Published on October 3rd, 2019 | by James Simpson0
How Does Insurance Adjuster Evaluate Your Personal Injury Claim
Filing a personal injury claim generally involves three entities: the claimant, the negotiator, and the compensator.
The claimant, which is you, in case you are filing a personal injury claim, seeks consultation from the negotiator, which is your attorney. The claim is filed against the entity who is responsible for the injury, which is the considered compensator, including the individual or a group of individuals, or an organization, and their insurance company, combined.
Once you file the claim, the very first entity to respond to your claim is the defendant’s insurance company. As soon as the claim is filed, the insurance adjusters get to work, reviewing each and every aspect of the claim made. Their job is to make sure that justified compensation is paid to you if the defendant is proven guilty.
This article concerns the tasks that an insurance adjuster undertakes to evaluate your personal injury claim.
Where Did You Encounter The Injury?
When you seek compensation for an injury due to any kind of accident, the chances are pretty high that you’ll be dealing with an insurance company. Depending upon the place where you were injured and the defendant, the type of insurance policy you claim against varies. For example, if you’ve sustained an injury after getting into a car accident, you or your attorney would be dealing with the at-fault driver’s car insurance company. Similarly, if you’ve sustained a slip and fall injury at someone’s porch, the chances are you’d be dealing with the property owner’s homeowner’s insurance or liability insurance. Simply put, depending upon the type of insurance policy, your chances of receiving the compensation for your claim also varies. And this is what the insurance adjuster tries to establish if your injuries are covered under the policy norms of the insurance bearer.
Try To Understand What Motivates The Insurance Adjuster.
Once you file a claim for your injury, the defendant’s insurer assigns an adjuster to the case. The main motif of the adjuster is to investigate the incident and establish the worth of the claim made. It is important that you understand who the insurance adjuster is employed with. Regardless of the legitimacy of your claim, the insurance adjuster will try to keep any payout as low as possible to keep the profits high for their employer.
While the insurance adjusters try to be as loyal as possible to their employer, their secondary motive is to avoid any legal suits or court trials as well. They would also seek any third party help to establish if the claim is totally valid or partially. Justin Kimball of Preszler Law of Nova Scotia explains that an accident reconstruction expert can help determine who was at fault for a car accident. In other words, the insurance adjuster wouldn’t leave any stone unturned to make sure that any payout is as low as possible, along with minimal chances of facing any personal injury lawsuit.
The biggest fear for any insurance company is to face a lawsuit, as it is risky territory for them. If the claim makes its way to the courtroom, before a jury, and if the jury passes a verdict in favor of the claimant, then the liabilities stand pretty steep. The costs associated with legal procedures, damages, hiring an attorney, and many more add up for the insurance company or the liable entity.
Therefore, the insurance adjuster will try to figure out a compensation value that is acceptable by the claimant as well as avoids any courtroom trials for the insurance company, at the same time.
How Does The Insurance Adjuster Decide What To Offer?
An insurance adjuster usually considers the same factors that a jury would consider if your claim happens to enter a courtroom trial. These factors may include:
- Lost income
- Medical expenses (until the claim and also the ones to occur in future)
- Pain and suffering, and
- Other negative effects caused due to the injury to the claimant
Out of these, medical expenses and lost income are easy to determine. However, the other two factors are subjective and require extensive learning of the subject at hand by the adjuster.
Apart from these, there are two other factors that insurance adjusters take into account while estimating the offer to be made. These include- policy limitations and how strong the claimant’s case stands.
Let us understand how these two factors are determined…
Regardless of the claim made, the insurance company is liable to pay only the principal value of the policy. In other words, the maximum amount that an insurance company is liable to pay cannot exceed the value of the policy. For example, if the value of homeowner’s insurance is $50,000, then the maximum payout that the insurance company can offer is $50,000, regardless of the claim value. The rest of the amount is either to be paid by the at-fault party or is recovered through auction-sale of their possessions.
How Strong Does Your Case Stand?
If you have a really strong case, then the insurer is very likely to offer an out of court settlement, along with a hefty payout. As already mentioned, the courtroom is the risky territory for insurance companies and if they are certain that the court proceedings would result in your favor, they are likely to avoid courtroom trials at any cost. On the other hand, if you have a weak case, then the insurer is very likely to offer you a meek compensation for your claim. This is because they understand that you stand a very feeble chance at winning the courtroom trials and get almost nothing out of your claim.
Now that you understand how insurance companies work, and what motivates the insurance adjusters, you can use this information to your advantage. You can now negotiate the best personal injury settlement possible. While you do so, it is important that you hire an expert personal injury lawyer. It is very likely that they’d notice any discrepancies in the settlement offered since they have an expert eye for it.