning, adjusters will next consider the value of the damages involved in the claim. Personal injury cases contain two categories of damages: those that can be calculated to an exact amount (medical bills and lost earnings), and pain and suffering damages, which are slightly trickier to calculate.

Even in the case of medical bills, however, which can simply be added up like receipts, adjusters may not take those damages at face value. If an adjuster considers a medical bill to be “soft,” they may cut those bills in half for valuation purposes. “Soft” medical bills are costs related to health care providers such as a chiropractor or physical therapy professionals, instead of physicians or hospitals.

To calculate the costs of pain and suffering damages, insurance adjusters use a few commonly-known methods, though there is no technical standard equation used in all cases.

One option is the multiplier method. Adjusters will multiply the total medical bills related to the claim by a number from one (for more minor injuries) to five (for more severe injuries) to find the amount.

The other common option is the per diem method. Adjusters will consider a formula based on daily suffering. We’ll use the example of a leg injury to illustrate this method. If the injured hurt their leg in a car accident, the person would gauge their daily pain and all of the actions they were not able to perform due to the injury. The injured would assign a compensation cost to each day, and then multiply that figure by the number of days they were injured.

In either case, the injured will need to keep careful records of their injuries, as well as any documentation for visits to a physician or hospital to substantiate their claims. Pain and suffering damages are calculated more easily and accurately when adjusters have documentation of any medical reports or bills; prescription receipts; over-the-counter medication receipts; proof of lost wages or school absences; a complete log of all treatment, pain, and missed activities; and photographic evidence of any and all injuries.


How Personal Injury Attorneys Can Help

If you were recently injured in a personal injury accident, gaining experienced representation from a personal injury attorney will help ensure you receive a fair settlement. Not only will a personal injury attorney help to gather all of your necessary documentation, but they also have the added benefit of dealing with insurance adjusters on a regular basis.

Experienced legal counsel know the tricks insurance adjusters will try to use to lower an injured party’s settlement and can help protect your legal rights and ensure you receive a fair value on your claim.

By taking action and hiring a personal injury attorney, you can show the insurance companies that you are serious about receiving a fair settlement, and willing to fight to protect your legal rights. In Cape Coral, the experienced personal injury attorneys at Lusk, Drasites & Tolisano can help ensure you won’t be taken advantage of by an insurance company, and will fight to get you the best possible settlement.

Contact Information