After a car accident, navigating the world of insurance claims can feel overwhelming, especially when bodily injuries are involved. Understanding how insurance adjusters value an injury claim can not only demystify the process but also help you advocate for fair compensation.
Below we will take a closer look at the step-by-step process insurance adjusters follow to value an injury claim, the factors that influence the claim’s value, and what you should know to strengthen your case to better understand what your injury settlement will be.
Insurance adjusters are tasked with determining the extent and validity of injury claims following a motor vehicle crash. To do so, they follow a structured evaluation process, which often includes the following when they value an injury claim:
The first step in evaluating a claim is collecting all possible evidence related to the accident. Insurance adjusters will examine:
The adjuster’s primary goal at this stage is to establish a factual foundation for the claim, ensuring no key details are overlooked.
Medical documentation plays a critical role in evaluating bodily injury claims. When they value an injury claim, adjusters will request and review:
Adjusters analyze these records to assess the severity of the injuries and determine whether the medical expenses align with the treatments provided. They also scrutinize whether the injuries were caused by the accident or if pre-existing conditions might be a factor when they value an injury claim.
An essential component of any claim evaluation is establishing who was at fault for the crash. Adjusters assess aspects of the collision, such as:
Fault laws can differ significantly from one state to another, which can greatly impact how liability is determined after an accident. States generally follow one of two main systems – fault-based or no-fault.
In fault-based states, the party responsible for causing the accident is liable for covering damages, and victims can pursue compensation through the at-fault party’s insurance. Conversely, no-fault states require individuals to file claims through their own insurance regardless of who caused the accident, limiting the right to sue except in cases of serious injury.
Some states also use pure comparative negligence, where even if the injured party is mostly at fault, they may still recover damages reduced by their percentage of responsibility. Others follow modified comparative negligence, which typically bars recovery if the injured party is found to be 50% or 51% or more at fault.
Finally, adjusters determine the total financial impact of the accident by evaluating all types of personal injury damages. Here’s how they break it down:
These are tangible costs – known legally as special damages – backed by documentation, including:
These damages account for intangible losses – known legally as general damages – and include losses such as:
Insurance companies often use formulas to estimate non-economic damages. For instance, a multiplier method may apply, multiplying actual economic damages by a factor (e.g., 1.5 to 5) based on the severity of the injury.
Alternatively, the per diem method calculates non-economic damages by assigning a daily value to pain and suffering, then multiplying it by the number of days the injury affects the individual. For example, $200 per day for 100 days would total $20,000. This approach offers a practical way to quantify injuries but requires justification for the daily rate.
Several variables can impact the overall value of your bodily injury claim. Insurance adjusters weigh these factors carefully when determining an appropriate settlement offer when they value an injury claim:
Naturally, more severe injuries result in higher claim valuations. Catastrophic injuries like paralysis or traumatic brain injuries (TBI) not only demand considerable medical attention but also have long-term effects on life quality and earning capacity.
Medical costs are often the largest and most straightforward component of a claim. However, adjusters may contest inflated or unrelated medical bills. Consistent documentation of treatments and doctor recommendations strengthens the validity of your claim.
When injuries prevent you from working, whether temporarily or permanently, this loss directly contributes to your claim’s value. Adjusters will review employer-provided pay stubs, tax returns, and letters to verify lost wages or diminished earning capacity.
Quantifying pain and suffering is inherently subjective, which makes this element of your claim open to negotiation. Factors like the length of recovery, ongoing discomfort, and any permanent disability weigh into the final calculation.
Adjusters will thoroughly review medical records to identify any pre-existing injuries or conditions. If they suspect your injury existed before the accident, they may attempt to reduce the claim’s value by arguing it’s unrelated or exaggerated.
The clearer the evidence of another party’s fault, the stronger your claim becomes. Weak or disputed liability can significantly decrease settlement amounts, as insurers might see a higher risk in taking the matter to court.
It’s important to note that the at-fault driver’s insurance policy limits set a ceiling for the settlement amount. Even a high-value claim may be limited by the maximum coverage available in the policy.
Minimum policy limits vary significantly depending on the state and the type of vehicle involved. For example, commercial trucks are often required to carry much higher liability limits compared to standard passenger vehicles due to the potential for greater damages in accidents. States set their own minimum requirements, with some mandating coverage as low as $15,000, while others require substantially higher limits.
If you’ve been injured in a motor vehicle accident, there are steps you can take to support your case and ensure you receive fair compensation:
Insurance adjusters evaluate bodily injury claims by reviewing evidence, medical documentation, and legal liability to determine compensation – but keep in mind, they work for the insurance company, not for you. Their goal is often to settle claims for as little as possible, so how they value an injury claim may not reflect the true impact of the accident on your life.
To ensure a fair outcome, it’s important to have an advocate on your side. Our experienced injury attorneys at Thompson Law can help you navigate the claims process, protect your rights, and fight for a settlement that truly accounts for your losses. With the right guidance and preparation, you can approach the process with confidence and focus on what matters most – your recovery.
The force of impact in a collision can significantly influence the value of your claim. High-impact collisions are more likely to result in severe injuries, such as broken bones, spinal damage, or traumatic brain injuries, which often lead to higher medical expenses and longer recovery times.
Insurers may use the force of impact as a metric to analyze the severity of injuries and the overall damage sustained. Providing evidence, such as photographs of vehicle damage, accident reconstruction reports, or medical records, can help demonstrate how the force of the collision directly contributed to your injuries, potentially strengthening your claim.
Insurance adjusters may take emotional distress into account, but it depends on the case and the evidence provided. Medical documentation or expert testimony related to psychological trauma can help substantiate claims for emotional suffering.
Yes, your medical history and any pre-existing conditions are often reviewed by insurance adjusters. They may attempt to attribute your injuries to prior incidents, which makes it crucial to provide clear evidence linking your injuries directly to the accident.
The location where the accident occurred can impact your claim’s value, as laws and average jury awards vary by jurisdiction. Additionally, local medical costs and court tendencies may also play a part in the adjuster’s valuation.
Thompson Law charges NO FEE unless we obtain a settlement for your case. We’ve put over $1.9 billion in cash settlements in our clients’ pockets. Contact us today for a free, no-obligation consultation to discuss your accident, get your questions answered, and understand your legal options.
State law limits the time you have to file a claim after an injury accident, so call today.
